Surgical tourism: the role of cardiothoracic surgery societies in evaluating international surgery centers

Hearts in the sky: understanding the cardiovascular implications of air travel

Air travel is widely regarded as the safest mode of transportation, with the United States leading in airline passengers. However, travelers with pre-existing heart conditions face acute cardiovascular risks. Flight pilots and cabin crew are particularly vulnerable to air travel's physiological changes, which can significantly impair their health and performance. Cabin pressure differences and reduced oxygen levels at cruising altitudes of 5000-8000 feet make air travel challenging for individuals with underlying cardiac and pulmonary problems. This, along with dry air, sleep deprivation, missed medication and prolonged sitting, can lead to physiological changes. In-flight and pre-flight stressors contribute to increased health issues, and studies show a rise in medical emergencies during flights. Prolonged exposure to the airplane environment can lead to various health issues for pilots and cabin crew. These changes include impaired judgment, cognitive function and discomfort in the sinuses and ears due to pressure differentials. Therefore, thorough medical screening, skilled instrument use and compliance with safety measures are essential to mitigate these risks. This article reviews the cardiac implications of air travel, discussing the underlying pathophysiology, associated risks and preventive measures to ensure safer flights for individuals with cardiovascular diseases.

Experiences and Attitudes of International Travelers with Cardiovascular Disease: A Qualitative Analysis

Cardiovascular disease (CVD) is the leading cause of death among international travelers. It is unknown whether CVD is a barrier to international travel. The purpose of this study was to describe the travel experiences of a cohort of individuals with CVD, to identify their perceived barriers to travel, and to generate recommendations for CVD travelers, medical practitioners, and the travel industry. Semi-structured interviews were conducted with CVD patients who had attended either a regional, structured, multidisciplinary CVD prevention program or a cardiac rehabilitation program. Coding and thematic analysis of the transcripts were supported by NVivo® computer software. Peer debriefing with an independent researcher was undertaken. Demographic and clinical data such as gender, age, and types of cardiovascular condition were also recorded. Twelve patients (eight males), with a mean age of 68 ± 7.58 years, agreed to semi-structured interviews (26-78 minutes duration). The key themes emerging from the interviews included altered travel perception, accessing medical care overseas, issues with medications, medical device concerns at airports, restricted leisure travel activities, and optimal self-care. All interviewees perceived a health benefit to travel and did not regard CVD as a significant barrier to international travel. Certain cardiovascular conditions precipitated more travel anxiety. These findings highlight the unique experiences of CVD patients when engaging in international travel. Cardiovascular disease optimization and responsible travel health behaviors would facilitate medically uneventful overseas travel. The results may inform pretravel health advice given to CVD travelers. Further studies on issues relating to air travel in CVD are warranted.

Postoperative Atrial Fibrillation: Evaluation of its Economic Impact on the Costs of Cardiac Surgery

Objective

The objective of this study was to calculate the direct costs of postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular hospital.

Methods

We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication.

Results

The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups.

Conclusion

POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies.

Surgical ethics: today and tomorrow

Ethical behavior has always been deeply ingrained in surgical culture, but ethical deliberation has only recently become an important component of cardiac surgical practice. In our earlier review, we covered a range of issues including several related to informed consent, conflict of interest, professional self-regulation and innovation, among many others. This update covers several topics of interest to cardiac surgeons and cardiologists, focusing on controversial issues specific to the practice of cardiothoracic surgery: informed consent, relations with hospitals and euthanasia and physician-assisted suicide. The future holds much uncertainty for cardiac surgical practice, research and culture, and we provide an update on ethical issues to serve as a platform for envisioning what is to come.