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Liu T, Devlin PJ, Whippo B, Vassallo P, Hoel A, Pham DT, Johnston DR, Chris Malaisrie S, Mehta CK. Neighborhood Socioeconomic Status and Readmission in Acute Type A Aortic Dissection Repair. J Surg Res 2024; 296:772-780. [PMID: 38382156 DOI: 10.1016/j.jss.2023.12.049] [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: 04/27/2023] [Revised: 12/08/2023] [Accepted: 12/29/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION We examined the association of socioeconomic status as defined by median household income quartile (MHIQ) with mortality and readmission patterns following open repair of acute type A aortic dissection (ATAAD) in a nationally representative registry. METHODS Adults who underwent open repair of ATAAD were selected using the US Nationwide Readmissions Database and stratified by MHIQ. Patients were selected based on diagnostic and procedural codes. The primary endpoint was 30-d readmission. RESULTS Between 2016 and 2019, 10,288 individuals (65% male) underwent open repair for ATAAD. Individuals in the lowest income quartile were younger (median: 60 versus 64, P < 0.05) but had greater Elixhauser comorbidity burden (5.9 versus 5.7, P < 0.05). Across all groups, in-hospital mortality was approximately 15% (P = 0.35). On multivariable analysis adjusting for baseline comorbidity burden, low socioeconomic status was associated with increased readmission at 90 d, but not at 30 d. Concomitant renal disease (odds ratio [OR], 1.68; P < 0.001), pulmonary disease (OR, 1.26; P < 0.001), liver failure (OR 1.2, P = 0.04), and heart failure (OR, 1.17; P < 0.001) were all associated with readmission at 90 d. The primary indication for readmission was most commonly cardiac (33%), infectious (16.5%), and respiratory (9%). CONCLUSIONS In patients who undergo surgery for ATAAD, lower MHIQ was associated with higher odds of readmission following open repair. While early readmission for individuals living in the lowest income communities is likely attributable to greater baseline comorbidity burden, we observed that 90-d readmission rates are associated with lower MHIQ regardless of comorbidity burden. Further investigation is required to determine which patient-level and system-level interventions are needed to reduce readmissions in the immediate postoperative period for resource poor areas.
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Affiliation(s)
- Tom Liu
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul J Devlin
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Beth Whippo
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patricia Vassallo
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Douglas R Johnston
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sukit Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Christopher K Mehta
- Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Amin Muhammad A, Kumar S, Khatri M. Impact of aortic valve disease on outcomes of aortic root replacement. J Card Surg 2022; 37:5690-5691. [PMID: 36183396 DOI: 10.1111/jocs.16989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 01/06/2023]
Affiliation(s)
| | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | - Mahima Khatri
- Dow University of Health Sciences, Karachi, Pakistan
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Thompson MP, Yaser JM, Fliegner MA, Syrjamaki JD, Nathan H, Sukul D, Theurer PF, Clark MJ, Likosky DS, Prager RL. High Socioeconomic Deprivation and Coronary Artery Bypass Grafting Outcomes: Insights from Michigan. Ann Thorac Surg 2021; 113:1962-1970. [PMID: 34390700 DOI: 10.1016/j.athoracsur.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiovascular outcomes are worse among individuals from areas with limited socioeconomic resources. This study evaluated the relationship between high socioeconomic deprivation and isolated coronary artery bypass grafting (CABG) outcomes. METHODS We linked statewide Society of Thoracic Surgeons Adult Cardiac Surgery Database data to Medicare fee-for-service records for 10,423 Michigan residents undergoing isolated CABG between 01/2012-12/2018. High socioeconomic deprivation was defined as residing in the highest decile of zip code-level area deprivation index (ADI). Multivariable logistic regression estimated the relationship between top ADI decile and major morbidity, in-hospital mortality, and operative mortality. Survival analyses evaluated long-term survival comparing patients in the top versus not in the top ADI decile. RESULTS A total of 1,036 patients were in the top decile of ADI (ADI>82.4), and were more likely to be female, black, and have a higher predicted risk of mortality. Patients in the top ADI decile had significantly higher rates of major morbidity (17.4% versus 11.4%, adjusted odds ratio =1.26, 95% CI: 1.04-1.54, p=0.021) and in-hospital mortality (3.2% versus 1.3%, adjusted odds ratio=1.84, 95% CI: 1.18-2.86, p=0.007), but not operative mortality. The adjusted hazard of mortality was 16% higher for patients residing in the top ADI decile (95% CI: 1.01-1.33, p=0.032). CONCLUSIONS Isolated CABG patients residing in the highest areas of socioeconomic deprivation differed with respect to demographic and clinical characteristics, and experienced worse short and long-term outcomes compared with those not in the top ADI decile.
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Affiliation(s)
- Michael P Thompson
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA;; Michigan Value Collaborative, Ann Arbor, MI, USA.
| | | | | | | | - Hari Nathan
- Michigan Value Collaborative, Ann Arbor, MI, USA; Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Patricia F Theurer
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
| | - Melissa J Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA;; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
| | - Richard L Prager
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI, USA;; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, USA
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Lomonaco I, Araújo AS, de Figueiredo MRF, Holanda MA, Pereira EDB. Assessment of functional status by the Duke Activity Status Index in stable bronchiectasis. Expert Rev Respir Med 2021; 15:1239-1244. [PMID: 34251944 DOI: 10.1080/17476348.2021.1951238] [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: 10/20/2022]
Abstract
INTRODUCTION Bronchiectasis is a growing global health problem. OBJECTIVE AND METHODS To evaluate the functional status of stable bronchiectasis patients recruited from a terciary hospital in Fortaleza, Brazil.The patients were submitted to spirometry, six minute walking test (6MWT), step test (6MST), measurement of fibrinogen,E-FACED scores(incorporates FEV1 ,age,colonisation by Pseudomonas,radiological extension, dyspnoea and exarcebation) and Duke Activity Status Index(DASI) test.Each item of DASI scored proportionally to the metabolic equivalentes(METs). The sum of DASI scores was applied for an estimation of oxygen consumption(VO2). RESULTS The sample comprised 101 patients.Patients with post-tuberculosis bronchiectsis had the lowest level of functional parameters than those with others etiologies[DASI(19.9 ±10.9 vs 31.2±14.4 p<0.001); VO2 (18.1 ± 4.7 vs 23.1 ± 6.1 p< 0.001 respectively)]. DASI scores and estimated VO2 correlated with E-FACED(r= -0.44 p=0.001; and r= -0.44 p=0.001 respectively) and 6MST r= 0.37 p<0.001 and r=0.40 p<0.001 respectively). CONCLUSION After multivariate analysis , bronchiectasis post-TB , E-FACED and 6MWT explained the impact on performance in bronchiectasis patients.
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Affiliation(s)
- Isabella Lomonaco
- Department of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Amanda Souza Araújo
- Department of Surgery, Federal University of Ceará, Fortaleza, Brazil.,Department of Rehabilitation, Hospital de Messejana dr. Carlos Alberto Studart, Fortaleza, Brazil
| | - Mara Rúbia F de Figueiredo
- Department of Surgery, Federal University of Ceará, Fortaleza, Brazil.,Department of Rehabilitation, Hospital de Messejana dr. Carlos Alberto Studart, Fortaleza, Brazil
| | - Marcelo A Holanda
- Department of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Eanes D B Pereira
- Department of Medicine, Federal University of Ceará, Fortaleza, Brazil
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Dávolos I, González Naya E, Marini Marcilla M. Sexual Activity After Myocardial Revascularization Surgery. Curr Probl Cardiol 2020; 46:100678. [PMID: 32861464 DOI: 10.1016/j.cpcardiol.2020.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
After a cardiovascular event, patients and their families often face numerous changes in their lives. Poorly addressing physical and psychological challenges can lead to an impaired quality of life. Sexuality is an important quality of life aspect to many patients and couples who can be negatively affected by a cardiovascular event. Sexual health requires a positive and respectful approach to sexuality and sexual relationships. Time to resume sexual activity after myocardial revascularization surgery is a gap in cardiologic practice. We know from literature that coronary patients have decreased sexual activity. There are barriers from the medical environment such as lack of knowledge, confidence and training, and many others that arise from the patient's perspective, which do not allow generating a space to address sexual problems. This review aims to familiarize and update cardiologists, providing knowledge and resources to face the impact of myocardial revascularization surgery on the quality of sexual life, promoting multidisciplinary management among doctors and other health professionals.
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Affiliation(s)
- Ignacio Dávolos
- Cardiologist, MTSAC. Cardiovascular Rehabilitation at Hospital de Clínicas José de San Martín and Sanatorio Juncal, Exercise Cardiology Council of the Argentine Society of Cardiology; Corresponding author: Ignacio Dávolos, Cardiology Division at Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
| | - Enrique González Naya
- Cardiologist, Specialist in Sports Medicine. Head of Cardiovascular Rehabilitation at IADT; Exercise Cardiology Council of the Argentine Society of Cardiology
| | - Maya Marini Marcilla
- Gynecologist, Obstetrician, Sexologist. Obstetrics Coordinator at Sanatorio de la Trinidad Palermo. Collaborator in the Sexology and Sexual Medicine Area, Urology Division, Dr. Enrique Tornú Hospital, Member of the Society of Obstetrics and Gynecology of Buenos Aires and of the Argentine Society of Human Sexuality
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Dávolos I, González Naya E, Marini Marcilla M. Sexual Activity After Myocardial Revascularization Surgery. Curr Probl Cardiol 2020; 46:100660. [PMID: 32829934 DOI: 10.1016/j.cpcardiol.2020.100660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
After a cardiovascular event, patients and their families often face numerous changes in their lives. Poorly addressing physical and psychological challenges can lead to an impaired quality of life. Sexuality is an aspect of quality of life that is important to many patients and couples who can be negatively affected by a cardiovascular event. Sexual health requires a positive and respectful approach to sexuality and sexual relationships. The timing of return to sexual activity after myocardial revascularization surgery is a gap in cardiology practice. We know from the literature that coronary patients have a decrease in sexual activity. There are barriers from the medical environment such as lack of knowledge, confidence, and training, and many others that arise from the patient's perspective, which do not allow generating a space to address sexual problems. This review aims to familiarize and update the cardiologist, bringing knowledge and resources closer to the impact of myocardial revascularization surgery on the quality of sexual life of patients, always encouraging multidisciplinary management among doctors and other professionals in health.
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Affiliation(s)
- Ignacio Dávolos
- Cardiologist, MTSAC. Cardiovascular Rehabilitation at Hospital de Clínicas José de San Martín, Exercise Cardiology Council, Epidemiology and Cardiovascular Prevention Council of the Argentine Society of Cardiology; Cardiologist, Specialist in Sports Medicine. Head of Cardiovascular Rehabilitation at IADT, Exercise Cardiology Council of the Argentine Society of Cardiology; Gynecologist, Obstetrician, Sexologist. Obstetrics Coordinator at Sanatorio de la Trinidad Palermo. Collaborator in the Sexology and Sexual Medicine Area, Urology Division, Dr. Enrique Tornú Hospital. Member of the Society of Obstetrics and Gynecology of Buenos Aires and of the Argentine Society of Human Sexuality.
| | - Enrique González Naya
- Gynecologist, Obstetrician, Sexologist. Obstetrics Coordinator at Sanatorio de la Trinidad Palermo. Collaborator in the Sexology and Sexual Medicine Area, Urology Division, Dr. Enrique Tornú Hospital. Member of the Society of Obstetrics and Gynecology of Buenos Aires and of the Argentine Society of Human Sexuality
| | - Maya Marini Marcilla
- Gynecologist, Obstetrician, Sexologist. Obstetrics Coordinator at Sanatorio de la Trinidad Palermo. Collaborator in the Sexology and Sexual Medicine Area, Urology Division, Dr. Enrique Tornú Hospital. Member of the Society of Obstetrics and Gynecology of Buenos Aires and of the Argentine Society of Human Sexuality
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Bond MMK, de Oliveira JLR, Farsky PS, Amato VL, Jara AA, Farias E, Jacomine AM, Sehn A, França JÍD, de Souza LCB, dos Santos MA. Use of Quality of Life in Cardiovascular Surgery in Coronary Artery Bypass Grafting: Validation, Reproducibility, and Quality of Life in One Year of Follow-Up. Ann Thorac Surg 2019; 108:764-769. [DOI: 10.1016/j.athoracsur.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/29/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
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Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e039. [PMID: 31321372 PMCID: PMC6553630 DOI: 10.5435/jaaosglobal-d-19-00039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Alternative payment models in total lower extremity joint replacement (TJR) increasingly emphasize patient-reported outcomes (PROs) to link the latter to value-based payments. It is unclear to what extent demographic, psychosocial, and clinical characteristics are related to PROs measured preoperatively with the commonly used Hip/Knee Osteoarthritis Outcome Scores (HOOS/KOOS) and the Veterans RAND 12-Item Health Survey (VR-12) questionnaires. We aim to identify (1) the preoperative relationship between HOOS/KOOS and VR-12 scores and several demographic, psychosocial, and clinical patient characteristics and (2) the best modifiable factors for optimization, which may result in improved baseline PROs before TJR. Methods All TJR cases performed in 2017 at the two highest-volume hospitals within an urban academic health system were queried. Preoperative HOOS/KOOS and VR-12 surveys were administered through an e-collection platform. VR-12 physical and mental component scores (PCS, MCS) were generated. Patient information was extracted from the electronic health record. Bivariate and multivariate regression analyses were performed. Odds ratios (ORs) and 95% confidence intervals were reported. Results In univariate analysis, patients with HOOS/KOOS, VR-12 PCS, and MCS in the ≤25th percentile group were more likely to have an ASA score of ≥3 compared with those with higher scores. In multivariate analysis, increased and decreased odds of low HOOS/KOOS were associated with a one-unit increase in Charlson Comorbidity Index (OR, 1.16) and VR-12 MCS (OR, 0.97), respectively. Increased odds of low baseline VR-12 PCS and MCS were associated with ASA class ≥3 (OR, 1.65 and 1.40). Decreased odds of a low MCS were associated with an increase in HOOS/KOOS (OR, 0.98) (P ≤ 0.05 for all). Conclusion Of the factors that are associated with low baseline PRO scores, preoperatively addressing mismanaged comorbidities, mental health, and physical function were identified as the best modifiable factors for optimization, which may result in improved baseline PROs before TJR.
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Hawkins RB, Charles EJ, Mehaffey JH, Williams CA, Robinson WP, Upchurch GR, Kern JA, Tracci MC. Socioeconomic Distressed Communities Index associated with worse limb-related outcomes after infrainguinal bypass. J Vasc Surg 2019; 70:786-794.e2. [PMID: 31204218 DOI: 10.1016/j.jvs.2018.10.123] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/27/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Several studies have demonstrated that socioeconomic factors may affect surgical outcomes. Analyses in vascular surgery have been limited by the availability of individual or community-level socioeconomic data. We sought to determine whether the Distressed Communities Index (DCI), a composite socioeconomic ranking by ZIP code, could predict short- and long-term outcomes for patients with peripheral artery disease. METHODS All Virginia Quality Initiative patients (n = 2578) undergoing infrainguinal bypass (2011-2017) within a region of 17 centers were assigned a composite DCI score. The score was developed by the Economic Innovation Group and is normally distributed from 0 (no distress) to 100 (severe distress) based on measures of community unemployment, education level, poverty rate, median income, business growth, and housing vacancies. Severely distressed communities were defined as the top quartile DCI (>75). Hierarchical regression assessed short-term outcomes, and time-to-event analyses assessed long-term results. RESULTS Infrainguinal bypass patients in this study came from disproportionately distressed communities, with 29% of patients living within the highest distress DCI quartile (P < .0001), with high variability by hospital (DCI range, 12-67). These patients from severely distressed areas were younger, more likely to smoke, and disproportionately African American and had higher rates of medical comorbidities (all P < .05). Whereas patients from severely distressed communities had an equivalent rate of 30-day major adverse cardiac and cerebrovascular events (5% vs 4%; P = .86), they had increased rates of major adverse limb events (MALEs) at 13% vs 10% (P = .03). This trend persisted in the long term, with higher 1-year estimates of MALEs (21% vs 17%; P = .01) as well as the components of amputation (17% vs 12%; P = .006) and thrombectomy (11% vs 6%; P = .002). Patients with high socioeconomic distress also had higher rates of occlusion (17% vs 11%; P = .003). CONCLUSIONS In this study, patients from severely distressed communities were found to have increased rates of MALEs, an association that persisted long term. Mitigating risk associated with socioeconomic determinants of health has the potential to improve outcomes for patients with peripheral artery disease.
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Affiliation(s)
- Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va; Center for Health Policy, University of Virginia, Charlottesville, Va
| | - Eric J Charles
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va; Center for Health Policy, University of Virginia, Charlottesville, Va
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va; Center for Health Policy, University of Virginia, Charlottesville, Va
| | - Carlin A Williams
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va
| | - William P Robinson
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va
| | - Gilbert R Upchurch
- Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va
| | - John A Kern
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va
| | - Margaret C Tracci
- Center for Health Policy, University of Virginia, Charlottesville, Va; Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, Va.
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Bond MMK, Oliveira JLRD, Souza LCBD, Farsky PS, Amato VL, Togna DJD, Ghorayeb SK, Santos MAD. Quality of Life in Cardiovascular Surgery: Elaboration and Initial Internal Validation of a Quality of Life Questionnaire. Braz J Cardiovasc Surg 2019; 33:476-482. [PMID: 30517256 PMCID: PMC6257538 DOI: 10.21470/1678-9741-2018-0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/24/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Elaboration and internal validation of the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire adapted to the reality of Brazilian cardiovascular surgery. METHODS Cross-sectional pilot study of a prospective cohort included in the Documentation and Surgical Registry Center (CEDREC) for internal validation of the QLCS questionnaire. Four hundred forty-five patients submitted to cardiovascular surgery and who answered a QLCS questionnaire 30 days after hospital discharge were included. It was applied via telephone. To verify the questions' internal consistency, Cronbach's alpha was used. The total QLCS score was calculated as the sum of 5 questions, ranging from 5 to 25 points. Mann-U-Whitney test was used to relate the symptoms with the quality of life (QoL). Level of significance was 5%. RESULTS After 30 days of surgery, about 95% of the patients had already returned to normal routine and 19% of them were already performing physical activity. In the evaluation of the QLCS's internal consistency, a Cronbach's alpha of 0.74 was found, suggesting that this was probably an adequate questionnaire to evaluate QoL in this population. In the comparison between the presence and absence of symptoms and the median of QoL, the presence of pain at the incision (P=0.002), chest pain (P<0.001), shortness of breath (P<0.001), and return to physical activity (P<0.001) were statistically significant. CONCLUSION The process of elaboration and validation of questionnaires includes a series of steps. The QLCS questionnaire is probably an adequate tool for the evaluation of QoL in the postoperative patient of cardiovascular surgery, in this first stage of internal validation.
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Charles EJ, Mehaffey JH, Hawkins RB, Fonner CE, Yarboro LT, Quader MA, Kiser AC, Rich JB, Speir AM, Kron IL, Tracci MC, Ailawadi G. Socioeconomic Distressed Communities Index Predicts Risk-Adjusted Mortality After Cardiac Surgery. Ann Thorac Surg 2019; 107:1706-1712. [PMID: 30682354 DOI: 10.1016/j.athoracsur.2018.12.022] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 11/01/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effects of socioeconomic factors other than insurance status and race on outcomes after cardiac operations are not well understood. We hypothesized that the Distressed Communities Index (DCI), a comprehensive socioeconomic ranking by zip code, would predict operative mortality after coronary artery bypass grafting (CABG). METHODS All patients who underwent isolated CABG (2010 to 2017) in the Virginia Cardiac Services Quality Initiative database were analyzed. The DCI accounts for unemployment, education level, poverty rate, median income, business growth, and housing vacancies, with scores ranging from 0 (no distress) to 100 (severe distress). Patients were stratified by DCI quartiles (I: 0 to 24.9, II: 25 to 49.9, III: 50 to 74.9, IV: 75 to 100) and compared. Hierarchical linear regression modeled the association between the DCI and mortality. RESULTS A total of 19,756 CABG patients were analyzed, with mean predicted risk of mortality of 2.0% ± 3.5%. Higher DCI scores were associated with increasing predicted risk of mortality. Overall operative mortality was 2.1% (n = 424) and increased with increasing DCI quartile (I: 1.6% [n = 95], II: 2.1% [n = 77], III: 2.4% [n = 114], IV: 2.6% [n = 138]; p = 0.0009). The observed-to-expected ratio for mortality increased as level of socioeconomic distress increased. After risk adjustment for The Society of Thoracic Surgeons predicted risk of mortality, year of surgical procedure, and hospital, the DCI remained predictive of operative mortality after CABG (odds ratio, 1.14 for each 25-point increase in DCI; 95% confidence interval 1.04 to 1.26; p = 0.007). CONCLUSIONS The DCI independently predicts risk-adjusted operative mortality after CABG. Socioeconomic status, although not part of traditional risk calculators, should be considered when building risk models, evaluating resource utilization, and comparing hospitals.
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Affiliation(s)
- Eric J Charles
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia
| | - Clifford E Fonner
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia
| | - Leora T Yarboro
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia
| | - Mohammed A Quader
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Andy C Kiser
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina
| | - Jeffrey B Rich
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan M Speir
- Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia; Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Irving L Kron
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia
| | - Margaret C Tracci
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Center for Health Policy, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Surgery, University of Virginia, Charlottesville, Virginia; Virginia Cardiac Services Quality Initiative, Virginia Beach, Virginia.
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Chen Y, Yiu KH. Growing importance of valvular heart disease in the elderly. J Thorac Dis 2016; 8:E1701-E1703. [PMID: 28149618 DOI: 10.21037/jtd.2016.12.23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yan Chen
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China; ; Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Shenzhen 518053, China
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Inflammatory Response in Patients under Coronary Artery Bypass Grafting Surgery and Clinical Implications: A Review of the Relevance of Dexmedetomidine Use. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/905238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite the fact that coronary artery bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB) prolongs life and reduces symptoms in patients with severe coronary artery diseases, these benefits are accompanied by increased risks. Morbidity associated with cardiopulmonary bypass can be attributed to the generalized inflammatory response induced by blood-xenosurfaces interactions during extracorporeal circulation and the ischemia/reperfusion implications, including exacerbated inflammatory response resembling the systemic inflammatory response syndrome (SIRS). The use of specific anesthetic agents with anti-inflammatory activity can modulate the deleterious inflammatory response. Consequently, anti-inflammatory anesthetics may accelerate postoperative recovery and better outcomes than classical anesthetics. It is known that the stress response to surgery can be attenuated by sympatholytic effects caused by activation of central (α-)2-adrenergic receptor, leading to reductions in blood pressure and heart rate, and more recently, that they can have anti-inflammatory properties. This paper discusses the clinical significance of the dexmedetomidine use, a selective (α-)2-adrenergic agonist, as a coadjuvant in general anesthesia. Actually, dexmedetomidine use is not in anesthetic routine, but this drug can be considered a particularly promising agent in perioperative multiple organ protection.
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Tavares LDA, Barreto Neto J, Jardim JR, Souza GMDCE, Hlatky MA, Nascimento OA. Cross-cultural adaptation and assessment of reproducibility of the Duke Activity Status Index for COPD patients in Brazil. J Bras Pneumol 2013; 38:684-91. [PMID: 23288112 DOI: 10.1590/s1806-37132012000600002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 09/13/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To cross-culturally adapt the Duke Activity Status Index (DASI) for use in Brazil and evaluate the reproducibility of the new (Brazilian Portuguese-language) version. METHODS We selected stable patients with clinical and spirometric diagnosis of COPD. Initially, the DASI was translated into Brazilian Portuguese, and the cross-cultural adaptation was performed by an expert committee. Subsequently, 12 patients completed the questionnaire, so that their questions and difficulties could be identified and adjustments could be made. An independent translator back-translated the final version into English, which was then submitted to and approved by the original author. The final Brazilian Portuguese-language version of the DASI was applied to 50 patients at three distinct times. For the assessment of interobserver reproducibility, it was applied twice within a 30-min interval by two different interviewers. For the assessment of intraobserver reproducibility, it was applied again 15 days later by one of the interviewers. RESULTS The mean age of the patients was 62.3 ± 10.0 years, the mean FEV1 was 45.2 ± 14.7% of the predicted value, and the mean body mass index was 26.8 ± 5.8 kg/m². The intraclass correlation coefficients for intraobserver and interobserver reproducibility were 0.95 and 0.90, respectively. The correlations between the DASI and the Saint George's Respiratory Questionnaire (SGRQ) domains were all negative and statistically significant. The DASI correlated best with the SGRQ activity domain (r = -0.70), the total SGRQ score (r = -0.66), and the six-minute walk distance (r = 0.55). CONCLUSIONS The Brazilian Portuguese-language version of the DASI is reproducible, fast, and simple, correlating well with the SGRQ.
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Neves LMT, Alberto KN, Arenas FP, Luis Vicente Franco de O, Arena R, Cipriano Junior G. Translation and cross-cultural adaptation of the Duke activity status index to Brazilian Portuguese. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000300017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION: The limited number of valid and reliable questionnaires for the evaluation of exercise tolerance has stimulated the development of simple international assessment tools for this purpose, one of the most widely used of which is the Duke Activity Status Index (DASI). However, this index has not yet been translated and adapted to the Portuguese language. OBJECTIVE: To develop a Brazilian version of the DASI and cross-culturally adapt it for the evaluation of cardiorespiratory fitness among patients with cardiovascular disease in Brazil. MATERIALS AND METHODS: The translation process involved four stages: initial translation, back-translation, multidisciplinary committee review and pre-test with 16 subjects (8 cardiac patients and 8 healthy individuals). Patients were screened from outpatient Cardiac Surgery, São Paulo Hospital. The Mann-Whitney and chi-square tests were employed to determine differences between controls and individuals with heart disease. RESULTS: The sample was characterized by individuals aged ≥ 50 years who were mainly from the southeastern region of Brazil (62.5%) and were non-smokers (56.2%). Less than half of the cohort was considered physically active (43.75%). The level of non-understanding was less than 10% of the sample. Doubts were prevalent among individuals with heart disease (75%) regarding the level of fatigue caused when performing a task. CONCLUSION: The present findings demonstrate that the DASI was successfully translated and adapted to Brazilian Portuguese.
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Speziale G, Nasso G, Barattoni MC, Esposito G, Popoff G, Argano V, Greco E, Scorcin M, Zussa C, Cristell D, Coppola R, Chierchia S, Marchese A, Caldarola P, Fattouch K, Tavazzi L. Short-term and long-term results of cardiac surgery in elderly and very elderly patients. J Thorac Cardiovasc Surg 2011; 141:725-31, 731.e1. [DOI: 10.1016/j.jtcvs.2010.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 04/07/2010] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
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Claridge JA, Leukhardt WH, Golob JF, McCoy AM, Malangoni MA. Moving beyond traditional measurement of mortality after injury: evaluation of risks for late death. J Am Coll Surg 2010; 210:788-94, 794-6. [PMID: 20421051 DOI: 10.1016/j.jamcollsurg.2009.12.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 12/22/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate long-term mortality after trauma, and to determine risk factors and possible disparities related to mortality after hospital discharge. STUDY DESIGN Level I trauma center registry data from a 6-year period (2000 through 2005) were linked to patient electronic medical records, the National Death Index with cause of death codes, and census data using geographic information science (GIS) methodologies. Census data provided supplemental demographic and socioeconomic information from patient neighborhoods. RESULTS The hospital mortality rate for 15,285 patients was 3.3%, and mortality after discharge was 4.8%. Overall mortality for the study period was 8.1% (average follow-up, 2.8 years, 1-year mortality, 5.4%). Mortality after discharge was related to the initial injury in 33%, possibly related in 23%, and unrelated in 44% of patients. Logistic regression analysis demonstrated that independent predictors of hospital mortality were age, Injury Severity Score, gunshot injury, significant head injury, fall, and spinal cord injury. In contrast, independent risk factors for mortality after discharge were age, hospital length of stay, discharge from the hospital to a locale other than home, and the presence of spinal cord injury. Intoxication at hospital admission and injury due to a gunshot wound or motor vehicle collision were protective for late mortality. Bivariate analysis of census data demonstrated that lower socioeconomic status was associated with improved hospital survival, and non-native status was associated with mortality after discharge. CONCLUSIONS There is significant mortality attributable to trauma for up to 1 year after hospital discharge. These findings suggest that mortality after trauma needs to be measured beyond hospital discharge in order to assess the complete impact of injury.
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Affiliation(s)
- Jeffrey A Claridge
- Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center Campus, Cleveland, OH 44109-1998, USA
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Speziale G, Nasso G, Barattoni MC, Bonifazi R, Esposito G, Coppola R, Popoff G, Lamarra M, Scorcin M, Greco E, Argano V, Zussa C, Cristell D, Bartolomucci F, Tavazzi L. Operative and Middle-Term Results of Cardiac Surgery in Nonagenarians. Circulation 2010; 121:208-13. [DOI: 10.1161/circulationaha.108.807065] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Speziale
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Giuseppe Nasso
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Maria Cristina Barattoni
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Raffaele Bonifazi
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Giampiero Esposito
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Roberto Coppola
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Georges Popoff
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Mauro Lamarra
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Marcio Scorcin
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Ernesto Greco
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Vincenzo Argano
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Claudio Zussa
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Donald Cristell
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Francesco Bartolomucci
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
| | - Luigi Tavazzi
- From the Gruppo Villa Maria Hospitals of Care and Research, Bari (G.S., G.N., R.B., F.B.), Lecce (G.E.), Rapallo (R.C.), Firenze (G.P.), Cotignola (M.C.B., M.L., C.Z., L.T.), Torino (E.G., M.S.), Palermo (V.A.), and Reggio Emilia (D.C.), Italy
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Wang J, Han J, Jia Y, Zeng W, Shi J, Hou X, Meng X. Early and intermediate results of rescue extracorporeal membrane oxygenation in adult cardiogenic shock. Ann Thorac Surg 2010; 88:1897-903. [PMID: 19932257 DOI: 10.1016/j.athoracsur.2009.08.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 08/02/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We retrospectively evaluated the early and intermediate results of use of temporary extracorporeal membrane oxygenation (ECMO) support and examined its effect on quality of life (QOL). METHODS Over four years 62 of 12,644 patients (0.49%) undergoing cardiac surgery (valve procedures, n = 39; coronary artery bypass grafting, n = 13; coronary artery bypass grafting plus valve procedures, n = 4; heart transplantation, n = 4; and total aortic arch replacement, n = 2) required temporary postoperative ECMO support. During a follow-up study (mean 2.3 +/- 1.5 years, 100% complete), 32 were still alive and answered the Short-Form 36 Health Survey QOL questionnaire. RESULTS The mean duration of ECMO support was 61 +/- 37 hours. Forty patients (64.5%) were successfully weaned from ECMO. Thirty-four patients (54.8%) were discharged from the hospital after 44.3 +/- 17.6 days. The in-hospital mortality rate was 45.2% and the main cause of death was multiple organ failure. A risk factor for in-hospital death was a peak lactate level greater than 12 mol/L before ECMO initiation. There were few significant differences in the mean QOL scores between the ECMO survivors and other patients who had undergone cardiac surgery without ECMO support; only the measures of vitality and mental health were significantly lower in the ECMO survivors (p < 0.05). Both the ECMO survivors and the patients who did not receive ECMO support had significantly lower QOL scores (except for vitality and mental health) than the general Chinese population (p < 0.05). CONCLUSIONS Extracorporeal membrane oxygenation is an acceptable technique for the treatment of postoperative cardiogenic shock in adults, although early intervention and reduced complications could improve results. However, the use of ECMO has little influence on QOL.
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Affiliation(s)
- Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, Peoples Republic of China
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Sawatzky JAV, Naimark BJ. The Coronary Artery Bypass Graft Surgery Trajectory: Gender Differences Revisited. Eur J Cardiovasc Nurs 2009; 8:302-8. [DOI: 10.1016/j.ejcnurse.2009.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 01/01/2009] [Accepted: 02/08/2009] [Indexed: 12/01/2022]
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Hesdorffer DC, Lee P. Health, wealth, and culture as predominant factors in psychosocial morbidity. Epilepsy Behav 2009; 15 Suppl 1:S36-40. [PMID: 19286476 DOI: 10.1016/j.yebeh.2009.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 03/05/2009] [Indexed: 11/25/2022]
Abstract
Depression is the most common psychological morbidity in epilepsy, yet this comorbidity is not well understood. Possible explanations for this comorbidity include recurrence of premorbid depression, increased risk for severe epilepsy due to a history of depression, shared risk factors for depression and epilepsy, AED-induced depression in vulnerable individuals, and coping styles in the face of stressors linked to epilepsy. Preexisting vulnerability to depression may contribute to each of these explanations. Vulnerability may arise from the influence of common risk factors, family history of depression, a history of depression before initiation of relevant AEDs, or coping styles and may reflect allostatic load. These exposures may precede the occurrence of epilepsy or follow the onset of epilepsy, in both cases increasing the risk for depression in prevalent epilepsy. Their careful evaluation is vital to identifying people at greatest risk for depression in epilepsy and for informing interventions to prevent the occurrence of this disabling epilepsy comorbidity.
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Affiliation(s)
- Dale C Hesdorffer
- Gertrude H. Sergievsky Center and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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