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Morbidity in cardiac surgery

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https://www.readbyqxmd.com/read/28228937/predictors-of-total-morbidity-burden-on-days-3-5-and-8-after-cardiac-surgery
#1
Julie Sanders, Jackie Cooper, Michael G Mythen, Hugh E Montgomery
BACKGROUND: Post-operative morbidity affects up to 36% of cardiac surgical patients. However, few countries reliably record morbidity outcome data, despite patients wanting to be informed of all the risks associated with surgery. The Cardiac Post-Operative Morbidity Score (C-POMS) is a new tool for describing and scoring (0-13) total morbidity burden after cardiac surgery, derived by noting the presence/absence of 13 morbidity domains on days 3, 5, 8 and 15. Identifying modifiable C-POMS risk factors may suggest targets for intervention to reduce morbidity and healthcare costs...
2017: Perioperative Medicine
https://www.readbyqxmd.com/read/28219918/clinical-outcomes-of-remote-ischemic-preconditioning-prior-to-cardiac-surgery-a-meta-analysis-of-randomized-controlled-trials
#2
REVIEW
Brian Pierce, Indra Bole, Vaiibhav Patel, David L Brown
BACKGROUND: Multiple randomized controlled trials of remote ischemic preconditioning (RIPC) prior to cardiac surgery have failed to demonstrate clinical benefit. The aim of this updated meta-analysis was to evaluate the effect of RIPC on outcomes following cardiac surgery. METHODS AND RESULTS: Searches of PubMed, Cochrane, EMBASE, and Web of Science databases were performed for 1970 to December 13, 2015. Randomized controlled trials comparing RIPC with a sham procedure prior to cardiac surgery performed with cardiopulmonary bypass were assessed...
February 20, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28219677/nsqip-based-quality-improvement-curriculum-for-surgical-residents
#3
Mary M Mrdutt, Claire L Isbell, Justin L Regner, Bonnie R Hodges, Yolanda Munoz Maldonado, J Scott Thomas, Harry T Papaconstantinou
BACKGROUND: General surgery training has historically lacked a standardized approach to resident Quality Improvement (QI) education aside from traditional Morbidity and Mortality conference. In 2013, the Accreditation Council for Graduate Medical Education (ACGME) formalized QI as a component of residency training. Our residency chose the National Surgical Quality Improvement Program (NSQIP) Quality In-Training Initiative (QITI) as the foundation for our QI training. We hypothesized that a focused curriculum based on outcomes would produce change in culture and improve quality of patient care...
February 17, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28216364/clinical-outcomes-of-obturator-canal-bypass
#4
Jonathan Bath, Maham Rahimi, Becky Long, Efthymios Avgerinos, Joseph Giglia
OBJECTIVE: Infected aortofemoral grafts pose a formidable challenge with a significant risk of limb loss and high mortality. Despite successful reports of obturator canal bypass (OCB) for infected aortofemoral graft and complicated groins, the technique has not gained widespread use. We reviewed our experience with OCB and performed a systematic review of the literature. METHODS: A retrospective review of patients who underwent OCB in our institution between 1995 and 2013 was conducted...
February 16, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28211020/goal-directed-fluid-restriction-during-brain-surgery-a-prospective-randomized-controlled-trial
#5
Jinfeng Luo, Jing Xue, Jin Liu, Bin Liu, Li Liu, Guo Chen
BACKGROUND: The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain surgery. METHODS: High-risk patients undergoing brain surgery were randomly assigned to a usual care group (control group) or a GDFR group. In the GDFR group, (1) fluid maintenance was restricted to 3 ml/kg/h of a crystalloid solution and (2) colloid boluses were allowed only in case of hypotension associated with a low cardiac index and a high stroke volume variation...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28208923/long-term-outcome-in-patients-with-esophageal-stenting-for-cancer-esophagus-our-experience-at-a-rural-hospital-of-punjab-india
#6
Parvinder Singh, Abhitesh Singh, Anantbir Singh, Ghansham Sharma, Parmod Kumar Bhatia, Amarjeet Singh Grover
INTRODUCTION: Cancer of the esophagus is among the leading cause of cancer deaths in Punjab, India. Patients generally present with dysphagia as their first symptom and more often they have advanced disease at the time of presentation to a tertiary care centre. Palliative procedures have important roles in this setting. Stenting is the best option to palliate the symptoms of dysphagia, from which patient is suffering the most. AIM: To know the success rate, early and long term complications and mortality in esophageal stenting, when it was done in malignant esophageal stricture patients...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28202201/acute-kidney-injury-is-an-independent-risk-factor-for-myocardial-injury-after-noncardiac-surgery-in-critical-patients
#7
Xiu-Juan Zhao, Feng-Xue Zhu, Shu Li, Hong-Bin Zhang, You-Zhong An
BACKGROUND: Myocardial injury after noncardiac surgery (MINS) contributes to mortality and morbidity. However, risk factors accelerating its development remain unclear. The aim of this study was to identify the incidence and risk factors of MINS. METHODS: A retrospective and observational cohort study of critical patients (n=1087) after noncardiac surgery was carried out at a large and tertiary university hospital from January 2012 to January 2013. The clinical data including medical history as well as intraoperative and postoperative variables were recorded...
January 26, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28201958/blood-infusion-and-the-risk-of-haemorrhage-in-patients-undergoing-cardiac-surgery-with-extracorporeal-circulation
#8
Manuel Luque-Oliveros, María Ángeles García-Carpintero, Omar Cauli
PURPOSE: Patients undergoing cardiac surgery with extracorporeal circulation (ECC) frequently present haemorrhages as a complication associated with high morbidity and mortality. One of the factors that influences this risk is the volume of blood infused during surgery. The objective of this study was to determine the optimal volume of autologous blood that can be processed during cardiac surgery with ECC. We also determined the number of salvaged red blood cells to be reinfused into the patient in order to minimize the risk of haemorrhage in the postoperative period...
February 13, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28198997/randomized-clinical-trial-of-comprehensive-geriatric-assessment-and-optimization-in-vascular-surgery
#9
J S L Partridge, D Harari, F C Martin, J L Peacock, R Bell, A Mohammed, J K Dhesi
BACKGROUND: Increasing numbers of older patients are undergoing vascular surgery. Inadequate preoperative assessment and optimization may contribute to increased postoperative morbidity and mortality. METHODS: Patients aged at least 65 years scheduled for elective aortic aneurysm repair or lower-limb arterial surgery were enrolled in an RCT of standard preoperative assessment or preoperative comprehensive geriatric assessment and optimization. Randomization was stratified by sex and surgical site (aorta/lower limb)...
February 15, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28197280/predictors-of-permanent-pacemaker-implantation-after-coronary-artery-bypass-grafting-and-valve-surgery-in-adult-patients-in-current-surgical-era
#10
Bandar Al-Ghamdi, Yaseen Mallawi, Azam Shafquat, Alexandra Ledesma, Nadiah AlRuwaili, Mohamed Shoukri, Shahid Khan, Aly Al Sanei
BACKGROUND: Permanent pacemaker (PPM) implantation after cardiac surgery is required in 0.4-6% of patients depending on cardiac surgery type. PPM implantation in the early postoperative period may reduce morbidity and postoperative hospital stay. We performed a retrospective review of electronic medical records of adult patients with coronary artery bypass grafting (CABG), valve surgery, or both, over a 3-year period. Our aim was to identify predictors of PPM requirements and PPM dependency on follow-up in the current surgical era...
August 2016: Cardiology Research
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#11
Pradeep Kumar, M K Renuka, M S Kalaiselvan, A S Arunkumar
CONTEXT: Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU). AIMS: We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU. SETTINGS AND DESIGN: This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28194489/the-effect-of-preoperative-anemia-on-the-outcome-after-coronary-surgery
#12
Tuomas Tauriainen, Joni Koski-Vähälä, Eeva-Maija Kinnunen, Fausto Biancari
BACKGROUND: Preoperative anemia is associated with increased morbidity and mortality after cardiac surgery. Since anemia is ultimately treated with red blood cell transfusions, we investigated the independent impact of anemia and transfusion on the outcome after coronary artery bypass grafting (CABG). METHODS: This study included 2761 consecutive patients who underwent isolated CABG. Anemia was defined as hemoglobin <12.0 g/dL in women and <13.0 g/dL in men...
February 13, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28193800/cardiovascular-and-ventilatory-consequences-of-laparoscopic-surgery
#13
Tamara M Atkinson, George D Giraud, Brandon M Togioka, Daniel B Jones, Joaquin E Cigarroa
Although laparoscopic surgery accounts for >2 million surgical procedures every year, the current preoperative risk scores and guidelines do not adequately assess the risks of laparoscopy. In general, laparoscopic procedures have a lower risk of morbidity and mortality compared with operations requiring a midline laparotomy. During laparoscopic surgery, carbon dioxide insufflation may produce significant hemodynamic and ventilatory consequences such as increased intraabdominal pressure and hypercarbia. Hemodynamic insults secondary to increased intraabdominal pressure include increased afterload and preload and decreased cardiac output, whereas ventilatory consequences include increased airway pressures, hypercarbia, and decreased pulmonary compliance...
February 14, 2017: Circulation
https://www.readbyqxmd.com/read/28193259/acute-kidney-injury-increases-the-risk-of-end-stage-renal-disease-after-cardiac-surgery-in-an-asian-population-a-prospective-cohort-study
#14
Sophia Tsong Huey Chew, Roderica Rui Ge Ng, Weiling Liu, Khuan Yew Chow, Lian Kah Ti
BACKGROUND: Acute kidney injury (AKI) after cardiac surgery is associated with increased morbidity and mortality. The long-term association between AKI and end-stage renal disease (ESRD) in an Asian population is unknown. Given the high prevalence of diabetes and a younger age of presentation for cardiac surgery, it is important to track this progression of kidney disease. Therefore, we studied the long-term risk of ESRD and mortality in our Asian patients who developed AKI after cardiac surgery...
February 13, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28190436/neurologic-complications-of-cardiac-and-vascular-surgery
#15
K N Sheth, E Nourollahzadeh
This chapter will provide an overview of the major neurologic complications of common cardiac and vascular surgeries, such as coronary artery bypass grafting and carotid endarterectomy. Neurologic complications after cardiac and vascular surgeries can cause significant morbidity and mortality, which can negate the beneficial effects of the intervention. Some of the complications to be discussed include ischemic and hemorrhagic stroke, seizures, delirium, cognitive dysfunction, cerebral hyperperfusion syndrome, cranial nerve injuries, and peripheral neuropathies...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28180122/acute-kidney-injury-risk-factors-for-icu-patients-following-cardiac-surgery-the-application-of-joint-modeling
#16
Batoul Khoundabi, Anoshirvan Kazemnejad, Marjan Mansourian, Seyed Mohammadreza Hashemian, Mehdi Kazempoor Dizaji
BACKGROUND: Admission to the ICU (intensive care unit) is frequently complicated by early AKI (acute kidney injury). The development of AKI following cardiac surgery is particularly associated with increased mortality and morbidity. According to AKIN (acute kidney injury network) criteria, UO (urinary output) is a predictor for AKI. OBJECTIVES: The goal of this study was to determine the effects of some AKI risk factors on AKI and also to investigate changes in UO as a predictor of AKI using joint modeling...
September 2016: Trauma Monthly
https://www.readbyqxmd.com/read/28180098/analysis-of-risk-factors-for-conversion-from-off-pump-to-on-pump-coronary-artery-bypass-graft
#17
Junghyeon Lim, Won Yong Lee, Yong Joon Ra, Jae Han Jeong, Ho Hyun Ko
BACKGROUND: Off-pump coronary artery bypass (OPCAB) is performed worldwide, but significant risks are associated with conversion to on-pump surgery. Therefore, we evaluated the composite outcomes between an OPCAB group and a conversion group. METHODS: From January 2008 to December 2012, 100 consecutive patients underwent OPCAB at Hallym University Sacred Heart Hospital, of whom 84 underwent OPCAB without adverse events (OPCAB group), and 16 were converted to on-pump surgery (conversion group)...
February 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28174394/-past-present-and-future-of-national-clinical-database
#18
Tadashi Iwanaka
The National Clinical Database of Japan( NCD) was established in April 2010 in the collaboration of 9 surgical subspecialty societies on the platform of the Japan Surgical Society(JSS). Registrations began in 2011, and because NCD is strongly linked to the board certification system by JSS, the ratio of registration of surgical procedures is very high, over than 97%. To date, more than 4,000 facilities have enrolled and over 7 million cases were registered over a 5-year period. The analyses of NCD are compared to the foreign database, such as American College of Surgeon National Surgical Quality Improvement Program in the gastrointestinal (GI) surgical field, and the Society of Thoracic Surgeons National Adult Cardiac Database in the cardiovascular surgical field, with a goal of creating a standardized surgery database for quality improvement...
January 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28173877/bilateral-ovarian-micrometastatic-adenocarcinoma-upon-prophylactic-oophorectomy-concurrent-with-low-anterior-resection-for-rectal-cancer
#19
Robin Irons, Erin McIntosh, Alexandre Hageboutros, David Warshal, Steven McClane
BACKGROUND: This case report draws attention to the debated role of prophylactic oophorectomy in women undergoing definitive surgical resection of colon and rectal cancers. It can be challenging to discern the indications and appropriate patient population for this procedure based on the current literature. Potential benefits include treatment and prevention of metastatic disease, preventing development of primary ovarian cancer, and prolonging survival. Negative effects include an increase in operative time and potential morbidity, development of osteoporosis, the risk of cardiac events, and decreasing sexual function...
February 7, 2017: World Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28166998/isolated-tracheoesophageal-fistula-versus-esophageal-atresia-early-morbidity-and-short-term-outcome-a-single-institution-series
#20
R B Tröbs, W Finke, M Bahr, C Roll, M Nissen, M R Vahdad, G Cernaianu
PURPOSE: We compared the postnatal course, morbidity and early results after repair for cases of isolated or "pure" TEF with those for cases of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF). METHODS: Twenty-four consecutive infants were divided into two groups: isolated TEF [TEF group] (n = 5) and EA with distal TEF [EA group] (n = 19). RESULTS: A high rate of prematurity (29%) and major cardiac and other surgically-relevant malformations (0...
March 2017: International Journal of Pediatric Otorhinolaryngology
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