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Quality improvment in cardiac surgery

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https://www.readbyqxmd.com/read/29456915/short-term-complications-of-anterior-fixation-of-odontoid-fractures
#1
Holt S Cutler, Javier Z Guzman, Nathan J Lee, Parth Kothari, Jun S Kim, John I Shin, Dante M Leven, Samuel K Cho
Study Design: Retrospective study. Objective: Anterior fixation of odontoid fracture has been associated with high morbidity and mortality in small, single institution series. Identifying risk factors may improve risk stratification and highlight factors that could be optimized preoperatively. The objective of this study was to determine the 30-day complication rate following anterior fixation of odontoid fractures and to identify associated risk factors among patients in a large national database...
February 2018: Global Spine Journal
https://www.readbyqxmd.com/read/29456049/six-month-outcomes-after-high-risk-coronary-artery-bypass-graft-surgery-and-preoperative-intra-aortic-balloon-counterpulsation-use-an-inception-cohort-study
#2
Edward Litton, Frances Bass, Anthony Delaney, Graham Hillis, Silvana Marasco, Shay McGuinness, Paul S Myles, Christopher M Reid, Julian A Smith
OBJECTIVE: To inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS). DESIGN: Inception cohort study. SETTING: A total of 13 established cardiac centers in Australia, Canada, New Zealand, and the United Kingdom. PARTICIPANTS: Adult patients were eligible for inclusion if they were listed for CABG surgery and had 2 or more LCOS risk factors (low ejection fraction, severe left main coronary artery disease, redo sternotomy, unstable angina)...
January 5, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29454380/quality-of-life-satisfaction-and-outcomes-after-ministernotomy-versus-full-sternotomy-isolated-aortic-valve-replacement-quality-avr-study-protocol-for-a-randomised-controlled-trial
#3
Emiliano A Rodríguez-Caulo, Ana Guijarro-Contreras, Juan Otero-Forero, María José Mataró, Gemma Sánchez-Espín, Arantza Guzón, Carlos Porras, Miguel Such, Antonio Ordóñez, José María Melero-Tejedor, Manuel Jiménez-Navarro
BACKGROUND: During the last decade, the use of ministernotomy in cardiac surgery has increased. Quality of life and patient satisfaction after ministernotomy have never been compared to conventional full sternotomy in randomised trials. The aim of the study is to determine if this minimally invasive approach improves quality of life, satisfaction and clinical morbimortality outcomes. METHODS/DESIGN: The QUALITY-AVR trial is a single-blind, single-centre, independent, and pragmatic randomised clinical trial comparing ministernotomy ("J" shaped upper hemisternotomy toward right 4th intercostal space) to full sternotomy in patients with isolated severe aortic stenosis scheduled for elective aortic valve replacement...
February 17, 2018: Trials
https://www.readbyqxmd.com/read/29452368/validity-of-the-swedish-cardiac-surgery-registry
#4
Per Vikholm, Torbjörn Ivert, Johan Nilsson, Anders Holmgren, Wolfgang Freter, Lisa Ternström, Haider Ghaidan, Ulrik Sartipy, Christian Olsson, Hans Granfeldt, Sigurdur Ragnarsson, Örjan Friberg
OBJECTIVES: Our goal was to validate the Swedish Cardiac Surgery Registry by reviewing the reported cardiac operations to assess the completeness and quality of the registered data and the EuroSCORE II variables. METHODS: A total of 5837 cardiac operations were reported to the Swedish Cardiac Surgery Registry in Sweden during 2015. A randomly selected sample of 753 patient records (13%) was scrutinized by 3 surgeons at all 8 units in Sweden performing open cardiac surgery in adults...
February 14, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29440154/outcomes-comparison-of-different-surgical-strategies-for-the-management-of-severe-aortic-valve-stenosis-study-protocol-of-a-prospective-multicentre-european-registry-e-avr-registry
#5
Francesco Onorati, Riccardo Gherli, Giovanni Mariscalco, Evaldas Girdauskas, Eduardo Quintana, Francesco Santini, Marisa De Feo, Sandro Sponga, Piergiorgio Tozzi, Mohamad Bashir, Andrea Perrotti, Aniello Pappalardo, Vito Ruggieri, Giuseppe Santarpino, Mauro Rinaldi, Silva Ronaldo, Francesco Nicolini
INTRODUCTION: Traditional and transcatheter surgical treatments of severe aortic valve stenosis (SAVS) are increasing in parallel with the improved life expectancy. Recent randomised controlled trials (RCTs) reported comparable or non-inferior mortality with transcatheter treatments compared with traditional surgery. However, RCTs have the limitation of being a mirror of the predefined inclusion/exclusion criteria, without reflecting the 'real clinical world'. Technological improvements have recently allowed the development of minimally invasive surgical accesses and the use of sutureless valves, but their impact on the clinical scenario is difficult to assess because of the monocentric design of published studies and limited sample size...
February 10, 2018: BMJ Open
https://www.readbyqxmd.com/read/29433878/the-effect-of-resident-involvement-on-bariatric-surgical-outcomes-an-acs-nsqip-analysis
#6
Ivy N Haskins, Jihad Kudsi, Kathleen Hayes, Richard L Amdur, Paul P Lin, Khashayar Vaziri
BACKGROUND: Surgical residency training programs in the United States are modeled on the principle of graduated responsibility. Residents are given greater responsibility and autonomy in the operating room and during perioperative care as they gain surgical skills and progress through their training. The impact of this method of surgical training on patient outcomes remains unknown. The purpose of this study is to compare early patient morbidity and mortality after bariatric surgery in cases with and without resident participation using the American College of Surgeons National Surgical Quality Improvement Program database...
March 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29433600/development-and-preliminary-testing-of-the-brief-developmental-assessment-an-early-recognition-tool-for-children-with-heart-disease
#7
Jo Wray, Katherine L Brown, Deborah Ridout, Monica Lakhanpaul, Liz Smith, Angie Scarisbrick, Sara O'Curry, Aparna Hoskote
Introduction Neurodevelopmental abnormalities are common in children with CHD and are the highest-priority concerns for parents and professionals following cardiac surgery in childhood. There is no additional routine monitoring of development for children with CHD in the United Kingdom; hence, neurodevelopmental concerns may be detected late, precluding early referral and intervention. METHODS: An early recognition tool - the "Brief Developmental Assessment" - was developed using quality improvement methodology involving several iterations and rounds of pilot testing...
February 13, 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/29427617/single-versus-multi-center-surgeons-risk-adjusted-coronary-artery-bypass-graft-procedural-outcomes
#8
A Laurie W Shroyer, William E Gioia, Muath Bishawi, Amelia S Wallace, Brian C Gulack, Ying Xian, Sean M O'Brien, Vinod H Thourani, Thomas V Bilfinger
BACKGROUND: Since 2010, 460+ hospital mergers have occurred in the United States rerouting historical coronary artery bypass graft [CABG] referral patterns. The goals of this study were: 1) to compare risk-adjusted CABG outcomes between single-center versus multi-center surgeons; and 2) for multi-center surgeons, to evaluate the risk-adjusted outcomes between their home (primary) versus satellite (secondary) hospitals. METHODS: Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, non-emergent, first-time CABG procedures (n = 543,403) performed in the United States between 2011 and 2014 were extracted across 1,120 centers and for 2,676 surgeons...
February 7, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29423742/the-effect-of-preoperative-pneumonia-on-postsurgical-mortality-and-morbidity-a-nsqip-analysis
#9
Sarah Jamali, Michael Dagher, Nadeem Bilani, Aurelie Mailhac, Mohamad Habbal, Salah Zeineldine, Hani Tamim
BACKGROUND: Currently, only indirect evidence suggests that preoperative pneumonia is a significant risk factor for poor postsurgical outcomes. Although this relationship is clinically intuitive, this is the first study that aims to quantify the extent to which pneumonia impacts morbidity and mortality. The objective of this study was to determine the impact of preoperative pneumonia on 30-day mortality and morbidity among both elective and emergency surgical patients. METHODS: We conducted a retrospective cohort study using 2008-2012 data from the American College of Surgeons National Surgical Quality Improvement Program database...
February 8, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29397933/associations-between-unplanned-cardiac-reinterventions-and-outcomes-after-pediatric-cardiac-operations
#10
John M Costello, Michael C Mongé, Kevin D Hill, Sunghee Kim, Sara K Pasquali, Babatunde A Yerokun, Jeffrey P Jacobs, Carl L Backer, Mjaye L Mazwi, Marshall L Jacobs
BACKGROUND: After pediatric heart operations, we sought to determine the incidence of unplanned cardiac reinterventions during the same hospitalization, assess risk factors for these reinterventions, and explore associations between reinterventions and outcomes. We hypothesized that younger patients undergoing more complex operations would be at greater risk for unplanned cardiac reinterventions and that operative mortality and postoperative length of stay (PLOS) would be greater in patients who undergo reintervention than in those who do not...
February 1, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29393140/acute-kidney-injury-in-cardiac-surgery
#11
Jiarui Xu, Wuhua Jiang, Bo Shen, Yi Fang, Jie Teng, Yimei Wang, Xiaoqiang Ding
Patients who have undergone cardiac surgery are at high risk of acute kidney injury (AKI) and often associated with poor short- and long-term outcomes. It is considered that the burden of AKI can be reduced and the quality of care can be improved by raising the appropriate awareness and using the right tools for early prevention and better management, by (1) improving awareness by understanding the epidemiology and pathophysiology; (2) using tools for risk assessment for early prevention; (3) increasing the use of electronic screening for early diagnosis; and (4) developing right clinical strategies for better treatment...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29389252/risk-factors-and-predictive-model-development-of-thirty-day-post-operative-surgical-site-infection-in-the-veterans-administration-surgical-population
#12
Xinli Li, William Nylander, Tracy Smith, Soonhee Han, William Gunnar
BACKGROUND: Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population...
February 1, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29374511/amiodarone-protocol-provides-cost-effective-reduction-in-postoperative-atrial-fibrillation
#13
J Hunter Mehaffey, Robert B Hawkins, Matthew Byler, Judy Smith, John A Kern, Irving Kron, Gorav Ailawadi, Tanya Wanchek, Leora T Yarboro
BACKGROUND: Postoperative Atrial Fibrillation (POAF) following cardiac surgery results in a significant increase in morbidity, mortality, and healthcare cost. Prophylactic amiodarone has been shown to reduce the incidence of POAF, however the cost-effectiveness of a protocol driven approach remains unknown. METHODS: All patients with a Society of Thoracic Surgeons (STS) risk score enrolled in a prophylactic amiodarone protocol (n=153) were propensity score matched 1:3 with patients prior to protocol implementation (n=3574)...
January 24, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29369117/does-goal-directed-haemodynamic-and-fluid-therapy-improve-peri-operative-outcomes-a-systematic-review-and-meta-analysis
#14
Matthew A Chong, Yongjun Wang, Nicolas M Berbenetz, Ian McConachie
BACKGROUND: Much uncertainty exists as to whether peri-operative goal-directed therapy is of benefit. OBJECTIVES: To discover if peri-operative goal-directed therapy decreases mortality and morbidity in adult surgical patients. DESIGN: An updated systematic review and random effects meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase and the Cochrane Library were searched up to 31 December 2016...
January 23, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29361303/virtual-surgical-planning-flow-simulation-and-3-dimensional-electrospinning-of-patient-specific-grafts-to-optimize-fontan-hemodynamics
#15
Dominik Siallagan, Yue-Hin Loke, Laura Olivieri, Justin Opfermann, Chin Siang Ong, Diane de Zélicourt, Anastasios Petrou, Marianne Schmid Daners, Vartan Kurtcuoglu, Mirko Meboldt, Kevin Nelson, Luca Vricella, Jed Johnson, Narutoshi Hibino, Axel Krieger
BACKGROUND: Despite advances in the Fontan procedure, there is an unmet clinical need for patient-specific graft designs that are optimized for variations in patient anatomy. The objective of this study is to design and produce patient-specific Fontan geometries, with the goal of improving hepatic flow distribution (HFD) and reducing power loss (Ploss), and manufacturing these designs by electrospinning. METHODS: Cardiac magnetic resonance imaging data from patients who previously underwent a Fontan procedure (n = 2) was used to create 3-dimensional models of their native Fontan geometry using standard image segmentation and geometry reconstruction software...
December 5, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29352162/a-prolonged-run-in-period-of-standard-subcutaneous-microdialysis-ameliorates-quality-of-interstitial-glucose-signal-in-patients-after-major-cardiac-surgery
#16
Othmar Moser, Julia Münzker, Stefan Korsatko, Christoph Pachler, Karlheinz Smolle, Wolfgang Toller, Thomas Augustin, Johannes Plank, Thomas R Pieber, Julia K Mader, Martin Ellmerer
We evaluated a standard subcutaneous microdialysis technique for glucose monitoring in two critically ill patient populations and tested whether a prolonged run-in period improves the quality of the interstitial glucose signal. 20 surgical patients after major cardiac surgery (APACHE II score: 10.1 ± 3.2) and 10 medical patients with severe sepsis (APACHE II score: 31.1 ± 4.3) were included in this investigation. A microdialysis catheter was inserted in the subcutaneous adipose tissue of the abdominal region...
January 19, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29343930/yoga-based-postoperative-cardiac-rehabilitation-program-for-improving-quality-of-life-and-stress-levels-fifth-year-follow-up-through-a-randomized-controlled-trial
#17
Eraballi Amaravathi, Nagendra Hongasandra Ramarao, Nagarathna Raghuram, Balaram Pradhan
Objectives: This study was aimed to assess the efficacy of yoga-based lifestyle program (YLSP) in improving quality of life (QOL) and stress levels in patients after 5 years of coronary artery bypass graft (CABG). Methodology: Three hundred patients posted for elective CABG in Narayana Hrudayalaya Super Speciality Hospital, Bengaluru, were randomized into two groups: YLSP and conventional lifestyle program (CLSP), and follow-up was done for 5 years. Intervention: In YLSP group, all practices of integrative approach of yoga therapy such as yama, niyama, asana, pranayama, and meditation were used as an add-on to conventional cardiac rehabilitation...
January 2018: International Journal of Yoga
https://www.readbyqxmd.com/read/29341033/-lung-volume-reduction-surgery
#18
C Caviezel, D Franzen, W Weder
Lung volume reduction surgery (LVRS) offers improvement in lung function, quality of life and even survival in well selected patients with severe emphysema. Patients with all types of emphysema morphology can profit from LVRS when certain selection criteria are present. Hyperinflation plays a key role in qualifying for the procedure. Candidate selection should be performed at high volume centers with a multidisciplinary emphysema board. Qualified thoracic surgeons together with pulmonologists and radiologists identify the suitable patient considering emphysema morphology with its target areas for resection, lung function parameters and cardiac comorbidities...
January 2018: Pneumologie
https://www.readbyqxmd.com/read/29338867/validation-of-a-definition-of-excessive-postoperative-bleeding-in-infants-undergoing-cardiac-surgery-with-cardiopulmonary-bypass
#19
Rachel S Bercovitz, Allison C Shewmake, Debra K Newman, Robert A Niebler, John P Scott, Eckehard Stuth, Pippa M Simpson, Ke Yan, Ronald K Woods
OBJECTIVE: To derive and validate an objective definition of postoperative bleeding in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Using a retrospective cohort of 124 infants and neonates, we included published bleeding definitions and cumulative chest tube output over different postoperative periods (eg, 2, 12, or 24 hours after intensive care unit admission) in a classification and regression tree model to determine chest tube output volumes that were associated with red blood cell transfusions and surgical re-exploration for bleeding in the first 24 hours after intensive care unit admission...
December 13, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29337126/rigid-plate-fixation-vs-wire-cerclage-patient-reported-and-economic-outcomes-from-a-randomized-trial
#20
Keith B Allen, Vinod H Thourani, Yoshifumi Naka, Kendra J Grubb, John Grehan, Nirav Patel, T Sloane Guy, Kevin Landolfo, Marc Gerdisch, Mark Bonnell, David J Cohen
BACKGROUND: In a multicenter randomized trial, sternal closure following cardiac surgery using rigid plate fixation (RPF) compared with wire cerclage (WC) resulted in improved sternal healing, reduced sternal complications and was cost neutral at 6 months. Additional secondary endpoints are presented from this trial. METHODS: Twelve US centers randomized 236 patients to RPF (n=116) or WC (n=120). Patient reported outcomes measures (PROMs) including pain, function, and quality-of-life (QOL) scores were assessed through 6-months and correlated to computed tomographic derived sternal healing scores using logistic regression...
January 11, 2018: Annals of Thoracic Surgery
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