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Quality improvment in cardiac surgery

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https://www.readbyqxmd.com/read/29233331/the-society-of-thoracic-surgeons-adult-cardiac-surgery-database-2018-update-on-outcomes-and-quality
#1
Richard S D'Agostino, Jeffrey P Jacobs, Vinay Badhwar, Felix G Fernandez, Gaetano Paone, David W Wormuth, David M Shahian
Through nearly 3 decades of iterative refinement, The Society of Thoracic Surgeons Adult Cardiac Surgery Database has evolved into one of the most comprehensive and respected clinical data registries in health care. It is a widely acknowledged exemplar for accurately benchmarking risk-adjusted outcomes in cardiac surgery and underpins all quality measurement and improvement activities of The Society of Thoracic Surgeons. This is the latest in a series of annual reports that outlines current national aggregate outcomes and volume trends in cardiac surgery and summarizes database-related work in quality measurement and performance improvement during the past year...
January 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29229258/perioperative-information-systems-opportunities-to-improve-delivery-of-care-and-clinical-outcomes-in-cardiac-and-vascular-surgery
#2
REVIEW
Robert E Freundlich, Jesse M Ehrenfeld
A variety of existing perioperative informatics tools offer clinicians and researchers the opportunity to improve the delivery of care and clinical outcomes for patients undergoing cardiac and vascular surgery. Many of these tools can be used to improve the reliability of the care delivery process through the application of clinical decision support tools and/or quality improvement methodologies at a number of junctures. In this review, the authors will offer a concise overview of the existing perioperative informatics literature, with a focus on tools considered to be of utility in confronting the unique challenges inherent to cardiac and vascular surgery...
November 4, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29229124/mortality-after-emergency-hartmann-s-procedure-in-octogenarians-a-propensity-score-matched-analysis
#3
Ian C Bostock, Maureen V Hill, Timothy C Counihan, Srinivas Joga Ivatury
BACKGROUND: Complicated diverticulitis is associated with a postoperative mortality rate of 20%. We hypothesized that age ≥80 was an independent risk factor for mortality after Hartmann's procedure for diverticular disease when controlling for baseline comorbidities. METHODS: Patients who underwent an urgent or emergent Hartmann's procedure (Current Procedural Terminology codes 44143 and 44206) for diverticular disease (International Classification of Diseases-9:562...
January 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29221765/advances-in-fetal-echocardiography
#4
REVIEW
Helena M Gardiner
The development of fetal echocardiography and success in prenatal cardiac screening programs over the past 30 years has been driven by technical innovation and influenced by the different approaches of the various specialties practicing it. Screening for congenital heart defects no longer focuses on examining a limited number of pregnant women thought to be at increased risk, but instead forms an integrated part of a high-quality anatomical ultrasound performed in the second trimester using the 'five-transverse view' protocol...
December 5, 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29218804/impact-of-diabetes-on-free-flap-surgery-of-the-head-and-neck-a-nsqip-analysis
#5
Jacob S Brady, Aparna Govindan, Meghan M Crippen, Andrey Filimonov, Jean Anderson Eloy, Soly Baredes, Richard Chan Woo Park
OBJECTIVE: Diabetes is associated with microvascular pathology and may predispose patients undergoing microvascular surgery to complications. This study assesses diabetes as a risk factor for complications following free flap surgery of the head and neck. PATIENTS AND METHODS: In this retrospective cohort study, data on free flap surgeries of the head and neck between 2005 and 2014 was collected from the National Surgical Quality Improvement Program (NSQIP) database...
December 8, 2017: Microsurgery
https://www.readbyqxmd.com/read/29205995/volume-and-health-outcomes-evidence-from-systematic-reviews-and-from-evaluation-of-italian-hospital-data
#6
Laura Amato, Danilo Fusco, Anna Acampora, Katia Bontempi, Alessandro Cesare Rosa, Paola Colais, Fabio Cruciani, Mariangela D'Ovidio, Francesca Mataloni, Silvia Minozzi, Zuzana Mitrova, Luigi Pinnarelli, Rosella Saulle, Salvatore Soldati, Chiara Sorge, Simona Vecchi, Martina Ventura, Marina Davoli
BACKGROUND Improving quality and effectiveness of healthcare is one of the priorities of health policies. Hospital or physician volume represents a measurable variable with an impact on effectiveness of healthcare. An Italian law calls for the definition of «qualitative, structural, technological, and quantitative standards of hospital care». There is a need for an evaluation of the available scientific evidence in order to identify qualitative, structural, technological, and quantitative standards of hospital care, including the volume of care above or below which the public and private hospitals may be accredited (or not) to provide specific healthcare interventions...
September 2017: Epidemiologia e Prevenzione
https://www.readbyqxmd.com/read/29200062/is-compliance-with-surgical-care-improvement-project-cardiac-scip-card-2-measures-for-perioperative-%C3%AE-blockers-associated-with-reduced-incidence-of-mortality-and-cardiovascular-related-critical-quality-indicators-after-noncardiac-surgery
#7
Miklos D Kertai, Mary Cooter, Richard J Pollard, William Buhrman, Solomon Aronson, Joseph P Mathew, Mark Stafford-Smith
BACKGROUND: While continuation of β-blockers (BBs) perioperatively has become a national quality improvement measure, the relationship between BB withdrawal and mortality and cardiovascular-related critical quality indicators has not been studied in a contemporary cohort of patients undergoing noncardiac surgery. METHODS: For this retrospective study, the quality assurance database of a large community-based anesthesiology group practice was used to identify 410,288 surgical cases, 18 years of age or older, who underwent elective or emergent noncardiac surgical procedures between January 1, 2009, and December 31, 2014...
November 30, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29196866/reducing-bottlenecks-to-improve-the-efficiency-of-the-lung-cancer-care-delivery-process-a-process-engineering-modeling-approach-to-patient-centered-care
#8
Feng Ju, Hyo Kyung Lee, Xinhua Yu, Nicholas R Faris, Fedoria Rugless, Shan Jiang, Jingshan Li, Raymond U Osarogiagbon
The process of lung cancer care from initial lesion detection to treatment is complex, involving multiple steps, each introducing the potential for substantial delays. Identifying the steps with the greatest delays enables a focused effort to improve the timeliness of care-delivery, without sacrificing quality. We retrospectively reviewed clinical events from initial detection, through histologic diagnosis, radiologic and invasive staging, and medical clearance, to surgery for all patients who had an attempted resection of a suspected lung cancer in a community healthcare system...
December 1, 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/29186407/surgical-ablation-of-atrial-fibrillation-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#9
Graham R McClure, Emilie P Belley-Cote, Iqbal H Jaffer, Nazari Dvirnik, Kevin R An, Gabriel Fortin, Jessica Spence, Jeff Healey, Rohit K Singal, Richard P Whitlock
Aims: The aim of this review was to assess the effect of concomitant surgical atrial fibrillation (AF) ablation on postoperative freedom from AF and patient-important outcomes. Methods and results: We searched Cochrane CENTRAL, MEDLINE, and EMBASE databases from inception to May 2016 for randomized controlled trials (RCTs) evaluating surgical AF ablation using any lesion set vs. no surgical AF ablation in adults with AF undergoing cardiac surgery. We performed screening, risk-of-bias evaluation, and data collection independently and in duplicate...
November 27, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29159844/incidence-and-predictors-of-30-day-postoperative-readmission-in-children
#10
Daniel Vo, David Zurakowski, David Faraoni
BACKGROUND: Hospital readmissions are being used as a quality metric for hospital reimbursement without a clear understanding of the factors that contribute to readmission. OBJECTIVE: The objective of this study was to report the incidence of 30-day postsurgical readmission in children, identify the predictors for readmission, and create an algorithm to identify high-risk children. METHODS: Data from the 2012-2014 Pediatric database of the American College of Surgeons National Surgical Quality Improvement Program were analyzed using univariable and multivariable logistical regression analysis...
November 20, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29155116/the-effect-of-steroids-on-complications-readmission-and-reoperation-after-posterior-lumbar-fusion
#11
Michael B Cloney, Roxanna M Garcia, Zachary A Smith, Nader S Dahdaleh
BACKGROUND DATA: The effects of chronic corticosteroid therapy on complications, readmission, and reoperation after posterior lumbar fusion (PLF) remains under-investigated and was examined to determine differences in outcomes. METHODS: We analyzed patients from 2006 to 2013 using the National Surgery Quality Improvement Program database (NSQIP) undergoing PLF. Patients taking steroids for a chronic condition were compared to those not taking steroids. Multivariable regression identified factors independently associated with complications, readmission, and reoperation...
November 15, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/29153941/the-impact-of-readmission-hospital-on-failure-to-rescue-rates-following-major-urologic-cancer-surgery
#12
Jasmir G Nayak, Sarah K Holt, Jonathan L Wright, Matthew Mossanen, Atreya Dash, John L Gore
PURPOSE: Patients readmitted to secondary hospitals rather than the primary hospital where their surgery took place may be at risk for poorer outcomes. We sought to evaluate the effect of site of readmission on failure-to-rescue complication rates following urologic cancer surgery. MATERIALS AND METHODS: Retrospective review of major urologic cancer surgeries in the Washington State Comprehensive Hospital Abstract Reporting System between 1998 and 2013. Failure-to-rescue (FTR) rates, defined as inpatient death after a complication requiring hospital readmission, were compared between patients readmitted to their primary hospital with those readmitted to a secondary hospital...
November 16, 2017: Urologic Oncology
https://www.readbyqxmd.com/read/29153787/the-society-of-thoracic-surgeons-national-database-2017-annual-report
#13
Jeffrey P Jacobs, David M Shahian, Richard S D'Agostino, Marshall L Jacobs, Benjamin D Kozower, Vinay Badhwar, Vinod H Thourani, Henning A Gaissert, Felix G Fernandez, Richard L Prager
The Society of Thoracic Surgeons (STS) National Database has three major component databases: the STS Adult Cardiac Surgery Database (ACSD), the STS Congenital Heart Surgery Database (CHSD), and the STS General Thoracic Surgery Database (GTSD). Beginning in January 2016, The Annals of Thoracic Surgery began publishing a monthly series of scholarly articles on outcomes analysis, quality improvement, and patient safety. This article summarizes the status of the STS National Database as of October 2017 and summarizes the articles about the STS National Database that appeared in The Annals of Thoracic Surgery 2017 series "Outcomes Analysis, Quality Improvement, and Patient Safety...
December 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29146612/derivation-and-validation-of-a-geriatric-sensitive-perioperative-cardiac-risk-index
#14
Rami Alrezk, Nicholas Jackson, Mohanad Al Rezk, Robert Elashoff, Nancy Weintraub, David Elashoff, Gregg C Fonarow
BACKGROUND: Surgical patients aged 65 and over face a higher risk of cardiac complications from noncardiac surgery. The Revised Cardiac Risk Index (RCRI) and the Gupta Myocardial Infarction or Cardiac Arrest (MICA) calculator are widely used to predict this risk, but they are not specifically designed to predict MICA in geriatric patients. Our hypothesis is that a new geriatric-sensitive index, derived from geriatric data, will capture this population's unique response to risk factors...
November 16, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29143088/the-association-of-preoperative-hematocrit-and-transfusion-with-mortality-in-patients-undergoing-elective-non-cardiac-surgery
#15
Rodney A Gabriel, Anthony I Clark, Albert P Nguyen, Ruth S Waterman, Ulrich H Schmidt
BACKGROUND: Patients with anemia frequently undergo surgery, as it is unclear at what threshold clinicians should consider delaying surgery for preoperative anemia optimization. The primary objective of this study was to determine whether there is an association of varying degrees of anemia and transfusion with 30-day mortality. METHODS: This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2013...
November 15, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29140555/withdrawn-electrical-cardioversion-for-atrial-fibrillation-and-flutter
#16
REVIEW
Gillian E Mead, Andrew Elder, Andrew D Flapan, John Cordina
BACKGROUND: Atrial fibrillation increases stroke risk and adversely affects cardiovascular haemodynamics. Electrical cardioversion may, by restoring sinus rhythm, improve cardiovascular haemodynamics, reduce the risk of stroke, and obviate the need for long-term anticoagulation. OBJECTIVES: To assess the effects of electrical cardioversion of atrial fibrillation or flutter on the risk of thromboembolic events, strokes and mortality (primary outcomes), the rate of cognitive decline, quality of life, the use of anticoagulants and the risk of re-hospitalisation (secondary outcomes) in adults (>18 years)...
November 15, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29138760/cardiac-surgery-after-heart-transplantation-elective-operation-or-last-exit-strategy
#17
Johannes Goekler, Andreas Zuckermann, Emilio Osorio, Faris F Brkic, Keziban Uyanik-Uenal, Guenther Laufer, Arezu Aliabadi-Zuckermann
Background: Because of improved long-term survival after heart transplantation (HTx), late graft pathologies such as valvular disease or cardiac allograft vasculopathy (CAV) might need surgical intervention to enhance longer survival and ensure quality of life. To this date, there exist no guidelines for indication of cardiac surgery other than retransplantation after HTx. Methods: In this retrospective, single-center study, we evaluated patients who underwent cardiac surgery after HTx at our institution...
October 2017: Transplantation Direct
https://www.readbyqxmd.com/read/29134534/current-status-of-cardiovascular-surgery-in-japan-2013-and-2014-a-report-based-on-the-japan-cardiovascular-surgery-database-jcvsd-1-mission-and-history-of-jcvsd
#18
Shinichi Takamoto, Noboru Motomura, Hiroaki Miyata, Hiroyuki Tsukihara
The Japan Cardiovascular Surgery Database (JCVSD) was created in 2000 with the support of the Society of Thoracic Surgeons (STS). The STS database content was translated to Japanese using the same disease criteria and in 2001, data entry for adult cardiac surgeries was initiated online using the University Hospital Medical Information Network (UMIN). In 2008, data entry for congenital heart surgeries was initiated in the congenital section of JCVSD and preoperative expected mortality (JapanSCORE) in adult cardiovascular surgeries was first calculated using the risk model of JCVSD...
November 13, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29077977/packed-red-blood-cell-transfusion-in-older-adults-a-systematic-review
#19
Allison R Jones, Gwen McGhan, Jill Deaver
Most packed red blood cell (PRBC) transfusion research focuses on younger patient populations (younger than 65) given the complexity of care and presence of comorbidities in older adults. The purpose of the current study was to critically examine the current evidence related to PRBC transfusion among older adults (age ≥65). PubMed, CINAHL, and Embase were searched for randomized controlled trials that evaluated blood transfusion in any manner (e.g., prevention, associated outcomes). Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the search resulted in 10 studies focused on cardiac, orthopedic, and gastrointestinal surgery patients...
October 27, 2017: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/29074154/less-is-more-results-of-a-statewide-analysis-of-the-impact-of-blood-transfusion-on-coronary-artery-bypass-grafting-outcomes
#20
Todd C Crawford, J Trent Magruder, Charles Fraser, Alejandro Suarez-Pierre, Diane Alejo, Jennifer Bobbitt, Clifford E Fonner, Joseph K Canner, Keith Horvath, Kurt Wehberg, Bradley Taylor, Christopher Kwon, Glenn J Whitman, John V Conte, Rawn Salenger
BACKGROUND: Debate persists over the association between blood transfusions, especially those considered discretionary, and outcomes after cardiac operations. Using data from the Maryland Cardiac Surgery Quality Initiative, we sought to determine whether outcomes differed among coronary artery bypass grafting (CABG) patients receiving 1 U of red blood cells (RBCs) vs none. METHODS: We used a statewide database to review patients who underwent isolated CABG from July 1, 2011, to June 30, 2016, across 10 Maryland cardiac surgery centers...
October 24, 2017: Annals of Thoracic Surgery
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