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Chen JR, Tatum R, Sanders VL, Ahmad D, Morris RJ, Tchantchaleishvili V. Surgeon and Hospital Factors Associated With Outcomes in the New York State Database. J Surg Res 2024; 300:402-408. [PMID: 38848640 DOI: 10.1016/j.jss.2024.05.014] [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: 12/09/2023] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION We sought to explore the relationship between various surgeon-related and hospital-level characteristics and clinical outcomes among patients requiring cardiac surgery. METHODS We searched the New York State Cardiac Data Reporting System for all coronary artery bypass grafting (CABG) and valve cases between 2015 and 2017. The data were analyzed without dichotomization. RESULTS Among CABG/valve surgeons, case volume was positively correlated with years in practice (P = 0.002) and negatively correlated with risk-adjusted mortality ratio (P = 0.014). For CABG and CABG/valve surgeons, our results showed a negative association between teaching status and case volume (P = 0.002, P = 0.018). Among CABG surgeons, hospital teaching status and presence of cardiothoracic surgery residency were inversely associated with risk-adjusted mortality ratio (P = 0.006, P = 0.029). CONCLUSIONS There is a complex relationship between case volume, teaching status, and surgical outcomes suggesting that balance between academics and volume is needed.
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Affiliation(s)
- Joshua R Chen
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Tatum
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victoria L Sanders
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Danial Ahmad
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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2
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Francois K. Centralizing Care for Acute Aortic Dissection: A Key to Success. Ann Thorac Surg 2024; 117:778-779. [PMID: 37673309 DOI: 10.1016/j.athoracsur.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Katrien Francois
- Department of Cardiac Surgery, University Hospital Ghent, C. Heymanslaan 10, 9000 Ghent, Belgium.
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Bani Hani A, Awamleh N, Mansour S, Toubasi AA, AlSmady M, Abbad M, Banifawaz M, Abu Abeeleh M. Valve Surgery in a Low-Volume Center in a Low- and Middle-Income Country: A Retrospective Cross-Sectional Study. Int J Gen Med 2023; 16:4649-4660. [PMID: 37868818 PMCID: PMC10589403 DOI: 10.2147/ijgm.s433722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
Background Valvular heart disease (VHD) has a significant prevalence and mortality rate with surgical intervention continuing to be a cornerstone of therapy. We aim to report the outcome of patients undergoing heart valve surgery (HVS) in a low-volume center (LVC) in a low- and middle-income country (LMIC). Methods A cross-sectional retrospective study was conducted at the Jordan University Hospital (JUH), a tertiary teaching hospital in a developing country, between April 2014 and December 2019. Patients who underwent mitral valve replacement (MVR), aortic valve replacement (AVR), tricuspid valve replacement (TVR), double valve replacement (DVR), CABG + MVR, and CABG + AVR patients were included. Thirty-day and two-year mortalities were taken as the primary and secondary outcomes, respectively. Results A total number of 122 patients were included, and the mean age was 54.46 ± 14.89 years. AVR was most common (42.6%). There was no significant association between STS mortality score or Euroscore II with 30-day and 2-year mortality. Conclusion LVC will continue to have a role in LMICs, especially during development to HICs. Further global studies are needed to assert the safety of HVS in LVC and LMICs.
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Affiliation(s)
- Amjad Bani Hani
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| | - Nour Awamleh
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Shahd Mansour
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Ahmad A Toubasi
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Moaath AlSmady
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| | - Mutaz Abbad
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Banifawaz
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
| | - Mahmoud Abu Abeeleh
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, 11942, Jordan
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Rappoport N, Shahian DM, Galai N, Aviel G, Keaney JF, Shapira OM. Volume-Outcome Relationship of Resternotomy Coronary Artery Bypass Grafting. Ann Thorac Surg 2022:S0003-4975(22)01390-X. [PMID: 36328096 DOI: 10.1016/j.athoracsur.2022.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/26/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND We assessed volume-outcome relationships of resternotomy coronary artery bypass grafting (CABG). METHODS We studied 1,362,218 first-time CABG and 93,985 resternotomy CABG patients reported to The Society of Thoracic Surgeons Adult Cardiac Surgery Database between 2010 and 2019. Primary outcomes were in-hospital mortality and mortality and morbidity (M&M) rates calculated per hospital and per surgeon. Outcomes were compared across 6 total cardiac surgery volume categories. Multivariable generalized linear mixed-effects models were used considering continuous case volume as the main exposure, adjusting for patient characteristics and within-surgeon and hospital variation. RESULTS We observed a decline in resternotomy CABG unadjusted mortality and M&M from the lowest to the highest case-volume categories (hospital-level mortality, 3.9% ± 0.6% to 3.3% ± 0.1%; M&M, 18.5% ± 1.1% to 15.7% ± 0.4%, P < .001; surgeon-level mortality, 4.1% ± 0.3% to 4.1% ± 1.3%; M&M, 18.5% ± 0.6% to 14.5% ± 2.2%, P < .001). Looking at outcomes vs continuous volume showed that beyond a minimum annual volume (hospital 200-300 cases; surgeon 100-150 cases, approximately), mortality and M&M rates did not further improve. Using individual-level data and adjusting for patient characteristics and clustering within surgeon and hospital, we found higher procedural volume was associated with improved surgeon-level outcomes (mortality adjusted odds ratio, 0.39/100 procedures; 95% CI, 0.24-0.61; M&M adjusted odds ratio, 0.37/100 procedures; 95% CI, 0.28-0.48; P < .001 for both). Hospital-level adjusted volume-outcomes associations were not statistically significant. CONCLUSIONS We observed an inverse relationship between total cardiac case volume and resternotomy CABG outcomes at the surgeon level only, indicating that individual surgeon's experience, rather than institutional volume, is the key determinant.
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Affiliation(s)
- Nadav Rappoport
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery and The Center of Quality & Safety, Massachusetts General Hospital, Boston, Massachusetts
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Statistics, University of Haifa, Mount Carmel, Israel
| | - Gal Aviel
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - John F Keaney
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Oz M Shapira
- Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Madenci AL, Wanis KN, Cooper Z, Haneuse S, Subramanian SV, Hofman A, Hernán MA. Strengthening Health Services Research Using Target Trial Emulation: An Application to Volume-Outcomes Studies. Am J Epidemiol 2021; 190:2453-2460. [PMID: 34089045 DOI: 10.1093/aje/kwab170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 01/11/2023] Open
Abstract
The number of operations that surgeons have previously performed is associated with their patients' outcomes. However, this association may not be causal, because previous studies have often been cross-sectional and their analyses have not considered time-varying confounding or positivity violations. In this paper, using the example of surgeons who perform coronary artery bypass grafting, we describe (hypothetical) target trials for estimation of the causal effect of the surgeons' operative volumes on patient mortality. We then demonstrate how to emulate these target trials using data from US Medicare claims and provide effect estimates. Our target trial emulations suggest that interventions on physicians' volume of coronary artery bypass grafting operations have little effect on patient mortality. The target trial framework highlights key assumptions and draws attention to areas of bias in previous observational analyses that deviated from their implicit target trials. The principles of the presented methodology may be adapted to other scenarios of substantive interest in health services research.
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Akmaz B, van Kuijk SMJ, Sardari Nia P. Association between individual surgeon volume and outcome in mitral valve surgery: a systematic review. J Thorac Dis 2021; 13:4500-4510. [PMID: 34422376 PMCID: PMC8339780 DOI: 10.21037/jtd-21-578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/04/2021] [Indexed: 12/30/2022]
Abstract
Background Surgeon volume has been identified as a possible factor that influences outcomes in mitral valve (MV) surgery. The aim of this study was to systematically review all published studies on the association between individual surgeon volume and outcome in MV surgery. Methods PubMed was searched last on 19 November 2020. The reporting of this systematic review was done in accordance with PRISMA guidelines. Manuscripts were eligible when these studied individual surgeon volumes and its association with repair rate, mortality or reoperation. The methodological quality of the studies was assessed with the Newcastle-Ottawa Scale (NOS). Absolute numbers and percentages of the outcome measures, odds ratios (ORs), P values and threshold values regarding surgeon volume were collected. Results A total of 7 retrospective cohort studies were included in the qualitative analysis with total of 158488 patients. Definitions of surgeon volumes were found to be heterogenic and therefore pooling of data was not possible. Surgeon volume was significantly associated with repair rate (OR =1.25–5.5) and mortality (OR =0.46–0.84 and OR =1.50–2.27 depending on the reference group). Regarding reoperation, results were not consistent and did not always show a significant lower reoperation rate when surgeon volume increased. A mean threshold of minimally 30 MV surgeries per year was found. Discussion Higher surgeon volume is significantly associated with improved outcomes of repair rate and mortality. MV should preferentially be performed by high-volume surgeons and centralization of MV surgery might be necessary.
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Affiliation(s)
- Berdel Akmaz
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Saunders R, Hansson Hedblom A. The Economic Implications of Introducing Single-Patient ECG Systems for Cardiac Surgery in Australia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:727-735. [PMID: 34413659 PMCID: PMC8370584 DOI: 10.2147/ceor.s325257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Sternal wound infections (SWIs) are severe adverse events of cardiac surgery. This study aimed to estimate the economic burden of SWIs following coronary artery bypass grafts (CABG) in Australia. It also aimed to estimate the national and hospital cost-benefit of adopting single-patient electrocardiograph (spECG) systems for CABG monitoring, a measure that reduces the rate of surgical site infections (SSIs). Material and Methods A literature review, which focused on CABG-related SSIs, was conducted to identify data which were then used to adapt a published Markov cost-effectiveness model. The model adopted an Australian hospital perspective. Results The average SWI-related cost of care increase per patient was estimated at 1022 Australian dollars (AUD), and the annual burden to the Australian health care system at AUD 9.2 million. SWI burden comprised 360 additional intensive care unit (ICU) days; 1979 additional general ward (GW) days; and 186 readmissions. Implementing spECG resulted in 103 fewer ICU days, 565 fewer GW days, 48 avoided readmissions, and a total national cost saving of AUD 2.5 million, annually. A hospital performing 200 yearly CABGs was estimated to save AUD 54,830. Conclusion SWIs cause substantial costs to the Australian health care system. Implementing new technologies shown to reduce the SWI rate is likely to benefit patients and reduce costs.
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Tran Z, Williamson C, Hadaya J, Verma A, Sanaiha Y, Chervu N, Gandjian M, Benharash P. Trends and Outcomes of Surgical Re-exploration Following Cardiac Operations in the United States. Ann Thorac Surg 2021; 113:783-792. [PMID: 33878310 DOI: 10.1016/j.athoracsur.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Surgical re-exploration following cardiac surgery has been associated with increased in-hospital complications and mortality in limited series. The present study examined trends in reoperation and its impact on clinical outcomes and resource use in a nationally-representative cohort. We sought to determine patient and hospital factors associated with re-exploration and reoperative mortality, defined as failure-to-rescue-surgical (FTR-S). METHODS Adult hospitalizations entailing cardiac operations (coronary artery bypass and/or valve) were identified using the 2005-2018 National Inpatient Sample. Procedures were tabulated using International Classification of Diseases codes. Hospitals were ranked into tertiles according to risk-adjusted mortality, with the lowest stratified as high-performing. Multivariable regression models examined factors associated with re-exploration as well as clinical outcomes including FTR-S and resource utilization. RESULTS Of an estimated 3,490,245 hospitalizations, 78,003 (2.23%) required re-exploration with decreasing incidence over time. Valvular procedures, preoperative intra-aortic balloon pump and liver disease were associated with greater likelihood of re-exploration. Reoperation was associated with increased odds of mortality (adjusted odds ratio (AOR): 3.86, 95%CI: 3.61-4.12), perioperative complications and resource utilization. Increasing time from index operation to re-exploration was associated with higher odds of mortality (AOR:1.10/day, 95%CI: 1.07-1.12). High-performing hospitals were associated with lower odds of re-exploration (AOR: 0.88, 95%CI: 0.82-0.95) and FTR-S (AOR: 0.29, 95%CI: 0.23-0.35). CONCLUSIONS Surgical re-exploration following cardiac surgery has declined over time. High performing hospitals demonstrated lower rates of re-exploration and subsequent failure-to-rescue. Although unable to identify specific practices, our study highlights the presence of significant variation in takeback rates and further study of underlying factors is warranted.
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Affiliation(s)
- Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles
| | - Catherine Williamson
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles
| | - Matthew Gandjian
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles.
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Han JJ, Bojko MM, Duda MM, Iyengar A, Kelly JJ, Patrick WL, Helmers MR, Atluri P. Association Among Surgeon Experience, Patient Risk, and Outcomes in Coronary Artery Bypass Grafting. Ann Thorac Surg 2021; 111:86-93. [DOI: 10.1016/j.athoracsur.2020.04.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/22/2020] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
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Johnson JC, Morey BL, Carroll AM, Strevig MA, Ramirez AR, Mullenix PS, Wozniak CJ, Ricca RL. Cardiothoracic Surgical Volume Within the Military Health System: Fiscal Years 2007 to 2017. Ann Thorac Surg 2020; 111:1071-1076. [PMID: 32693044 DOI: 10.1016/j.athoracsur.2020.05.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/03/2020] [Accepted: 05/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiothoracic surgical services have been provided at 7 military treatment facilities over the past decade. Accurate case volume data for adult cardiac and general thoracic surgical service lines in the Military Health System is unknown. METHODS We queried the Military Health System Data Repository for adult cardiac and general thoracic cases performed at military treatment facilities in the Military Health System and surrounding purchased care markets for fiscal years 2007 to 2017. Cases were filtered and classified into major cardiac and major general thoracic categories. Five military treatment facility markets had sufficient cardiac case data to perform cost analysis. RESULTS Institutional major cardiac case volume was low across the Military Health System with less than 100 cardiopulmonary bypass cases per year (range, 17-151 cases per year) performed most years at each military treatment facility. Similarly, general thoracic surgical case volume was universally low, with less than 30 anatomic lung resections (range, 0-26) and fewer than 5 esophageal resections (range, 0-4) performed at each military treatment facility annually. Cost analysis revealed that provision of cardiac surgical services is significantly more expensive at most military treatment facilities compared with their surrounding purchased care markets. CONCLUSIONS Adult cardiac and general thoracic surgical volume within the Military Health System is low across all institutions and inadequate to provide clinical readiness for active-duty surgeons. Recapture of major cases from the purchased care market is unlikely and would not significantly increase military treatment facility or individual surgeon case volume.
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Affiliation(s)
- Jeffery C Johnson
- Directorate of Surgical Services, Naval Medical Center Portsmouth, Portsmouth, Virginia.
| | - Brittany L Morey
- Directorate of Surgical Services, Navy and Marine Corps Public Health Center, Portsmouth, Virginia
| | - Anna M Carroll
- Directorate of Surgical Services, Navy and Marine Corps Public Health Center, Portsmouth, Virginia
| | - Matthew A Strevig
- Directorate of Surgical Services, Navy and Marine Corps Public Health Center, Portsmouth, Virginia
| | - Alfredo R Ramirez
- Department of Cardiothoracic Sugery, Naval Medical Center San Diego, San Diego, California
| | - Philip S Mullenix
- Department of Cardiothoracic Sugery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Curtis J Wozniak
- Department of Cardiothoracic Sugery, David Grant USAF Medical Center, Fairfield, California
| | - Robert L Ricca
- Directorate of Surgical Services, Naval Medical Center Portsmouth, Portsmouth, Virginia
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Mortality in Australian Cardiothoracic Surgery: Findings From a National Audit. Ann Thorac Surg 2020; 109:1880-1888. [DOI: 10.1016/j.athoracsur.2019.09.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022]
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Faggion Vinholo T, Mori M, Mahmood SUB, Mullan CW, Weininger G, Yousef S, Geirsson A. Combined Valve Operations in the Aortic and Mitral Positions With or Without Added Tricuspid Valve Repair. Semin Thorac Cardiovasc Surg 2020; 32:665-672. [DOI: 10.1053/j.semtcvs.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/11/2022]
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Guida P, Iacoviello M, Passantino A, Scrutinio D. Measures of hospital competition and their impact on early mortality for congestive heart failure, acute myocardial infarction and cardiac surgery. Int J Qual Health Care 2019; 31:598-605. [PMID: 30380059 DOI: 10.1093/intqhc/mzy220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 05/25/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To measure competition amongst providers and to examine whether a correlation exists with hospitals mortality for congestive heart failure (CHF), acute myocardial infarction (AMI), isolated-coronary artery bypass graft (CABG) or valve surgery. DESIGN Cross-sectional study based on publically available data from the National Outcome Evaluation Program (Edition 2016) of the Italian Agency for Regional Health Services. SETTING AND PARTICIPANTS Patients discharged during 2015 for CHF or AMI, and between 2014 and 2015 for cardiac surgery (respectively, from 662, 395 and 91 hospitals). MAIN OUTCOME MEASURES Risk-adjusted mortality rates at 30 days and measures of hospital competition for areas centred on hospital' location (fixed-radius 50-150 km, variable-radius to capture 10-30 hospitals and 6-10% of national volume). Competition was estimated as number of providers and Herfindahl-Hirschman Index (HHI). RESULTS Indicators of competitions varied by condition and were sensitive to method used for the area definition. Hospital mortality after AMI and valve surgery increased with competition in areas identified by the variable-radius method (higher rates for a greater number of hospitals or lower HHIs). In area with fixed radius of 100-150 km, competition reduced mortality after CABG procedures (lower rates for a greater number of hospitals or smaller HHIs). Neither the number of hospitals nor HHI correlated with outcomes in CHF. CONCLUSIONS The measures of hospital competition changed according to definition of local market and results in mortality correlations varied among conditions. Understanding the relationship between hospital competition and outcomes is important to identify strategies to improve quality of care.
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Affiliation(s)
- Pietro Guida
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS, Institute of Cassano delle Murge, Cassano delle Murge, Bari, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Cardiothoracic Department, Policlinic University Hospital, Bari, Italy
| | - Andrea Passantino
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS, Institute of Cassano delle Murge, Cassano delle Murge, Bari, Italy
| | - Domenico Scrutinio
- Division of Cardiology and Cardiac Rehabilitation, Scientific Clinical Institutes Maugeri, IRCCS, Institute of Cassano delle Murge, Cassano delle Murge, Bari, Italy
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Bianco V, Aranda‐Michel E, Sultan I, Gleason TG, Chu D, Navid F, Kilic A. Inconsistent correlation between procedural volume and publicly reported outcomes in adult cardiac operations. J Card Surg 2019; 34:1194-1203. [DOI: 10.1111/jocs.14218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Edgar Aranda‐Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Thomas G. Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania
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Coulson TG, Mullany DV, Reid CM, Bailey M, Pilcher D. Measuring the quality of perioperative care in cardiac surgery. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 3:11-19. [PMID: 28927188 DOI: 10.1093/ehjqcco/qcw027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Indexed: 11/13/2022]
Abstract
Quality of care is of increasing importance in health and surgical care. In order to maintain and improve quality, we must be able to measure it and identify variation. In this narrative review, we aim to identify measures used in the assessment of quality of care in cardiac surgery and to evaluate their utility. The electronic databases Pubmed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, and CINAHL were searched for original published studies using the terms 'cardiac surgery' and 'quality or outcome or process or structure' as either keywords in the title or text or MeSH terms. Secondary searches and identification of references from original articles were carried out. We found a total of 54 original articles evaluating measurements of quality. While structure, process, and outcome indicators remain the mainstay of quality measurement, new and innovative methods of risk assessment have improved reliability and discrimination. Continuous assessment provides a promising method of both maintaining and improving quality of care. Future studies should focus on long-term and patient-centred outcomes, such as quality-of-life measures.
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Affiliation(s)
- Tim G Coulson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel V Mullany
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Bailey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Department of Intensive Care, The Alfred Hospital, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.,ANZICS Centre for Outcome and Resource Evaluation, Ievers Terrace, Carlton, Melbourne, Victoria, Australia
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Watkins AC, Ghoreishi M, Maassel NL, Wehman B, Demirci F, Griffith BP, Gammie JS, Taylor BS. Programmatic and Surgeon Specialization Improves Mortality in Isolated Coronary Bypass Grafting. Ann Thorac Surg 2018; 106:1150-1158. [PMID: 30056995 DOI: 10.1016/j.athoracsur.2018.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/09/2018] [Accepted: 05/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Throughout surgery, specialization in a procedure has been shown to improve outcomes. Currently, there is no evidence for or against subspecialization in coronary surgery. Tasked with the goal of improving outcomes after isolated coronary artery bypass grafting (CABG), our institution sought to determine whether the development of a subspecialized coronary surgery program would improve morbidity and mortality. METHODS All isolated CABG operations at a single institution were retrospectively examined in two distinct periods, 2002 to 2013 and 2013 to 2016, before and after the implementation of a subspecialized coronary surgery program. Improved policies included leadership and subspecialization of a program director, standardization of surgical technique and postoperative care, and monthly multidisciplinary quality review. Outcomes were collected and compared. RESULTS Between 2002 and 2013, 3,256 CABG operations were done by 16 surgeons, the most frequent surgeon doing 33%. Between 2013 and 2016, 1,283 operations were done by 10 surgeons, 70% by the coronary program director. CABGs done in the specialized era had shorter bypass and clamps times and increased use of bilateral internal mammary arteries. Blood transfusion and complication rates, including permanent stroke and prolonged ventilation, were significantly decreased after implementation of the coronary program. Likewise, overall operative mortality (2.67% vs 1.48%, p = 0.02) was significantly reduced. CONCLUSIONS Subspecialization in CABG and dedicated coronary surgery programs may lead to faster operations, increased use of bilateral internal mammary arteries, fewer complications, and improved survival after isolated CABG.
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Affiliation(s)
- A Claire Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Mehrdad Ghoreishi
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nathan L Maassel
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Brody Wehman
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Filiz Demirci
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bartley P Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bradley S Taylor
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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17
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Landoni G, Lomivorotov V, Silvetti S, Nigro Neto C, Pisano A, Alvaro G, Hajjar LA, Paternoster G, Riha H, Monaco F, Szekely A, Lembo R, Aslan NA, Affronti G, Likhvantsev V, Amarelli C, Fominskiy E, Baiardo Redaelli M, Putzu A, Baiocchi M, Ma J, Bono G, Camarda V, Covello RD, Di Tomasso N, Labonia M, Leggieri C, Lobreglio R, Monti G, Mura P, Scandroglio AM, Pasero D, Turi S, Roasio A, Votta CD, Saporito E, Riefolo C, Sartini C, Brazzi L, Bellomo R, Zangrillo A. Nonsurgical Strategies to Reduce Mortality in Patients Undergoing Cardiac Surgery: An Updated Consensus Process. J Cardiothorac Vasc Anesth 2018; 32:225-235. [DOI: 10.1053/j.jvca.2017.06.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Indexed: 11/11/2022]
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18
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Grieshaber P, Oster L, Schneider T, Johnson V, Orhan C, Roth P, Niemann B, Böning A. Total arterial revascularization in patients with acute myocardial infarction - feasibility and outcomes. J Cardiothorac Surg 2018; 13:2. [PMID: 29304874 PMCID: PMC5755408 DOI: 10.1186/s13019-017-0691-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/20/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In acute situations such as acute myocardial infarction (AMI) with indication for coronary artery bypass grafting (CABG), total arterial revascularization (TAR) is often rejected in favour of saphenous vein (SV) grafting, which is assumed to allow for quicker vessel harvesting, a simpler anastomosis technique, and thus quicker revascularization and fewer bleeding complications. The aim of this study was to evaluate whether reluctance to apply TAR in AMI is still justified from a technical point of view in the current era and whether superiority of TAR results is also evident in emergency patients with AMI undergoing CABG. METHODS In this retrospective analysis of 434 consecutive patients undergoing CABG for AMI with either TAR or with a combination of one internal mammary artery and SV grafts between 2008 and 2014, procedural data, short-term and mid-term outcome were compared. Propensity score matching of the groups was performed. RESULTS After propensity score matching, 250 patients were included in the analysis (TAR group: n = 98; SV group n = 152). The procedural time (TAR group: 211 min vs. SV group: 200 min, p = 0.46) did not differ between the groups. Erythrocyte transfusion rates were higher in the SV group (76% vs. 57%; p < 0.001). Rates of re-exploration for bleeding did not differ. Thirty-day mortality rates were comparable (TAR group: 3.4% vs. SV group: 4.5%, p = 0.68). Kaplan-Meier analysis until 7 years postoperatively revealed a tendency for improved survival after TAR (75% vs. 62%; log-rank p = 0.12). CONCLUSION TAR neither impairs rapid revascularization nor reduces its safety in patients with AMI. It may result in improved long-term outcome and should be preferred in the clinical setting of AMI.
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Affiliation(s)
- Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Lukas Oster
- Department of Anaesthesiology, Sana Hospital Berlin-Lichtenberg, Berlin, Germany
| | - Tobias Schneider
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Victoria Johnson
- Department of Cardiology and Angiology, University Hospital Giessen, Giessen, Germany
| | - Coskun Orhan
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Peter Roth
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Bernd Niemann
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392 Giessen, Germany
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Bjørnnes AK, Parry M, Lie I, Falk R, Leegaard M, Rustøen T. The association between hope, marital status, depression and persistent pain in men and women following cardiac surgery. BMC WOMENS HEALTH 2018; 18:2. [PMID: 29291728 PMCID: PMC5749023 DOI: 10.1186/s12905-017-0501-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
Abstract
Background Cardiac surgery is a major life event, and outcomes after surgery are associated with men’s and women’s ability to self-manage and cope with their cardiac condition in everyday life. Hope is suggested to impact cardiac health by having a positive effect on how adults cope with and adapt to illness and recommended lifestyle changes. Methods We did a secondary analysis of 416 individuals (23% women) undergoing elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013 enrolled in randomized controlled trial. Hope was assessed using The Herth Hope Index (HHI) at three, six and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations after cardiac surgery between hope, marital status, depression, persistent pain, and surgical procedure. Results For the total sample, no statistically significant difference between global hope scores from 3 to 12 months was observed (ranging from 38.3 ± 5.1 at 3 months to 38.7 ± 5.1 at 12 months), and no differences between men and women were observed at any time points. However, 3 out of 12 individual items on the HHI were associated with significantly lower scores in women: #1) I have a positive outlook toward life, #3) I feel all alone, and #6) I feel scared about my future. Over the study period, diminished hope was associated with older age, lower education, depression prior to surgery, and persistent pain at all measurement points. Isolated valve surgery was positively associated with hope. While neither sex nor marital status, as main effects, demonstrated significant associations with hope, women who were divorced/widowed/single were significantly more likely to have lower hope scores over the study period. Conclusion Addressing pain and depression, and promoting hope, particularly for women living alone may be important targets for interventions to improve outcomes following cardiac surgery. Trial registration Clinical Trials gov Identifier: NCT01976403. Date of registration: November 28, 2011.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Irene Lie
- Center for patient centered heart- and lung research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
| | - Ragnhild Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
| | - Marit Leegaard
- Faculty of Health Sciences, Institute of Nursing, Oslo and Akershus University College of Applied Sciences, P.O Box 4, St. Olavs Plass, N-0130, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway.,Institute of Health and Society, Oslo University Hospital, Ullevål, P.O Box 4956, Nydalen, 0424, Oslo, Norway
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20
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Alotaibi NM, Ibrahim GM, Wang J, Guha D, Mamdani M, Schweizer TA, Macdonald RL. Neurosurgeon academic impact is associated with clinical outcomes after clipping of ruptured intracranial aneurysms. PLoS One 2017; 12:e0181521. [PMID: 28727832 PMCID: PMC5519166 DOI: 10.1371/journal.pone.0181521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Surgeon-dependent factors such as experience and volume are associated with patient outcomes. However, it is unknown whether a surgeon's research productivity could be related to outcomes. The main aim of this study is to investigate the association between the surgeon's academic productivity and clinical outcomes following neurosurgical clipping of ruptured aneurysms. METHODS We performed a post-hoc analysis of 3567 patients who underwent clipping of ruptured intracranial aneurysms in the randomized trials of tirilazad mesylate from 1990 to 1997. These trials included 162 centers and 156 surgeons from 21 countries. Primary and secondary outcomes were: Glasgow outcome scale score and mortality, respectively. Total publications, H-index, and graduate degrees were used as academic indicators for each surgeon. The association between outcomes and academic factors were assessed using a hierarchical logistic regression analysis, adjusting for patient covariates. RESULTS Academic profiles were available for 147 surgeons, treating a total of 3307 patients. Most surgeons were from the USA (62, 42%), Canada (18, 12%), and Germany (15, 10%). On univariate analysis, the H-index correlated with better functional outcomes and lower mortality rates. In the multivariate model, patients under the care of surgeons with higher H-indices demonstrated improved neurological outcomes (p = 0.01) compared to surgeons with lower H-indices, without any significant difference in mortality. None of the other academic indicators were significantly associated with outcomes. CONCLUSION Although prognostication following surgery for ruptured intracranial aneurysms primarily depends on clinical and radiological factors, the academic impact of the operating neurosurgeon may explain some heterogeneity in surgical outcomes.
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Affiliation(s)
- Naif M. Alotaibi
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - George M. Ibrahim
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin Wang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Daipayan Guha
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Tom A. Schweizer
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - R. Loch Macdonald
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- * E-mail:
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21
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Liu X, Xie G, Zhang K, Song S, Song F, Jin Y, Fang X. Dexmedetomidine vs propofol sedation reduces delirium in patients after cardiac surgery: A meta-analysis with trial sequential analysis of randomized controlled trials. J Crit Care 2016; 38:190-196. [PMID: 27936404 DOI: 10.1016/j.jcrc.2016.10.026] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/10/2016] [Accepted: 10/25/2016] [Indexed: 12/30/2022]
Abstract
PURPOSE It is uncertain whether dexmedetomidine is better than propofol for sedation in postcardiac surgery patients. The purpose of this meta-analysis was to compare the effects of dexmedetomidine and propofol sedation on outcomes in adult patients after cardiac surgery. METHODS Randomized controlled trials comparing outcomes in cardiac surgery patients sedated with dexmedetomidine or propofol were retrieved from PubMed, Embase, Web of Science, the Cochrane Library, and Clinicaltrials.Gov until May 23, 2016. RESULTS A total of 969 patients in 8 studies met the selection criteria. The results revealed that dexmedetomidine was associated with a lower risk of delirium (risk ratio, 0.40;95% confidence interval [CI], 0.24-0.64; P=.0002), a shorter length of intubation (hours; mean difference, -0.95; 95% CI, -1.26 to -0.64; P<.00001), but a higher incidence of bradycardia (risk ratio 3.17; 95% CI, 1.41-7.10; P=.005) as compared to propofol. There were no statistical differences in the incidence of hypotension or atrial fibrillation, or the length of intensive care unit stay between dexmedetomidine and propofol sedation regimens. CONCLUSIONS Dexmedetomidine sedation could reduce postoperative delirium and was associated with shorter length of intubation, but might increase bradycardia in patients after cardiac surgery compared with propofol.
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Affiliation(s)
- Xu Liu
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Guohao Xie
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kai Zhang
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shengwen Song
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Song
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yue Jin
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiangming Fang
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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22
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Russell EA, Baker RA, Bennetts JS, Brown A, Reid CM, Tam R, Tran L, Walsh WF, Maguire GP. Case load and valve surgery outcome in Australia. Int J Cardiol 2016; 221:144-51. [PMID: 27400312 DOI: 10.1016/j.ijcard.2016.06.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/24/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Australia it has been suggested that heart valve surgery, particularly for rheumatic heart disease (RHD), should be consolidated in higher volume centres. International studies of cardiac surgery suggest large volume centres have superior outcomes. However the effect of site and surgeon case load on longer term outcomes for valve surgery has not been investigated. METHODS The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed. The adjusted association between both average annual site and surgeon case load on short term complications and short and long-term survival was determined. RESULTS Outcomes associated with 20,116 valve procedures at 25 surgical sites and by 93 surgeons were analysed. Overall adjusted analysis showed increasing site and surgeon case load was associated with longer ventilation, less reoperation and more anticoagulant complications. Increasing surgeon case load was also associated with less acute kidney injury. Adjusted 30-day mortality was not associated with site or surgeon case load. There was no consistent relationship between increasing site case load and long term survival. The association between surgeon case load and outcome demonstrated poorer adjusted survival in the highest volume surgeon group. CONCLUSIONS In this Australian study, the adjusted association between surgeon and site case load was not simple or consistent. Overall larger volume sites or surgeons did not have superior outcomes. Mandating a particular site case load level for valve surgery or a minimum number of procedures for individual surgeons, in an Australian context, cannot be supported by these findings.
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Affiliation(s)
| | - Robert A Baker
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA.
| | - Jayme S Bennetts
- Department of Surgery, School of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA, Australia.
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, SA, Australia; School of Population Health, University of South Australia, Adelaide, SA, Australia.
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, Australia; School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Robert Tam
- Department of Cardiothoracic Surgery, Townsville, Hospital, Queensland, Australia.
| | - Lavinia Tran
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Graeme P Maguire
- Baker IDI, Melbourne, Victoria, Australia; School of Medicine, James Cook University, Cairns, Queensland, Australia; School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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23
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Harries RL, Williams AP, Ferguson HJM, Mohan HM, Beamish AJ, Gokani VJ. The future of surgical training in the context of the 'Shape of Training' Review: Consensus recommendations by the Association of Surgeons in Training. Int J Surg 2016; 36 Suppl 1:S5-S9. [PMID: 27562689 DOI: 10.1016/j.ijsu.2016.08.238] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/20/2016] [Indexed: 11/16/2022]
Abstract
ASiT has long maintained that in order to provide the best quality care to patients in the UK and Republic of Ireland, it is critical that surgeons are trained to the highest standards. In addition, it is imperative that surgery remains an attractive career choice, with opportunities for career progression and job satisfaction to attract and retain the best candidates. In 2013, the Shape of Training review report set out recommendations for the structure and delivery of postgraduate training in light of an ever increasingly poly-morbid and ageing population. This consensus statement outlines ASIT's position regarding recommendations for improving surgical training and aims to help guide discussions with regard to future proposed changes to surgical training.
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Affiliation(s)
- Rhiannon L Harries
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK.
| | - Adam P Williams
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Henry J M Ferguson
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Helen M Mohan
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Andrew J Beamish
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Vimal J Gokani
- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
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- Association of Surgeons in Training, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
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24
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Bjørnnes AK, Parry M, Lie I, Fagerland MW, Watt-Watson J, Rustøen T, Stubhaug A, Leegaard M. Pain experiences of men and women after cardiac surgery. J Clin Nurs 2016; 25:3058-68. [PMID: 27301786 DOI: 10.1111/jocn.13329] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To compare the prevalence and severity of pain in men and women during the first year following cardiac surgery and to examine the predictors of persistent postoperative pain 12 months post surgery. BACKGROUND Persistent pain has been documented after cardiac surgery, with limited evidence for differences between men and women. DESIGN Prospective cohort study of patients in a randomised controlled trial (N = 416, 23% women) following cardiac surgery. METHODS Secondary data analysis of data collected prior to surgery, across postoperative days 1-4, at two weeks, and at one, three, six and 12 months post surgery. The main outcome was worst pain intensity (Brief Pain Inventory-Short Form). RESULTS Twenty-nine percent (97/339) of patients reported persistent postoperative pain at rest at 12 months that was worse in intensity and interference for women than for men. For both sexes, a more severe co-morbidity profile, lower education and postoperative pain at rest at one month post surgery were associated with an increased probability for persistent postoperative pain at 12 months. Women with more concerns about communicating pain and a lower intake of analgesics in the hospital had an increased probability of pain at 12 months. CONCLUSION Sex differences in pain are present up to one year following cardiac surgery. Strategies for sex-targeted pain education and management pre- and post-surgery may lead to better pain outcomes. RELEVANCE TO CLINICAL PRACTICE These results suggest that informing patients (particularly women) about the benefits of analgesic use following cardiac surgery may result in less pain over the first year post discharge.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Monica Parry
- Nurse Practitioner Programs, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Irene Lie
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.,Ullevål/Center for Patient Centered Heart- and Lung Research, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Judy Watt-Watson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tone Rustøen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marit Leegaard
- Faculty of Health Sciences, Institute of Nursing, Oslo, Norway.,Akershus University College of Applied Sciences, Oslo, Norway
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25
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Kim LK, Looser P, Swaminathan RV, Minutello RM, Wong SC, Girardi L, Feldman DN. Outcomes in patients undergoing coronary artery bypass graft surgery in the United States based on hospital volume, 2007 to 2011. J Thorac Cardiovasc Surg 2016; 151:1686-92. [DOI: 10.1016/j.jtcvs.2016.01.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/11/2016] [Accepted: 01/26/2016] [Indexed: 11/25/2022]
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26
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Denniss AR, Gregory AT. Countdown to a Silver Jubilee for Heart, Lung and Circulation Journal in 2016 – Looking Back in Order to Move Forward. Heart Lung Circ 2015; 24:1137-40. [DOI: 10.1016/s1443-9506(15)01460-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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27
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Maddern GJ. Appropriate Centralised Care - the Next Surgical Challenge. Heart Lung Circ 2015; 24:843-4. [PMID: 26021971 DOI: 10.1016/j.hlc.2015.04.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Guy J Maddern
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
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