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Brunetta E, Del Monaco G, Rodolfi S, Zachariah D, Vlachos K, Latini AC, De Santis M, Ceriotti C, Galimberti P, Taormina A, Battaglia V, Falasconi G, Maceda DP, Efremidis M, Letsas KP, Selmi C, Stefanini GG, Condorelli G, Frontera A. Incidence and predictors of post-surgery atrial fibrillation occurrence: A cohort study in 53,387 patients. J Arrhythm 2024; 40:815-821. [PMID: 39139903 PMCID: PMC11317654 DOI: 10.1002/joa3.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/19/2024] [Accepted: 05/02/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction Atrial fibrillation (AF) represents the most common arrhythmia in the postoperative setting. We aimed to investigate the incidence of postoperative AF (POAF) and determine its predictors, with a specific focus on inflammation markers. Methods We performed a retrospective single tertiary center cohort study including consecutive adult patients who underwent a major surgical procedure between January 2016 and January 2020. Patients were divided into four subgroups according to the type of surgery. Results Among 53,387 included patients (79.4% male, age 64.5 ± 9.5 years), POAF occurred in 570 (1.1%) with a mean latency after surgery of 3.4 ± 2.6 days. Ninety patients died (0.17%) after a mean of 13.7 ± 8.4 days. The 28-day arrhythmia-free survival was lower in patients undergoing lung and cardiovascular surgery (p < .001). Patients who developed POAF had higher levels of C-reactive protein (CRP) (0.70 ± 0.03 vs. 0.40 ± 0.01 log10 mg/dl; p < .001). In the multivariable Cox regression analysis, adjusting for confounding factors, CRP was an independent predictor of POAF [HR per 1 mg/dL increase in log-scale = 1.81 (95% CI 1.18-2.79); p = .007]. Moreover, independent predictors of POAF were also age (HR/1 year increase = 1.06 (95% CI 1.04-1.08); I < .001), lung and cardiovascular surgery (HR 23.62; (95% CI 5.65-98.73); p < .001), and abdominal and esophageal surgery (HR 6.26; 95% CI 1.48-26.49; p = .013). Conclusions Lung and cardiovascular surgery had the highest risk of POAF in the presented cohort. CRP was an independent predictor of POAF and postsurgery inflammation may represent a major driver in the pathophysiology of the arrhythmia.
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Affiliation(s)
- Enrico Brunetta
- Unit of Rheumatology and Clinical Immunology, IRCCS Humanitas Research HospitalRozzanoItaly
| | - Guido Del Monaco
- Arrhythmology Department, IRCCS Humanitas Research HospitalRozzanoItaly
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly
- Cardio Center, Humanitas Clinical and Research Hospital IRCCSMilanItaly
| | - Stefano Rodolfi
- Unit of Rheumatology and Clinical Immunology, IRCCS Humanitas Research HospitalRozzanoItaly
| | - Donah Zachariah
- Department of Cardiac ElectrophysiologyRoyal Papworth HospitalCambridgeUK
| | | | - Alessia Chiara Latini
- Arrhythmology Department, IRCCS Humanitas Research HospitalRozzanoItaly
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly
- Cardio Center, Humanitas Clinical and Research Hospital IRCCSMilanItaly
| | - Maria De Santis
- Unit of Rheumatology and Clinical Immunology, IRCCS Humanitas Research HospitalRozzanoItaly
| | - Carlo Ceriotti
- Arrhythmology Department, IRCCS Humanitas Research HospitalRozzanoItaly
| | - Paola Galimberti
- Arrhythmology Department, IRCCS Humanitas Research HospitalRozzanoItaly
| | - Antonio Taormina
- Arrhythmology Department, IRCCS Humanitas Research HospitalRozzanoItaly
| | - Vincenzo Battaglia
- Arrhythmology Department, IRCCS Humanitas Research HospitalRozzanoItaly
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly
- Cardio Center, Humanitas Clinical and Research Hospital IRCCSMilanItaly
| | - Giulio Falasconi
- Arrhythmology Department, IRCCS Humanitas Research HospitalRozzanoItaly
| | | | | | | | - Carlo Selmi
- Unit of Rheumatology and Clinical Immunology, IRCCS Humanitas Research HospitalRozzanoItaly
| | - Giulio Giuseppe Stefanini
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly
- Cardio Center, Humanitas Clinical and Research Hospital IRCCSMilanItaly
| | - Gianluigi Condorelli
- Department of Biomedical SciencesHumanitas University, Pieve EmanueleMilanItaly
- Cardio Center, Humanitas Clinical and Research Hospital IRCCSMilanItaly
| | - Antonio Frontera
- Arrhythmology Department, IRCCS Humanitas Research HospitalRozzanoItaly
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Fink A, Puchwein P, Fahrleitner-Pammer A, Eder-Halbedl M, Bernhardt GA. Increased Early Postoperative Complication Rate after Osteoporotic Hip Fracture in Patients with Low 25 (OH) Vitamin D Levels. Nutrients 2024; 16:1917. [PMID: 38931272 PMCID: PMC11206968 DOI: 10.3390/nu16121917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
This study investigated the association of preoperative 25-hydroxy (25 (OH)) vitamin D levels with postoperative complications in osteoporotic hip fracture patients following surgery. We hypothesized that patients with low concentrations of 25 (OH) vitamin D might have an increased risk of developing adverse outcomes. Between January 2019 and December 2020, a retrospective observational study was conducted, including low-energy fragility fractures at the proximal femur. Regarding preoperative 25 (OH) vitamin D levels, patients were divided into two groups (<30 ng/mL and ≥30 ng/mL). Early and late postoperative complications were assessed and graded according to the Clavien-Dindo classification system. Logistic regression analysis was performed to demonstrate the association between preoperative 25 (OH) vitamin D levels (<30 ng/mL, ≥30 ng/mL) and postoperative complications after adjusting for age and sex. Of 314 patients, 222 patients (70.7%) had a 25 (OH) vitamin D level of <30 ng/mL. The mean serum 25 (OH) vitamin D level was 22.6 ng/mL (SD 13.2). In 116 patients (36.9%), postoperative complications were observed, with the most occurring in the short term (95 patients, 30.2%). Late postoperative complications were present in 21 patients (6.7%), most graded as Clavien I (57.1%). Logistic regression analysis identified a low vitamin D level (<30 ng/mL) as an independent risk factor for early postoperative complications (OR 2.06, 95% CI 1.14-3.73, p = 0.016), while no significant correlation was found in late complications (OR 1.08, 95% CI 0.40-2.95, p = 0.879). In conclusion, preoperative 25 (OH) vitamin D serum level might be an independent predictor for early postoperative complications. However, future studies are warranted to determine risk factors for long-term complications and establish appropriate intervention strategies.
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Affiliation(s)
- Andrea Fink
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria;
| | - Paul Puchwein
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria;
| | | | - Michael Eder-Halbedl
- Department of Orthopedics and Traumatology, LKH Feldbach-Fürstenfeld, Ottokar-Kernstock-Straße 18, 8330 Feldbach, Austria
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Bruce K, Mangram A, Sucher JF, Blake N, Balcome CD, Prokuski L, Dzandu J, Barletta JF, Shirah GR. Consequences of anemia in geriatric hip fractures: how low is too low? Trauma Surg Acute Care Open 2024; 9:e001175. [PMID: 38352959 PMCID: PMC10862255 DOI: 10.1136/tsaco-2023-001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/24/2023] [Indexed: 02/16/2024] Open
Abstract
Background The transfusion threshold for low hemoglobin (Hgb) in geriatric patients with hip fractures is widely debated. In certain populations, low Hgb is associated with poor outcomes. Our objective was to evaluate the relationship between lowest Hgb and outcome to identify the Hgb threshold where poor outcomes were more prevalent. Methods This retrospective cohort study included consecutive patients with hip fractures, aged ≥60 years, evaluated at two level 1 trauma centers from 2018 to 2021. Patients who did not undergo operative fixation or had a length of stay <1 day were excluded. The primary endpoint was adverse outcome defined as the composite of myocardial infarction, stroke, new-onset arrhythmia or death. We compared lowest Hgb and possible confounders between patients with and without adverse outcomes. Classification and regression tree (CART) analysis was performed to identify the threshold for Hgb where adverse outcomes were more prevalent. Multivariate analysis was performed. Results We evaluated 935 patients. Mean age was 80±10 years; admission Hgb was 12.5±1.7 g/dL. Diabetes was present in 20%, and 20% had coronary artery disease. Adverse outcomes were noted in 57 patients (6.1%). CART identified ≤7.1 g/dL as the Hgb threshold where adverse outcomes were more prevalent (15% vs. 4.1%, p<0.001). Additionally, a greater number of adverse outcomes were noted in the subgroup of patients having both a hemoglobin ≤7.1 g/dL and advanced age (age >79 years (22%)). After controlling for age, American Society of Anesthesiologist Physical Status Classification (ASA), antiplatelet medication, admission Hgb, time to operation and blood transfusions, lowest Hgb ≤7.1 g/dL remained a risk factor for adverse outcomes. Conclusions In geriatric patients with isolated hip fractures, Hgb ≤7.1 g/dL is associated with a significantly higher rate of adverse outcomes. This risk was most pronounced in patients older than 79 years; particular care should be taken in this demographic. Level of evidence/study type Level III/prognostic and epidemiological.
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Affiliation(s)
- Kimberli Bruce
- Trauma Services, HonorHealth John C Lincoln Medical Center, Phoenix, Arizona, USA
| | - Alicia Mangram
- Trauma Services, HonorHealth John C Lincoln Medical Center, Phoenix, Arizona, USA
| | - Joseph F Sucher
- Trauma Services, HonorHealth John C Lincoln Medical Center, Phoenix, Arizona, USA
| | - Nuria Blake
- HonorHealth John C Lincoln Medical Center, Phoenix, Arizona, USA
| | - Charles D Balcome
- Trauma Services, HonorHealth John C Lincoln Medical Center, Phoenix, Arizona, USA
| | - Laura Prokuski
- HonorHealth John C Lincoln Medical Center, Phoenix, Arizona, USA
| | - James Dzandu
- Trauma Services, HonorHealth John C Lincoln Medical Center, Phoenix, Arizona, USA
| | - Jeffrey F Barletta
- Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, Az, USA
| | - Gina R Shirah
- HonorHealth John C Lincoln Medical Center, Phoenix, Arizona, USA
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Should We Consider Recombinant Human Brain Natriuretic Peptide to Prevent Postoperative Atrial Fibrillation? J Cardiovasc Pharmacol 2023; 81:18-20. [PMID: 36214698 DOI: 10.1097/fjc.0000000000001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Parcha V, Booker KS, Kalra R, Kuranz S, Berra L, Arora G, Arora P. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Sci Rep 2021; 11:10231. [PMID: 33986390 PMCID: PMC8119690 DOI: 10.1038/s41598-021-89553-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Children and adolescents account for ~ 13% of total COVID-19 cases in the United States. However, little is known about the nature of the illness in children. The reopening of schools underlines the importance of understanding the epidemiology of pediatric COVID-19 infections. We sought to assess the clinical characteristics and outcomes in pediatric COVID-19 patients. We conducted a retrospective cross-sectional analysis of pediatric patients diagnosed with COVID-19 from healthcare organizations in the United States. The study outcomes (hospitalization, mechanical ventilation, critical care) were assessed using logistic regression. The subgroups of sex and race were compared after propensity score matching. Among 12,306 children with lab-confirmed COVID-19, 16.5% presented with respiratory symptoms (cough, dyspnea), 13.9% had gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), 8.1% had dermatological symptoms (rash), 4.8% had neurological (headache), and 18.8% had other non-specific symptoms (fever, malaise, myalgia, arthralgia and disturbances of smell or taste). In the study cohort, the hospitalization frequency was 5.3%, with 17.6% needing critical care services and 4.1% requiring mechanical ventilation. Following propensity score matching, the risk of all outcomes was similar between males and females. Following propensity score matching, the risk of hospitalization was greater in non-Hispanic Black (RR 1.97 [95% CI 1.49–2.61]) and Hispanic children (RR 1.31 [95% CI 1.03–1.78]) compared with non-Hispanic Whites. In the pediatric population infected with COVID-19, a substantial proportion were hospitalized due to the illness and developed adverse clinical outcomes.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA
| | - Katherine S Booker
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, MN, USA.,Division of Hospital Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | | | - Lorenzo Berra
- Anesthesia & Critical Care, Pulmonary Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA. .,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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Parcha V, Kalra R, Glenn AM, Davies JE, Kuranz S, Arora G, Arora P. Coronary artery bypass graft surgery outcomes in the United States: Impact of the coronavirus disease 2019 (COVID-19) pandemic. ACTA ACUST UNITED AC 2021; 6:132-143. [PMID: 33870234 PMCID: PMC8007527 DOI: 10.1016/j.xjon.2021.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
Objective There has been a substantial decline in patients presenting for emergent and routine cardiovascular care in the United States after the onset of the coronavirus disease 2019 (COVID-19) pandemic. We sought to assess the risk of adverse clinical outcomes among patients undergoing coronary artery bypass graft (CABG) surgery during the 2020 COVID-19 pandemic period and compare the risks with those undergoing CABG before the pandemic in the year 2019. Methods A retrospective cross-sectional analysis of the TriNetX Research Network database was performed. Patients undergoing CABG between January 20, 2019, and September 15, 2019, contributed to the 2019 cohort, and those undergoing CABG between January 20, 2020, and September 15, 2020, contributed to the 2020 cohort. Propensity-score matching was performed, and the odds of mortality, acute kidney injury, stroke, acute respiratory distress syndrome, and mechanical ventilation occurring by 30 days were evaluated. Results The number of patients undergoing CABG in 2020 declined by 35.5% from 5534 patients in 2019 to 3569 patients in 2020. After propensity-score matching, 3569 patient pairs were identified in the 2019 and the 2020 cohorts. Compared with those undergoing CABG in 2019, the odds of mortality by 30 days were 0.96 (95% confidence interval [CI], 0.69-1.33; P = .80) in those undergoing CABG in 2020. The odds for stroke (odds ratio [OR], 1.201; 95% CI, 0.96-1.39), acute kidney injury (OR, 0.76; 95% CI, 0.59-1.08), acute respiratory distress syndrome (OR, 1.01; 95% CI, 0.60-2.42), and mechanical ventilation (OR, 1.11; 95% CI, 0.94-1.30) were similar between the 2 cohorts. Conclusions The number of patients undergoing CABG in 2020 has substantially declined compared with 2019. Similar odds of adverse clinical outcomes were seen among patients undergoing CABG in the setting of COVID-19 compared with those in 2019.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, Minn
| | - Austin M Glenn
- School of Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - James E Davies
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Ala
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