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Lavanchy I, Passos L, Aymard T, Grünenfelder J, Emmert MY, Corti R, Gaemperli O, Biaggi P, Reser D. Gender-Tailored Heart Team Decision Making Equalizes Outcomes for Female Patients after Aortic Valve Replacement through Right Anterior Small Thoracotomy (RAST). J Cardiovasc Dev Dis 2024; 11:329. [PMID: 39452299 PMCID: PMC11508425 DOI: 10.3390/jcdd11100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/25/2024] [Accepted: 10/09/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Little is known about gender-dependent outcomes after aortic valve replacement (AVR) through right anterior thoracotomy (RAST). The aim of our study was to analyze the mid-term outcomes of our cohort. METHODS This study is a retrospective analysis of 338 patients (2013-2022). Subgroup analysis included a gender-dependent comparison of age groups ≤60 and >60 years. RESULTS Women were older (69.27 ± 7.98 vs. 64.15 ± 11.47, p < 0.001) with higher Euroscore II (1.25 ± 0.73 vs. 0.94 ± 0.45, p < 0.001). Bypass and cross-clamp time were shorter (109.36 ± 30.8 vs. 117.65 ± 33.1 minutes, p = 0.01; 68.26 ± 21.5 vs. 74.36 ± 23.3 minutes, p = 0.01), while ICU, hospital stay and atrial fibrillation were higher (2.48 ± 8.2 vs. 1.35 ± 1.4 days, p = 0.005; 11 ± 7.8 vs. 9.48 ± 2.3 days, p = 0.002; 6.7% vs. 4.4%, p = 0.024). Mortality was 0.9%, while stroke was 0.6%. Age subgroup analysis showed that women were older (p = 0.025) with longer ICU and hospital stays (p < 0.001, p = 0.007). On mid-term follow-up (4.52 ± 2.67 years) of 315 patients (94.3%), there was no significant difference in survival, MACCE and re-intervention comparing gender and age groups. CONCLUSIONS Despite older age, higher Euroscore II, longer ICU and hospital stay in women, mortality, MACCE and reoperation were low and comparable in gender and age groups. We believe that our patient-tailored heart team decision making combined with RAST translates into gender-tailored medicine, which equalizes the widely reported negative outcomes of female patients after cardiac surgery.
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Affiliation(s)
- Isabel Lavanchy
- Department of Cardiac Surgery and Cardiology, Heart Clinic, Hirslanden Hospital, Witellikerstrasse 40, 8032 Zurich, Switzerland; (T.A.); (J.G.); (R.C.); (O.G.); (P.B.)
| | - Laina Passos
- Department of Cardiac and Vascular Surgery, University Hospital Bern, Freiburgstrasse 20, 3010 Bern, Switzerland;
| | - Thierry Aymard
- Department of Cardiac Surgery and Cardiology, Heart Clinic, Hirslanden Hospital, Witellikerstrasse 40, 8032 Zurich, Switzerland; (T.A.); (J.G.); (R.C.); (O.G.); (P.B.)
| | - Jürg Grünenfelder
- Department of Cardiac Surgery and Cardiology, Heart Clinic, Hirslanden Hospital, Witellikerstrasse 40, 8032 Zurich, Switzerland; (T.A.); (J.G.); (R.C.); (O.G.); (P.B.)
| | - Maximilian Y. Emmert
- Deutsches Herzzentrum der Charite (DHZC), Department of Cardiothoracic and Vascular Surgery, 13353 Berlin, Germany;
- Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Roberto Corti
- Department of Cardiac Surgery and Cardiology, Heart Clinic, Hirslanden Hospital, Witellikerstrasse 40, 8032 Zurich, Switzerland; (T.A.); (J.G.); (R.C.); (O.G.); (P.B.)
| | - Oliver Gaemperli
- Department of Cardiac Surgery and Cardiology, Heart Clinic, Hirslanden Hospital, Witellikerstrasse 40, 8032 Zurich, Switzerland; (T.A.); (J.G.); (R.C.); (O.G.); (P.B.)
| | - Patric Biaggi
- Department of Cardiac Surgery and Cardiology, Heart Clinic, Hirslanden Hospital, Witellikerstrasse 40, 8032 Zurich, Switzerland; (T.A.); (J.G.); (R.C.); (O.G.); (P.B.)
| | - Diana Reser
- Department of Cardiac Surgery and Cardiology, Heart Clinic, Hirslanden Hospital, Witellikerstrasse 40, 8032 Zurich, Switzerland; (T.A.); (J.G.); (R.C.); (O.G.); (P.B.)
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Yu S, Dhawan R, Kenny ES, Banayan JM, Bodmer NJ, Sun LY, Oakes D. Like Mother, Like Daughter: A Case of Peripartum Spontaneous Coronary Artery Dissection. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00607-4. [PMID: 39366789 DOI: 10.1053/j.jvca.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 09/13/2024] [Indexed: 10/06/2024]
Affiliation(s)
- Sherman Yu
- Department of Anesthesia, Duke University, Durham, NC
| | - Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
| | - Eleanor S Kenny
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Natalie J Bodmer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA
| | - Louise Y Sun
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA
| | - Daryl Oakes
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA
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Ghiragosian C, Harpa M, Puscas A, Balau R, Al-Hussein H, Ghiragosian-Rusu SE, Avram C, Baba DF, Neagoe R, Suciu H. Histidine-Tryptophan-Ketoglutarate Cardioplegia Yields Different Results in Aortic Valve Surgery Depending on Patient Gender: A Pilot Study. Cureus 2024; 16:e67372. [PMID: 39310456 PMCID: PMC11413832 DOI: 10.7759/cureus.67372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Histidine-tryptophan-ketoglutarate (HTK) cardioplegia induces cardiac arrest through membrane hyperpolarization. Aortic valve pathology leads to pathophysiological changes in left ventricular vascularization that may prevent adequate cardioplegic distribution. The objective of the study was to ascertain whether the use of Bretschneider cardioplegia in aortic valve surgery yields different outcomes for male and female patients. METHODOLOGY Our study compares the perioperative data of 300 adult patients who underwent aortic valve replacement between June 2023 and June 2024 at the Emergency Cardiac Disease and Transplant Institute, Tîrgu Mures, Romania. Concomitant procedures, age under 18 years, retrograde or combined cardioplegia, and emergency surgery were excluded. The main outcome was operative mortality, and secondary outcomes were postoperative complications and paraclinical data such as ejection fraction and cardiac enzymes. RESULTS Male patients comprised 190 (62%) of the sample. The most common age group was 61-70 years in both groups. The mortality rate was 6 (5.4%) for women compared to 9 (4.7%) for men. Preoperative left ventricular ejection fraction was the primary covariate determining 30-day postoperative mortality. Left ventricular ejection fraction decreased by 2.2% in men and 1.1% in women 30 days after surgery. CONCLUSIONS The myocardial adaptation to aortic valve pathology exhibits gender-specific differences. However, the utilization of HTK cardioplegia obviates this disparity.
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Affiliation(s)
- Claudiu Ghiragosian
- Cardiac Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Marius Harpa
- Cardiovascular Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Alexandra Puscas
- Cardiovascular Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Radu Balau
- Cardiovascular Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Hussam Al-Hussein
- Cardiovascular Surgery, Department of Anatomy-Embryology M1, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Simina-Elena Ghiragosian-Rusu
- Pediatric Cardiology, Department of Pediatrics III, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Calin Avram
- Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Dragos-Florin Baba
- Cardiology, Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Radu Neagoe
- 2nd Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
| | - Horatiu Suciu
- Cardiovascular Surgery, Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, ROU
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Martín-Román ÁL, Moral A, Pinillos-Franco S. Are women breaking the glass ceiling? A gendered analysis of the duration of sick leave in Spain. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024; 24:107-134. [PMID: 37095293 PMCID: PMC10124936 DOI: 10.1007/s10754-023-09351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
We study the gender gap in the duration of sick leave in Spain by splitting this duration into two types of days - those which are related to biological characteristics and those derived from behavioral reasons. Using the Statistics of Accidents at Work for 2011-2019, we found that women presented longer standard durations (i.e., purely attached to physiological reasons) compared to men. However, when estimating individuals' efficiency as the ratio between actual and standard durations, we found that women were more inefficient at lower levels of income, whereas in case of men, this occurred at higher levels of income. These results were reinforced when considering that men and women do not recover from the same injury at the same rate. Women were more efficient than men across all the compensation distribution, especially at higher income levels.
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Affiliation(s)
- Ángel L Martín-Román
- Dpto. Análisis Económico, Facultad de Ciencias Sociales Jurídicas Y de La Comunicación, Universidad de Valladolid, Plaza Universidad, 40005, Segovia, Spain.
| | - Alfonso Moral
- Dpto. Análisis Económico, Facultad de Ciencias Sociales Jurídicas Y de La Comunicación, Universidad de Valladolid, Plaza Universidad, 40005, Segovia, Spain
| | - Sara Pinillos-Franco
- Dpto. Análisis Económico, Facultad de Ciencias Económicas Y Empresariales, Universidad Autónoma de Madrid, Calle Francisco Tomás Y Valiente 5, 28049, Madrid, Spain
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Adams DR, Xu LJ, Vickery TW, Scangas GA, Bleier BS, Gray ST, Metson R. The Impact of Gender on Long-Term Quality of Life After Sinus Surgery for Chronic Rhinosinusitis. Laryngoscope 2023; 133:3319-3326. [PMID: 37114661 DOI: 10.1002/lary.30719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To identify the impact of gender on the clinical outcomes of endoscopic sinus surgery (ESS) through the comparison of quality of life measures in female and male patients who undergo surgical treatment for chronic rhinosinusitis (CRS). STUDY DESIGN Prospective observational cohort study. METHODS Patients with CRS completed the 22-item Sino-Nasal Outcome Test (SNOT-22) and EuroQol 5-Dimension Survey (EQ-5D) preoperatively and annually for 5 years following ESS. Health utility values (HUV) were calculated from EQ-5D scores. Comparisons of cohort characteristics were performed with chi-square and t-tests. A multivariable linear mixed effects model evaluated changes in SNOT-22 and HUV over time by gender. RESULTS Among the 1268 patients (54% female) enrolled, 789 and 343 completed postoperative surveys at one and 5 years, respectively. Preoperatively, females experienced more severe symptoms: mean SNOT-22 score (51.1 ± 20.9 female vs. 44.7 ± 20.0 male, p < 0.001) and HUV (0.80 ± 0.14 female vs. 0.84 ± 0.11 male, p < 0.001). These gender differences were resolved by year one postoperatively (SNOT-22: p = 0.083; HUV: p = 0.465). Two years after surgery, however, females reported more severe symptoms (SNOT-22: 25.6 ± 20.7 female vs. 21.5 ± 17.4 male, p = 0.005; HUV: 0.88 ± 0.12 female vs. 0.90 ± 0.11 male, p = 0.018), a difference that persisted at year five. These gender-related differences remained after adjusting for age, race, ethnicity, nasal polyps, history of prior ESS, and smoking status (p < 0.001). Within-subject improvement was comparable between genders (SNOT-22: p = 0.869; HUV: p = 0.611). CONCLUSION Females with CRS reported more severe symptoms both before and 5 years after surgery compared to their male counterparts. Understanding the mechanism behind these gender-related differences is important for optimizing CRS treatment. LEVEL OF EVIDENCE 2 Laryngoscope, 133:3319-3326, 2023.
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Affiliation(s)
- Dara R Adams
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lucy J Xu
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thad W Vickery
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Benjamin S Bleier
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Carbone A, Ranieri B, Castaldo R, Franzese M, Rega S, Cittadini A, Czerny M, Bossone E. Sex differences in type A acute aortic dissection: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:1074-1089. [PMID: 36629802 DOI: 10.1093/eurjpc/zwad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/27/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND In acute aortic dissection (AAD) sex heterogeneity reports are not exhaustive and in part even conflicting. AIMS To explore sex differences in clinical features, management, and outcomes among patients with type A AAD. METHODS AND RESULTS A systematic review and meta-analysis of the literature were conducted for studies (2004-2022) reporting type A AAD sex differences. Among the 1938 studies retrieved, 16 (16 069 patients, 7142 women, and 8927 men) fulfilled all eligibility criteria. Data were aggregated used the random-effects model as pooled risk ratio and mean difference. Due to information reported by considered manuscripts, analysis were performed only among surgically treated type A AAD patients. At the time of hospital presentation type A AAD women were older than men but had lower body mass index (BMI), body surface area (BSA), and creatinine plasma levels. Active smoking, bicuspid aortic valve, and previous cardiac surgery were less common in women while diabetes mellitus was more frequent. Furthermore, women experienced more frequently pericardial effusion/cardiac tamponade than men. Interestingly, in-hospital surgical mortality did not differ between sexes [risk ratio (RR), 1.02; 95% confidence interval (CI), 0.53-1.99; P = 0.95], whereas 5 (RR 0.94; 95% CI: 0.92-0.97; P < 0.001) and 10-year survival (RR 0.82; 95% CI: 0.74-0.92; P = 0.004) was higher among men. A descriptive analysis of in-hospital outcomes among medically treated type A AAD patients confirmed prohibitive high mortality for both sexes (men 58.6% vs. women 53.8%, P = 0.59). CONCLUSIONS A female sex phenotype appears to be evident in type A AAD implying the need for a personalized management patient approach along with tailored preventive strategies. PROSPERO REGISTRY ID CRD42022359072.
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Affiliation(s)
- Andreina Carbone
- Unit of Cardiology, University of Campania 'Luigi Vanvitelli', Naples 80138, Italy
| | - Brigida Ranieri
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113, Naples 80143, Italy
| | - Rossana Castaldo
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113, Naples 80143, Italy
| | - Monica Franzese
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113, Naples 80143, Italy
| | - Salvatore Rega
- Department of Public Health, University of Naples 'Federico II', Via Pansini, 5, Naples 80131, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University of Naples 'Federico II', Via S Pansini, 5, Naples 80131, Italy
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples 80131, Italy
| | - Martin Czerny
- University Heart Center Freiburg Bad Krozingen, University Hospital Freiburg, Südring, 15, Bad Krozingen 79189, Germany
- Faculty of Medicine, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Eduardo Bossone
- Department of Public Health, University of Naples 'Federico II', Via Pansini, 5, Naples 80131, Italy
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Bradley S, White RS, Jiang SY, Ma X, Hoyler MM, Muehlschlegel JD, Karamnov S, Tangel VE, Lanahan J, Rong LQ. Sex Differences in In-Hospital Mortality After Open Cardiac Valve Surgery. Anesth Analg 2022; 135:944-953. [PMID: 36029223 PMCID: PMC9588500 DOI: 10.1213/ane.0000000000006076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cardiac valvular disease affects millions of people worldwide and is a major cause of morbidity and mortality. Female patients have been shown to experience inferior clinical outcomes after nonvalvular cardiac surgery, but recent data are limited regarding open valve surgical cohorts. The primary objective of our study was to assess whether female sex is associated with increased in-hospital mortality after open cardiac valve operations. METHODS Utilizing the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), we conducted a retrospective cohort study of patients who underwent open cardiac valve surgery from 2007 to 2018 in Washington, Maryland, Kentucky, and Florida; from 2007 to 2011 in California; and from 2007 to 2016 in New York. The primary objective of this study was to estimate the confounder-adjusted association between sex and in-hospital mortality (as recorded and coded by SID HCUP) after open cardiac valve surgery. We used multilevel multivariable models to account for potential confounders, including intrahospital practice patterns. RESULTS A total of 272,954 patients (108,443 women; 39.73% of sample population with mean age of 67.6 ± 14.3 years) were included in our analysis. The overall mortality rates were 3.8% for male patients and 5.1% for female patients. The confounder-adjusted odds ratio (OR) for in-hospital mortality for female patients compared to male patients was 1.41 (95% confidence interval [CI], 1.35-1.47; P < .001). When stratifying by surgical type, female patients were also at increased odds of in-hospital mortality ( P < .001) in populations undergoing aortic valve replacement (adjusted OR [aOR], 1.38; 95% CI, 1.25-1.52); multiple valve surgery (aOR, 1.38; 95% CI, 1.22-1.57); mitral valve replacement (aOR, 1.22; 95% CI, 1.12 - 1.34); and valve surgery with coronary artery bypass grafting (aOR, 1.64; 95% CI, 1.54 - 1.74; all P < .001). Female patients did not have increased odds of in-hospital mortality in populations undergoing mitral valve repair (aOR, 1.26; 95% CI, 0.98 - 1.64; P = .075); aortic valve repair (aOR, 0.87; 95% CI, 0.67 - 1.14; P = .32); or any other single valve repair (aOR, 1.10; 95% CI, 0.82 - 1.46; P = .53). CONCLUSIONS We found an association between female patients and increased confounder-adjusted odds of in-hospital mortality after open cardiac valve surgery. More research is needed to better understand and categorize these important outcome differences. Future research should include observational analysis containing granular and complete patient- and surgery-specific data.
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Affiliation(s)
- Stephanie Bradley
- From the Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Silis Y Jiang
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Xiaoyue Ma
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Marguerite M Hoyler
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Jochen D Muehlschlegel
- From the Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sergey Karamnov
- From the Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Virginia E Tangel
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Jill Lanahan
- From the Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lisa Qia Rong
- Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
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Fialka NM, Bozso SJ, El-Andari R, Kang JJ, O'Connell A, Moon MC, Macarthur R, Nagendran J. Sex differences in acute type A aortic dissection: a systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:632-644. [PMID: 35687063 DOI: 10.23736/s0021-9509.22.12273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The objective of this study is to provide a comprehensive comparison of outcomes following acute type A aortic dissection (ATAAD) repair in males and females. EVIDENCE ACQUISITION PubMed, Medline, and Web of Science were systematically searched by two authors for studies published from January 1st, 2000, to May 10th, 2021. Overall, 2405 articles were screened, and 16 were included in this review. Meta-analysis of the compiled data was performed. EVIDENCE SYNTHESIS Pooled estimates indicated no difference in operative (odds ratio (OR) 1.00, 95% confidence interval (CI) 0.59-1.67, P=0.99, I2=52%), in-hospital (OR 0.78, 95% CI 0.56-1.08; P=0.13, I2=57%), and 30-day mortality (OR 1.09, 95% CI 0.83-1.43, P=0.52, I2=45%) between the sexes. However, males had significantly reduced 5-year mortality rates (OR 0.71, 95% CI 0.51-1.00, P=0.05, I2=45%). There was no difference between sexes in rates of postoperative stroke (OR 1.07, 95% CI 0.86-1.33, P=0.54, I2=0%), atrial fibrillation (OR 0.99, 95% CI 0.82-1.19, P=0.92, I2=0%), as well as mesenteric or limb ischemia (OR 0.73, 95% CI 0.22-2.43, P=0.61, I2=77%; OR 0.83, 95% CI 0.30-2.30, P=0.72, I2=76%, respectively). Males did experience significantly increased rates of acute renal failure and reoperation (OR 1.35, 95% CI 1.16-1.56, P=0.0001, I2=29%; OR 1.40, 95% CI 1.09-1.81, P=0.010, I2=42%). CONCLUSIONS Composite analysis indicates that early mortality does not differ between the sexes; however, late outcomes favor males. Differences in preoperative presentation and subsequent procedure selection between the sexes likely contribute to the disparity in late outcomes. Decision-making for surgical treatment of ATAAD should account for sex-specific risk factors.
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Affiliation(s)
- Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan El-Andari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jimmy J Kang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Andrew O'Connell
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Michael C Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Roderick Macarthur
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada -
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Mejia OAV, Borgomoni GB, Palma Dallan LR, Mioto BM, Duenhas Accorsi TA, Lima EG, de Matos Soeiro A, Lima FG, Manuel de Almeida Brandão C, Alberto Pomerantzeff PM, Oliveira Dallan LA, Ferreira Lisboa LA, Jatene FB. Quality improvement program at Latin America. Int J Surg 2022; 106:106931. [PMID: 36126857 DOI: 10.1016/j.ijsu.2022.106931] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The current challenge of cardiac surgery (CS) is to improve outcomes in adverse scenarios. The aim of this study was to assess the impact of a quality improvement program (QIP) on hospital mortality in the largest CS center in Latin America. METHODS Patients were divided into two groups: before (Jan 2013-Dec 2015, n = 3534) and after establishment of the QIP (Jan 2017-Dec 2019, n = 3544). The QIP consisted of the implementation of 10 central initiatives during 2016. The procedures evaluated were isolated coronary artery bypass grafting surgery (CABG), mitral valve surgery, aortic valve surgery, combined mitral and aortic valve surgery, and CABG associated with heart valve surgery. Propensity Score Matching (PSM) was used to adjust for inequality in patients' preoperative characteristics before and after the implementation of QIP. A multivariate logistic regression model was built to predict hospital mortality and validated using discrimination and calibration metrics. RESULTS The PMS paired two groups using 5 variables, obtaining 858 patients operated before (non-QIP) and 858 patients operated after the implementation of the QIP. When comparing the QIP versus Non-QIP group, there was a shorter length of stay in all phases of hospitalization. In addition, the patients evolved with less anemia (P = 0.001), use of intra-aortic balloon pump (P = 0.003), atrial fibrillation (P = 0.001), acute kidney injury (P < 0.001), cardiogenic shock (P = 0.011), sepsis (P = 0.046), and hospital mortality (P = 0.001). In the multiple model, among the predictors of hospital mortality, the lack of QIP increased the chances of mortality by 2.09 times. CONCLUSION The implementation of a first CS QIP in Latin America was associated with a reduction in length of hospital stay, complications and mortality after the cardiac surgeries analyzed.
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Affiliation(s)
- Omar Asdrúbal Vilca Mejia
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Gabrielle Barbosa Borgomoni
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luís Roberto Palma Dallan
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Bruno Mahler Mioto
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Tarso Augusto Duenhas Accorsi
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Eduardo Gomes Lima
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Alexandre de Matos Soeiro
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Felipe Gallego Lima
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Carlos Manuel de Almeida Brandão
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Pablo Maria Alberto Pomerantzeff
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luís Alberto Oliveira Dallan
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Augusto Ferreira Lisboa
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Fábio Biscegli Jatene
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Ullah R, Hayat MK, Shakil R, Jan A, Rustam Z, Awan NI. Effect of COVID-19 on the Cardiothoracic and Vascular Surgery Procedures Mix at a Tertiary Care Hospital. Cureus 2022; 14:e21522. [PMID: 35223298 PMCID: PMC8863118 DOI: 10.7759/cureus.21522] [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] [Accepted: 01/23/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To assess the effect of the COVID-19 pandemic on the cardiothoracic and vascular surgery procedures volume at a tertiary care hospital. Materials & Methods This cross-sectional retrospective study was carried out at a tertiary care hospital's Cardiothoracic and Vascular Surgery department. All the four-year surgical procedures data were reviewed from August 2017 to August 2021. After extracting data from the hospital database software, a databank was generated in SPSS version 24.0. Average cases per month were calculated, and the data were stratified into three groups, Pre-COVID, COVID, and Post-COVID. Tables and charts were generated for the representation of data. Results The total number of patients that underwent cardiovascular and thoracic procedures during the years 2017-2021 were 3,624, with male predominance (71.5%). Procedures were divided into Pre-COVID (68.5%), COVID (15.2%) and Post-COVID (16.3%) groups. Coronary Artery Bypass Grafting (CABG) was the most common procedure throughout the study duration (56.8%) and during the COVID-19 pandemic (29 procedures/month). Congenital Heart Surgeries (16.6%) and Valvular surgeries (11.5%) were next on the list. However, congenital heart surgeries were most affected during the pandemic (16 to 5 procedures/month). The average number of surgeries per month peaked at 2017 (135 procedures/month) and after that declined to its low of 46/month during the COVID-19 pandemic (The year 2020). Conclusion Cardiothoracic and Vascular Surgeries have significantly decreased during the COVID-19 pandemic, especially the Coronary Artery Bypass (CABG) and Congenital Heart Surgeries. CABG procedures, however, remained the highest performed surgery even during the pandemic due to their emergent nature. Thoracic, vascular, and combined surgeries have stayed almost constant. The year 2020 (COVID-19 year) saw the lowest number of surgeries performed per month. An uprising trend in the number of surgical procedures is seen in the post-pandemic time (2021).
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Affiliation(s)
- Rafi Ullah
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
| | | | - Rafat Shakil
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
| | - Azam Jan
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
| | | | - Nabil I Awan
- Cardiothoracic Surgery, Rehman Medical Institute, Peshawar, PAK
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Godoy LA, Hill E, Cooke DT. Social Disparities in Thoracic Surgery Education. Thorac Surg Clin 2021; 32:91-102. [PMID: 34801200 DOI: 10.1016/j.thorsurg.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite an ever-diversifying US population, women, and underrepresented minorities lack proportionate membership in the CT surgery workforce. CT surgery is the surgical specialty practiced by the oldest surgeons as a group. This highlights a deficit within our specialty and foreshadows a shrinking of the CT surgery workforce that will be compounded by a lack of diversity as the workforce ages. If CT surgery is to continue to advance forward and attract the brightest, most skilled, and innovative people, we must invite, encourage, and guide qualified individuals from all races, cultures, genders, sexual orientations, and experiences to join us.
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Affiliation(s)
- Luis A Godoy
- Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, North Addition Office Building, 2335 Stockton Boulevard, Suite 6123, Sacramento, CA 95817-2214, USA.
| | - Elise Hill
- Department of Surgery, University of California, Davis Health, North Addition Office Building, 2335 Stockton Boulevard, Suite 6123, Sacramento, CA 95817-2214, USA
| | - David T Cooke
- Division of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, North Addition Office Building, 2335 Stockton Boulevard, Suite 6123, Sacramento, CA 95817-2214, USA
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12
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Seabra D, Gavina C. Surgical Mortality in Infective Endocarditis: Is There a Gender Paradox? INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20210182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Challenges in Patient Blood Management for Cardiac Surgery: A Narrative Review. J Clin Med 2021; 10:jcm10112454. [PMID: 34205971 PMCID: PMC8198483 DOI: 10.3390/jcm10112454] [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: 03/31/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
About 15 years ago, Patient Blood Management (PBM) emerged as a new paradigm in perioperative medicine and rapidly found support of all major medical societies and government bodies. Blood products are precious, scarce and expensive and their use is frequently associated with adverse short- and long-term outcomes. Recommendations and guidelines on the topic are published in an increasing rate. The concept aims at using an evidence-based approach to rationalize transfusion practices by optimizing the patient's red blood cell mass in the pre-, intra- and postoperative periods. However, elegant as a concept, the implementation of a PBM program on an institutional level or even in a single surgical discipline like cardiac surgery, can be easier said than done. Many barriers, such as dogmatic ideas, logistics and lack of support from the medical and administrative departments need to be overcome and each center must find solutions to their specific problems. In this paper we present a narrative overview of the challenges and updated recommendations for the implementation of a PBM program in cardiac surgery.
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Sex and gender differences in anesthesia: Relevant also for perioperative safety? Best Pract Res Clin Anaesthesiol 2020; 35:141-153. [PMID: 33742574 DOI: 10.1016/j.bpa.2020.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
Sex (a biological determination) and gender (a social construct) are not interchangeable terms and both impact perioperative management and patient safety. Sex and gender differences in clinical phenotypes of chronic illnesses and risk factors for perioperative morbidity and mortality are relevant for preoperative evaluation and optimization. Sex-related differences in physiology, as well as in pharmacokinetics and pharmacodynamics of anesthetic drugs may influence the anesthesia plan, the management of pain, postoperative recovery, adverse effects, patient satisfaction, and outcomes. Further studies are needed to characterize outcome differences between men and women in non-cardiac, cardiac, and transplantation surgery in order to individualize perioperative management and improve patient safety. Transgender patients represent a vulnerable population who need special perioperative care. Gender balance increases team performance and may improve perioperative outcomes.
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