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Al-Zubaidi FI, Hussein N, Smith H, Al-Adhami A, Sitaranjan D, Caputo M, Angelini GD, Harky A, Vohra HA. 20 Years of triple-valve surgery in the UK: demographic and outcome trends. Eur J Cardiothorac Surg 2024; 66:ezae268. [PMID: 38984815 PMCID: PMC11246163 DOI: 10.1093/ejcts/ezae268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVES To describe evolving demographic trends and early outcomes in patients undergoing triple-valve surgery in the UK between 2000 and 2019. METHODS We planned a retrospective analysis of national registry data including patients undergoing triple-valve surgery for all aetiologies of disease. We excluded patients in a critical preoperative state and those with missing admission dates. The study cohort was split into 5 consecutive 4-year cohorts (groups A, B, C, D and E). The primary outcome was in-hospital mortality, and secondary outcomes included prolonged admission, re-exploration for bleeding, postoperative stroke and postoperative dialysis. Binary logistic regression models were used to establish independent predictors of mortality, stroke, postoperative dialysis and re-exploration for bleeding in this high-risk cohort. RESULTS We identified 1750 patients undergoing triple-valve surgery in the UK between 2000 and 2019. Triple valve surgery represents 3.1% of all patients in the dataset. Overall mean age of patients was 68.5 ± 12 years, having increased from 63 ±12 years in group A to 69 ± 12 years in group E (P < 0.001). Overall in-hospital mortality rate was 9%, dropping from 21% in group A to 7% in group E (P < 0.001). Overall rates of re-exploration for bleeding (11%, P = 0.308) and postoperative dialysis (11%, P = 0.066) remained high across the observed time period. Triple valve replacement, redo sternotomy and poor preoperative left ventricular ejection fraction emerged as strong independent predictors of mortality. CONCLUSIONS Triple-valve surgery remains rare in the UK. Early postoperative outcomes for triple valve surgery have improved over time. Redo sternotomy is a significant predictor of mortality. Attempts should be made to repair the mitral and/or tricuspid valves where technically possible.
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Affiliation(s)
| | - Nabil Hussein
- Department of Cardiac Surgery, Castle Hill Hospital, Hull, UK
| | - Harry Smith
- Department of Cardiac Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Ahmed Al-Adhami
- Department of Cardiac Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Daniel Sitaranjan
- Department of Cardiac Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Amer Harky
- Department of Cardiac Surgery, Liverpool Heart & Chest, Liverpool, UK
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Dong T, Sinha S, Zhai B, Fudulu D, Chan J, Narayan P, Judge A, Caputo M, Dimagli A, Benedetto U, Angelini GD. Performance Drift in Machine Learning Models for Cardiac Surgery Risk Prediction: Retrospective Analysis. JMIRX MED 2024; 5:e45973. [PMID: 38889069 PMCID: PMC11217160 DOI: 10.2196/45973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/27/2024] [Accepted: 04/29/2024] [Indexed: 06/20/2024]
Abstract
Background The Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II risk scores are the most commonly used risk prediction models for in-hospital mortality after adult cardiac surgery. However, they are prone to miscalibration over time and poor generalization across data sets; thus, their use remains controversial. Despite increased interest, a gap in understanding the effect of data set drift on the performance of machine learning (ML) over time remains a barrier to its wider use in clinical practice. Data set drift occurs when an ML system underperforms because of a mismatch between the data it was developed from and the data on which it is deployed. Objective In this study, we analyzed the extent of performance drift using models built on a large UK cardiac surgery database. The objectives were to (1) rank and assess the extent of performance drift in cardiac surgery risk ML models over time and (2) investigate any potential influence of data set drift and variable importance drift on performance drift. Methods We conducted a retrospective analysis of prospectively, routinely gathered data on adult patients undergoing cardiac surgery in the United Kingdom between 2012 and 2019. We temporally split the data 70:30 into a training and validation set and a holdout set. Five novel ML mortality prediction models were developed and assessed, along with EuroSCORE II, for relationships between and within variable importance drift, performance drift, and actual data set drift. Performance was assessed using a consensus metric. Results A total of 227,087 adults underwent cardiac surgery during the study period, with a mortality rate of 2.76% (n=6258). There was strong evidence of a decrease in overall performance across all models (P<.0001). Extreme gradient boosting (clinical effectiveness metric [CEM] 0.728, 95% CI 0.728-0.729) and random forest (CEM 0.727, 95% CI 0.727-0.728) were the overall best-performing models, both temporally and nontemporally. EuroSCORE II performed the worst across all comparisons. Sharp changes in variable importance and data set drift from October to December 2017, from June to July 2018, and from December 2018 to February 2019 mirrored the effects of performance decrease across models. Conclusions All models show a decrease in at least 3 of the 5 individual metrics. CEM and variable importance drift detection demonstrate the limitation of logistic regression methods used for cardiac surgery risk prediction and the effects of data set drift. Future work will be required to determine the interplay between ML models and whether ensemble models could improve on their respective performance advantages.
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Affiliation(s)
- Tim Dong
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Shubhra Sinha
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Ben Zhai
- School of Computing Science, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Daniel Fudulu
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jeremy Chan
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, West Bengal, India
| | - Andy Judge
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Massimo Caputo
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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Merenda M, Earnest A, Ruseckaite R, Tse WC, Elder E, Hopper I, Ahern S. Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review. Aesthet Surg J Open Forum 2024; 6:ojae015. [PMID: 38650972 PMCID: PMC11033681 DOI: 10.1093/asjof/ojae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Little is known about the methods and outcomes of patient-reported outcome measure (PROM) use among high-risk medical device registries. The objective of this scoping review was to assess the utility and predictive ability of PROMs in high-risk medical device registries. We searched Ovid Medline, Embase, APA PsychINFO, Cochrane Library, and Scopus databases for published literature. After searching, 4323 titles and abstracts were screened, and 262 full texts were assessed for their eligibility. Seventy-six papers from across orthopedic (n = 64), cardiac (n = 10), penile (n = 1), and hernia mesh (n = 1) device registries were identified. Studies predominantly used PROMs as an outcome measure when comparing cohorts or surgical approaches (n = 45) or to compare time points (n = 13) including pre- and postintervention. Fifteen papers considered the predictive ability of PROMs. Of these, 8 treated PROMs as an outcome, 5 treated PROMs as a risk factor through regression analysis, and 2 papers treated PROMs as both a risk factor and as an outcome. One paper described PROMs to study implant survival. To advance methods of PROM integration into clinical decision-making for medical devices, an understanding of their use in high-risk device registries is needed. This scoping review found that there is a paucity of studies using PROMs to predict long-term patient and clinical outcomes in high-risk medical device registries. Determination as to why PROMs are rarely used for predictive purposes in long-term data collection is needed if PROM data are to be considered suitable as real-world evidence for high-risk device regulatory purposes, as well as to support clinical decision-making. Level of Evidence 4
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Affiliation(s)
- Michelle Merenda
- Corresponding Author: Mrs Michelle Merenda, Level 3, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia. E-mail:
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Dimagli A, Gaudino M, Harik L, Sinha S, Fudulu D, Chan J, Olaria RP, Soletti G, Alzghari T, Cancelli G, An KR, Benedetto U, Murphy G, Angelini G. Comparative Analysis of Coronary Artery Bypass Grafting Outcomes in Women Using Different Conduits in the National UK Data Set. Ann Thorac Surg 2024; 117:510-516. [PMID: 37977255 DOI: 10.1016/j.athoracsur.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/08/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND There is limited report of outcomes in women undergoing isolated coronary artery bypass grafting (CABG) with left internal thoracic artery and different second conduits (saphenous vein graft [SVG], radial artery [RA], and right internal thoracic artery [RITA]). METHODS The National Adult Cardiac Surgery Audit database was queried for women undergoing isolated CABG with left internal thoracic artery graft in the United Kingdom from 1996 to 2019. Propensity score-based pairwise comparisons were performed between graft types. The primary outcome was in-hospital mortality. RESULTS The study included 58,063 women (SVG, n = 48,881 [84.2%]; RA, n = 6136 [10.6%]; RITA, n = 2445 [4.2%]). SVG use was stable over the years; RA and RITA use decreased. In-hospital mortality was similar between the RA and RITA grafts (2.3% vs 2.8%; odds ratio [OR], 0.80; 95% CI, 0.53-1.22; P = .39) and between the RA and SVG (2.3% vs 2.0%; OR, 1.20; 95% CI, 0.93-1.55; P = .17) but higher in the RITA group compared with the SVG (2.7% vs 1.4%; OR, 2.04; 95% CI, 1.27-3.36; P = .004). Women receiving the RITA graft were more likely to have sternal wound infection (SWI) compared with the RA (0.6% vs 0.06%; P = .004) and the SVG (0.6% vs 0.2%; P = .032). SWI was consistently associated with higher risk of in-hospital mortality. CONCLUSIONS Conduit selection may affect operative outcomes in women undergoing CABG. The RA shows similar mortality and risk of deep SWI as the SVG.
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Affiliation(s)
- Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY; Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Daniel Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Jeremy Chan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | | | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Kevin R An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom; Department of Cardiac Surgery, Università degli Studi G. d'Annunzio, Chieti-Pescara, Italy
| | - Gavin Murphy
- Cardiovascular Research Centre, University of Leicester, Leicester, United Kingdom
| | - Gianni Angelini
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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Chan J, Narayan P, Fudulu DP, Dong T, Angelini GD. Trend in mitral valve prostheses of choice and early outcomes in the United Kingdom. Int J Cardiol 2024; 397:131607. [PMID: 38013051 DOI: 10.1016/j.ijcard.2023.131607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Despite the superiority of mitral valve repair, surgical mitral valve replacement (SMVR) remains an important intervention for patients with valve stenosis, infective endocarditis and complex mitral valve degeneration. There has been an increasing popularity in the worldwide use of biological valves due to the avoidance of long-term anti-coagulation and recent advancements in transcatheter techniques. We aim to evaluate the trend, early clinical outcomes and the choice of prostheses use in isolated SMVR over a 23 years period in the United Kingdom. METHODS All patients (n = 13,147) who underwent elective or urgent isolated SMVR from March 1996 to April 2019 were identified from the National Adult Cardiac Surgery Audit database. Trends in clinical outcomes, predicted/observed mortality of patients and the utilization of biological prostheses across 5 different age groups: <50, 50-59, 60-69, 70-79 and ≥80 years old were investigated. Early clinical outcomes associated with the use of mechanical and biological mitral valve prostheses in patients between the age of 60-70 years old were analysed. RESULTS The number of isolated SMVR performed has remained stable with approximately 600 cases annually since 2010. The in-hospital/30-day mortality rate has decreased from 7.41% (1996) to 3.92% (2018), despite the EuroScore II increasing from 1.42% in 1996 to 2.43% in 2018. Biological prostheses usage increased across all age group, and particularly in the 60-69 and 70-79 group, from 17.86% and 53.85% in 1996 to 48.85% and 82.38% in 2018, respectively. The use of mechanical prostheses was reduced in patients between the age of 50-59 from 100% in 1996 to 80.65% in 2018. There were no differences in short term outcomes among patients aged 60-70 years who received either a biological or mechanical prostheses. CONCLUSION There has been a significant reduction in surgical mitral valve replacement early in-hospital mortality, despite an observed increase in the risk profile of patients over 23 years. A shifting trend in valve replacement choices was observed with a rise in the use of biological prostheses, particularly within the 60-69 and 70-79 age group. Early in hospital outcomes for patients aged 60-70 were not determined by the implanted valve type.
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Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Pradeep Narayan
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Tim Dong
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8ED, United Kingdom.
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Narayan P, Dong T, Dimagli A, Fudulu DP, Chan J, Sinha S, Angelini GD. Impact of explanted valve type on aortic valve reoperations: nationwide UK experience. Eur J Cardiothorac Surg 2024; 65:ezae031. [PMID: 38305431 PMCID: PMC10902681 DOI: 10.1093/ejcts/ezae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES This nationwide retrospective cohort study assessed the impact of the explanted valve type on reoperative outcomes in aortic valve surgery within the UK over a 23-year period. METHODS Data were sourced from the National Institute for Cardiovascular Outcomes Research (NICOR) database. All patients undergoing first-time isolated reoperative aortic valve replacement between 1996 and 2019 in the UK were included. Concomitant procedures, homograft implantation or aortic root enlargement were excluded. Propensity score matching was utilized to compare outcomes and risk factors for in-hospital mortality was evaluated through multivariable logistic regression. Final model selection was conducted using Akaike Information Criterion through bootstrapping. The primary end point was in-hospital mortality, and secondary end points included postoperative morbidities. RESULTS Out of 2371 patients, 24.9% had mechanical and 75% had bioprosthetic valves implanted during the primary procedure. Propensity matched groups of 324 patients each, were compared. In-hospital mortality for mechanical and bioprosthetic valve explants was 7.1% and 5.9%, respectively (P = 0.632). On multivariable logistic regression analysis, valve type was not a risk factor for mortality [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.37-1.05; P = 0.1]. Age (OR 1.03, 95% CI 1.01-1.05; P < 0.05), left ventricular ejection fraction (OR 1.62, 95% CI 1.08-2.42; P < 0.05), creatinine ≥ 200 mg/dl (OR 2.21, 95% CI 1.17-4.04; P < 0.05) and endocarditis (OR 2.66, 95% CI 1.71-4.14; P < 0.05) emerged as risk factors for mortality. CONCLUSIONS The type of valve initially implanted (mechanical or bioprosthetic) did not determine mortality. Instead, age, left ventricular ejection fraction, renal impairment and endocarditis were significant risk factors for in-hospital mortality.
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Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Daniel P Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Jeremy Chan
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
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Argyriou A, Vohra H, Chan J, Ahmed EM, Rajakaruna C, Angelini GD, Fudulu DP. Incidence and outcomes of surgical pulmonary embolectomy in the UK. Br J Surg 2024; 111:znae003. [PMID: 38230762 PMCID: PMC11167207 DOI: 10.1093/bjs/znae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Surgical pulmonary embolectomy is rarely used for the treatment of massive acute pulmonary embolism. The aim of this study was to assess the incidence and outcomes of this operation by undertaking a retrospective analysis of a large national registry in the UK. METHODS All acute pulmonary embolectomies performed between 1996 and 2018 were captured in the National Institute of Cardiovascular Outcomes Research central database. Trends in the number of operations performed during this interval and reported in-hospital outcomes were analysed retrospectively. Multivariable logistic regression was used to identify independent risk factors for in-hospital death. RESULTS All 256 patients treated surgically for acute pulmonary embolism during the study interval were included in the analysis. Median age at presentation was 54 years, 55.9% of the patients were men, 48.0% had class IV heart failure symptoms, and 37.5% had preoperative cardiogenic shock. The median duration of bypass was 73 min, and median cross-clamp time was 19 min. Cardioplegic arrest was used in 53.1% of patients. The median duration of hospital stay was 11 days. The in-hospital mortality rate was 25%, postoperative stroke occurred in 5.4%, postoperative dialysis was required in 16%, and the reoperation rate for bleeding was 7.5%. Risk-adjusted multivariable analysis revealed cardiogenic shock (OR 2.54, 95% c.i. 1.05 to 6.21; P = 0.038), preoperative ventilation (OR 5.85, 2.22 to 16.35; P < 0.001), and duration of cardiopulmonary bypass exceeding 89 min (OR 7.82, 3.25 to 20.42; P < 0.001) as significant independent risk factors for in-hospital death. CONCLUSION Surgical pulmonary embolectomy is rarely performed in the UK, and is associated with significant mortality and morbidity. Preoperative ventilation, cardiogenic shock, and increased duration of bypass were significant predictors of in-hospital death.
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Affiliation(s)
- Amerikos Argyriou
- Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hunaid Vohra
- Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jeremy Chan
- Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Eltayeb Mohamed Ahmed
- Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Cha Rajakaruna
- Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gianni Davide Angelini
- Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Daniel Paul Fudulu
- Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Argus L, Taylor M, Ouzounian M, Venkateswaran R, Grant SW. Risk Prediction Models for Long-Term Survival after Cardiac Surgery: A Systematic Review. Thorac Cardiovasc Surg 2024; 72:29-39. [PMID: 36750201 DOI: 10.1055/s-0043-1760747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND The reporting of alternative postoperative measures of quality after cardiac surgery is becoming increasingly important as in-hospital mortality rates continue to decline. This study aims to systematically review and assess risk models designed to predict long-term outcomes after cardiac surgery. METHODS The MEDLINE and Embase databases were searched for articles published between 1990 and 2020. Studies developing or validating risk prediction models for long-term outcomes after cardiac surgery were included. Data were extracted using checklists for critical appraisal and systematic review of prediction modeling studies. RESULTS Eleven studies were identified for inclusion in the review, of which nine studies described the development of long-term risk prediction models after cardiac surgery and two were external validation studies. A total of 70 predictors were included across the nine models. The most frequently used predictors were age (n = 9), peripheral vascular disease (n = 8), renal disease (n = 8), and pulmonary disease (n = 8). Despite all models demonstrating acceptable performance on internal validation, only two models underwent external validation, both of which performed poorly. CONCLUSION Nine risk prediction models predicting long-term mortality after cardiac surgery have been identified in this review. Statistical issues with model development, limited inclusion of outcomes beyond 5 years of follow-up, and a lack of external validation studies means that none of the models identified can be recommended for use in contemporary cardiac surgery. Further work is needed either to successfully externally validate existing models or to develop new models. Newly developed models should aim to use standardized long-term specific reproducible outcome measures.
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Affiliation(s)
- Leah Argus
- The University of Manchester, Manchester, United Kingdom
| | - Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajamiyer Venkateswaran
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesborough, United Kingdom
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Zhang Z, Ng Ming Sheng S, Kempen JH, Fabiani C, Arora A, Gupta V, Tsui E, Cimino L, Symes RJ, Dell J, Finger RP, Heinz C, Agrawal R. Uveitis Registries - A Digital Tool for Patient Care, Education, Research, and Collaboration. Ocul Immunol Inflamm 2023; 31:1859-1869. [PMID: 36328530 DOI: 10.1080/09273948.2022.2140062] [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: 06/14/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Clinical registries are increasingly important in research and clinical advancement. This review explores and compares current uveitis registries and recommends future directions on how uveitis registries can complement one another for synergistic effect and benefit. METHODS From a systematic search, 861 citations were screened for longitudinal, non-interventional, and multicenter uveitis-specific registries. Additional registries were identified via consultations with uveitis experts. Characteristics of all registries were analyzed and compared. RESULTS Four registries were identified: Treatment Exit Options for Non-infectious Uveitis, AutoInflammatory Disease Alliance International Registry, Ocular Autoimmune Systemic Inflammatory Infectious Study, and Fight Uveitis Blindness!. Despite certain differences, these registries have the overarching goal of collecting large quantities of real-world, high-quality patient data to improve the understanding of uveitis. CONCLUSION The four uveitis registries share similar goals and collect clinical data from overlapping geographical regions. There is vast potential for collaboration, including data sharing to further augment datasets for analysis.
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Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sean Ng Ming Sheng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
- MyungSung Christian Medical Center (MCM) Eye Unit, MCM General Hospital and MyungSung Medical School, Boston Massachusetts, USA
- Department of Ophthalmology, Addis Ababa University Faculty of Medicine, Addis Ababa, Ethiopia
- Sight for Souls, Bellevue, Washington, USA
| | - Claudia Fabiani
- Ophthalmology Unit,Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Atul Arora
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, California, USA
| | - Luca Cimino
- Department of Surgery, Medicine Dentistry and Morphological Sciences with Interest in Transplant, University of Modena and Reggio Emilia, Modena, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Richard J Symes
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Jennifer Dell
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Department of Ophthalmology and Visual Sciences, Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
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Narayan P, Dimagli A, Fudulu DP, Sinha S, Dong T, Chan J, Angelini GD. Risk Factors and Outcomes of Reoperative Surgical Aortic Valve Replacement in the United Kingdom. Ann Thorac Surg 2023; 116:759-766. [PMID: 36716908 DOI: 10.1016/j.athoracsur.2022.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/07/2022] [Accepted: 12/29/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mortality after reoperative aortic valve surgery continues to decline but remains high compared with primary isolated replacement. We sought to examine temporal trends, morbidity, and mortality among patients undergoing isolated first-time reoperative aortic valve surgery. METHODS The study included all patients undergoing reoperative aortic valve surgery in the United Kingdom between January 2007 and March 2019. Patients undergoing isolated reoperative aortic valve replacement (AVR) were compared with a propensity matched cohort of patients undergoing isolated primary AVR. Outcomes measured included inhospital mortality, neurologic dysfunction, postoperative dialysis, deep sternal wound infections, and hospital length of stay. RESULTS During the study period, 40,858 primary isolated AVRs and 3015 first-time isolated reoperative AVRs were carried out in the United Kingdom. In the propensity matched reoperative group, median age of participants was 69.8 years (60.8-76.2) with median duration between the initial surgery and the reoperation being 7.69 years. Overall mortality was 3.1% (94) for reoperative AVR compared with 1.9% (56) for primary AVR. Mortality of both primary and reoperative AVR declined during the study period. Reoperation, age, New York Heart Association class, and chronic kidney disease were independently associated with early mortality. CONCLUSIONS Reoperative isolated AVR can be performed with acceptable inhospital mortality and provides a benchmark against which alternative strategies should be compared.
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Affiliation(s)
- Pradeep Narayan
- Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Mukundapur, Kolkata, West Bengal, India
| | - Arnaldo Dimagli
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Shubhra Sinha
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Tim Dong
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Jeremy Chan
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom.
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11
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Ombashi S, van der Goes PAJ, Versnel SL, Khonsari RH, van der Molen AEM. Guidance to develop a multidisciplinary, international, pediatric registry: a systematic review. Orphanet J Rare Dis 2023; 18:296. [PMID: 37735442 PMCID: PMC10512647 DOI: 10.1186/s13023-023-02901-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
AIM The European Reference Network for craniofacial anomalies and ear, nose and throat disorders (ERN-CRANIO) aims to improve craniofacial care on a European scale. Within ERN-CRANIO, the cleft lip and palate (CL/P) work stream seeks to ameliorate health outcomes for patients with CL/P. This work stream acknowledged the need for a European wide registry for comparable outcome measures and therapy endpoints to achieve this goal. This review aimed to provide a scientific basis for the conceptualization of this registry by studying previous registry initiatives. METHODS This review performed thematic analysis on twenty-four articles through narrative synthesis. An iterative process was used to identify key-themes required for prolonged registry success. RESULTS Analysis of the literature resulted in twenty-one distinct headings including quantitative and qualitative data. Quantitative data including registry characteristics were visualized in a table. The analysis of qualitative data resulted in the identification of fourteen key-themes, which have been summarized and visualized in a guidance. CONCLUSION This review has successfully identified key-themes required for the development of an international, multidisciplinary, pediatric registry for pan-European cleft care. The guidance provided by this review applies to the goals of ERN-CRANIO, but can be used by any initiative developing a registry.
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Affiliation(s)
- S Ombashi
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P A J van der Goes
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - S L Versnel
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R H Khonsari
- Service de Chirurgie Maxillofaciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de Médecine, Université Paris Cité, Paris, France
- Scientific Committee, ERN CRANIO, Rotterdam, The Netherlands
| | - A E Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center, Utrecht, The Netherlands
- Scientific Committee, ERN CRANIO, Rotterdam, The Netherlands
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12
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Bertolaccini L, Falcoz PE, Brunelli A, Batirel H, Furak J, Passani S, Szanto Z. The significance of general data protection regulation in the compliant data contribution to the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg 2023; 64:ezad289. [PMID: 37589648 DOI: 10.1093/ejcts/ezad289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/16/2023] [Indexed: 08/18/2023] Open
Abstract
The General Data Protection Regulation (GDPR), enacted in the European Union in 2018, has significantly transformed the landscape of personal data management and protection. This article provides an overview of GDPR's impact, focusing on its applicability, fundamental principles and influence on data management practices, particularly within the European Society of Thoracic Surgeons (ESTS) database. GDPR's reach extends to all entities collecting and processing personal data of European Union residents, regardless of their location. It encompasses various data types, emphasizing meticulous handling and protection of identifiable information. Special categories of data, such as health and sensitive attributes, require even more stringent protection. The regulation sets legal, fair and transparent data processing principles, emphasizing accuracy, purpose limitation and data minimization. It also stresses accountability, leading to the appointment of Data Protection Officers and significant penalties for non-compliance. The ESTS database, designed to enhance thoracic surgical research and care, collects data on European procedures. It follows GDPR principles by pseudonymizing data, ensuring secure data transmission and providing clear instructions for data submission. The database contributes to research, policymaking and practice improvement in thoracic surgery by offering a comprehensive dataset for analysis. Here, we aim to shed light on the complexities of GDPR implementation and emphasize the need for comprehensive data management strategies to ensure compliance and enhance privacy protection with the contribution to the ESTS database. GDPR compliance comes with challenges, including potential human dignity and privacy rights violations. Data breaches can result in unauthorized disclosures, and non-compliance can lead to substantial fines and reputational damage. The implementation of GDPR encourages organizations to prioritize ethical data practices, security measures and transparent data handling. In conclusion, GDPR has revolutionized personal data protection by emphasizing accountability, transparency and individual rights. It has impacted organizations globally, promoting responsible data management practices. Adhering to GDPR ensures privacy protection, trust-building and overall enhancement of data management in today's data-driven environment.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | - Hasan Batirel
- Faculty of Medicine, Department of Thoracic Surgery, Biruni University, Istanbul, Turkey
| | - Jozsef Furak
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Zalan Szanto
- Department of Thoracic Surgery, University of Pecs, Pecs, Hungary
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13
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Palamuthusingam D, Pascoe EM, Hawley CM, Johnson DW, Ratnayake G, McDonald S, Boudville N, Jose M, Fahim M. Evaluating data quality in the Australian and New Zealand dialysis and transplant registry using administrative hospital admission datasets and data-linkage. HEALTH INF MANAG J 2023; 52:212-220. [PMID: 35695032 DOI: 10.1177/18333583221097724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Clinical quality registries provide rich and useful data for clinical quality monitoring and research purposes but are susceptible to data quality issues that can impact their usage. Objective: This study assessed the concordance between comorbidities recorded in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and those in state-based hospital admission datasets. Method: All patients in New South Wales, South Australia, Tasmania, Victoria and Western Australia recorded in ANZDATA as requiring chronic kidney replacement therapy (KRT) between 01/07/2000 and 31/12/2015 were linked with state-based hospital admission datasets. Coronary artery disease, diabetes mellitus, cerebrovascular disease, chronic lung disease and peripheral vascular disease recorded in ANZDATA at each annual census date were compared overall, over time and between different KRT modalities to comorbidities recorded in hospital admission datasets, as defined by the International Classification of Diseases (ICD-10-AM), using both the kappa statistic and logistic regression analysis. Results: 29, 334 patients with 207,369 hospital admissions were identified. Comparison was made at census date for every patient comparison. Overall agreement was "very good" for diabetes mellitus (92%, k = 0.84) and "poor" to "fair" (21-61%, k = 0.02-0.22) for others. Diabetes mellitus recording had the highest accuracy (sensitivity 93% (±SE 0.2) and specificity 93% (±SE 0.2)), and cerebrovascular disease had the lowest (sensitivity 54% (±SE 0.2) and specificity 21% (±SE 0.3)). The false positive rates for cerebrovascular disease, peripheral vascular disease and chronic airway disease ranged between 18 and 33%. The probability of a false positive was lowest for kidney transplant patients for all comorbidities and highest for patients on haemodialysis. Conclusions and Implications: Agreement between the clinical quality registry and hospital admission datasets was variable, with the prevalence of comorbidities being higher in ANZDATA.
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Affiliation(s)
- Dharmenaan Palamuthusingam
- Kidney Health Service, Metro North Hospitals and Health Service, Department of Nephrology, Royal Brisbane and Women's Hospital, Australia
- Faculty of Medicine, University of Queensland, Australia
- School of Medicine, Griffith University, Australia
| | - Elaine M Pascoe
- Centre for Health Services Research, University of Queensland, Australia
| | - Carmel M Hawley
- Faculty of Medicine, University of Queensland, Australia
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Australia
| | - David W Johnson
- Faculty of Medicine, University of Queensland, Australia
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Australia
- Translational Research Institute, Australia
| | - Gishan Ratnayake
- Radiation Oncology, Princess Alexandra Raymond Terrace, Australia
| | - Stephen McDonald
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Australia
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australia Health and Medical Research Institute (SAHMRI), Australia
- Adelaide Medical School, The University of Adelaide, Australia
| | - Neil Boudville
- Faculty of Medicine, University of Western Australia, Australia
- Sir Charles Gairdner Hospital, Australia
| | - Matthew Jose
- Department of Nephrology, Royal Hobart Hospital, Australia
- Faculty of Medicine, University of Tasmania, Australia
| | - Magid Fahim
- Faculty of Medicine, University of Queensland, Australia
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Australia
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14
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Ruseckaite R, Mudunna C, Caruso M, Helwani F, Millis N, Lacaze P, Ahern S. Current state of rare disease registries and databases in Australia: a scoping review. Orphanet J Rare Dis 2023; 18:216. [PMID: 37501152 PMCID: PMC10373259 DOI: 10.1186/s13023-023-02823-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Rare diseases (RDs) affect approximately 8% of all people or > 400 million people globally. The Australian Government's National Strategic Action Plan for Rare Diseases has identified the need for a national, coordinated, and systematic approach to the collection and use of RD data, including registries. Rare disease registries (RDRs) are established for epidemiological, quality improvement and research purposes, and they are critical infrastructure for clinical trials. The aim of this scoping review was to review literature on the current state of RDRs in Australia; to describe how they are funded; what data they collect; and their impact on patient outcomes. METHODS We conducted a literature search on MEDLINE, EMBASE, CINAHL and PsychINFO databases, in addition to Google Scholar and grey literature. Dissertations, government reports, randomised control trials, conference proceedings, conference posters and meeting abstracts were also included. Articles were excluded if they did not discuss RDs or if they were written in a language other than English. Studies were assessed on demographic and clinical patient characteristics, procedure or treatment type and health-related quality of life captured by RDRs or databases that have been established to date. RESULTS Seventy-four RDRs were identified; 19 were global registries in which Australians participated, 24 were Australian-only registries, 10 were Australia and New Zealand based, and five were Australian jurisdiction-based registries. Sixteen "umbrella" registries collected data on several different conditions, which included some RDs, and thirteen RDRs stored rare cancer-specific information. Most RDRs and databases captured similar types of information related to patient characteristics, comorbidities and other clinical features, procedure or treatment type and health-related quality of life measures. We found considerable heterogeneity among existing RDRs in Australia, especially with regards to data collection, scope and quality of registries, suggesting a national coordinated approach to RDRs is required. CONCLUSION This scoping review highlights the current state of Australian RDRs, identifying several important gaps and opportunities for improvement through national coordination and increased investment.
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Affiliation(s)
- Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
| | - Chethana Mudunna
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Marisa Caruso
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Falak Helwani
- Rare Voices Australia, VIC, 3194, Melbourne, Australia
| | - Nicole Millis
- Rare Voices Australia, VIC, 3194, Melbourne, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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15
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Al-Zubaidi F, Pufulete M, Sinha S, Kendall S, Moorjani N, Caputo M, Angelini GD, Vohra HA. Mitral repair versus replacement: 20-year outcome trends in the UK (2000-2019). INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:ivad086. [PMID: 37208195 PMCID: PMC10250075 DOI: 10.1093/icvts/ivad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/10/2023] [Accepted: 05/18/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES Using a large national database, we sought to describe outcome trends in mitral valve surgery between 2000 and 2019. METHODS The study cohort was split into mitral valve repair (MVr) or replacement, including all patients regardless of concomitant procedures. Patients were grouped by four-year admission periods into groups (A to E). The primary outcome was in hospital mortality and secondary outcomes were return to theatre, postoperative stroke and postoperative length of stay. We investigated trends over time in patient demographics, comorbidities, intraoperative characteristics and postoperative outcomes. We used a multivariable binary logistic regression model to assess the relationship between mortality and time. Cohorts were further stratified by sex and aetiology. RESULTS Of the 63 000 patients in the study cohort, 31 644 had an MVr and 31 356 had a replacement. Significant demographic shifts were observed. Aetiology has shifted towards degenerative disease; endocarditis rates in MVr dropped initially but are now rising (period A = 6%, period C = 4%, period E = 6%; P < 0.001). The burden of comorbidities has increased over time. In the latest time period, women had lower repair rates (49% vs 67%, P < 0.001) and higher mortality rates when undergoing repair (3% vs 2%, P = 0.001) than men. Unadjusted postoperative mortality dropped in MVr (5% vs 2%, P < 0.001) and replacement (9% vs 7%, P = 0.015). Secondary outcomes have improved. Time period was an independent predictor for reduced mortality in both repair (odds ratio: 0.41, 95% confidence interval: 0.28-0.61, P < 0.001) and replacement (odds ratio: 0.50, 95% confidence interval: 0.41-0.61, P < 0.001). CONCLUSIONS In-hospital mortality has dropped significantly over time for mitral valve surgery in the UK. MVr has become the more common procedure. Sex-based discrepancies in repair rates and mortality require further investigation. Endocarditis rates in MVS are rising.
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Affiliation(s)
- Fadi Al-Zubaidi
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Maria Pufulete
- Faculty of Health Sciences, University of Bristol, Bristol Heart Institute, Bristol, UK
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Simon Kendall
- Department of Cardiac Surgery, South Tees Hospital, Newcastle, UK
| | - Narain Moorjani
- Department of Cardiac Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
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16
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Burns DJP, Angelini GD, Benedetto U, Caputo M, Ciulli F, Vohra HA. Early mortality and neurologic outcomes following mitral valve surgery in the very elderly. J Card Surg 2022; 37:4510-4516. [PMID: 36335608 DOI: 10.1111/jocs.17098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/17/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Valve repair is the gold standard for treatment of degenerative mitral valve disease. As the population ages, patients undergoing valve degeneration and therefore considered for mitral valve surgery will naturally be getting older. We sought to evaluate whether mitral repair retained a survival advantage over replacement in patients ≥80 years old. METHODS A retrospective cohort study was performed using data acquired from the United Kingdom National Adult Cardiac Surgery Audit for the outcomes of in-hospital mortality and postoperative cerebrovascular event (CVA). Individual multivariable logistic regression models were created to investigate adjusted associations between these outcomes and type of mitral valve operation, repair or replacement. Additionally, associations between the individual model parameters and in-hospital mortality and CVA were investigated. RESULTS A total of 1140 patients underwent mitral repair (66.4%, median age 82.3), and 577 patients underwent mitral replacement (33.6%, median age 82.1). The overall age range was 80-92. The incidence of in-hospital mortality favored the repair group (4.4% vs. 8.3%, p = .001). Multivariable logistic regression modeling demonstrated an increased adjusted odds of in-hospital mortality for mitral valve replacement (MVR) (odd ratio [OR]: 2.01, 1.15-3.50, p = .01). The only other parameter associated with an increased adjusted odds of in-hospital mortality was postoperative dialysis (OR: 14.2, 7.67-26.5, p < .001). There was not a demonstrated association between MVR and perioperative CVA (OR: 1.11, 0.49-2.4, p = .8). CONCLUSIONS In patients ≥80 years old, mitral valve repair (MVr) was shown to be associated with a decreased adjusted odds of mortality, with a null association with CVA. These results suggest that, if feasible, MVr should remain the preferred management strategy, even in the very elderly.
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Affiliation(s)
- Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Franco Ciulli
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Heart Institute, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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17
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Dixon LK, Dimagli A, Di Tommaso E, Sinha S, Fudulu DP, Sandhu M, Benedetto U, Angelini GD. Females have an increased risk of short-term mortality after cardiac surgery compared to males: Insights from a national database. J Card Surg 2022; 37:3507-3519. [PMID: 36116056 PMCID: PMC9826035 DOI: 10.1111/jocs.16928] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/15/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Female sex is considered a risk factor for mortality and morbidity following cardiac surgery. This study is the first to review the UK adult cardiac surgery national database to compare outcomes following surgical coronary revascularisation and valvular procedures between females and males. METHODS Using data from National Adult Cardiac Surgery Audit, we identified all elective and urgent, isolated coronary artery by-pass grafting (CABG), aortic valve replacement (AVR) and mitral valve replacement/repair (MVR) procedures from 2010 to 2018. We compared baseline data, operative data and outcomes of mortality, stroke, renal failure, deep sternal wound infection, return to theater for bleeding, and length of hospital stay. Multivariable mixed-effect logistical/linear regression models were used to assess relationships between sex and outcomes, adjusting for baseline characteristics. RESULTS Females, compared to males, had greater odds of experiencing 30-day mortality (CABG odd ratio [OR] 1.76, confidence interval [CI] 1.47-2.09, p < .001; AVR OR 1.59, CI 1.27-1.99, p < .001; MVR OR 1.37, CI 1.09-1.71, p = .006). After CABG, females also had higher rates of postoperative dialysis (OR 1.31, CI 1.12-1.52, p < .001), deep sternal wound infections (OR 1.43, CI 1.11-1.83, p = .005) and longer length of hospital stay (β 1.2, CI 1.0-1.4, p < .001) compared to males. Female sex was protective against returning to theater for postoperative bleeding following CABG (OR 0.76, CI 0.65-0.87, p < .001) and AVR (OR 0.72, CI 0.61-0.84, p < .001). CONCLUSION Females in the United Kingdom have an increased risk of short-term mortality after cardiac surgery compared to males. This highlights the need to focus on the understanding of the causes behind these disparities and implementation of strategies to improve outcomes in females.
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Affiliation(s)
| | | | | | - Shubhra Sinha
- Bristol Heart InstituteUniversity of BristolBristolUK
| | | | - Manraj Sandhu
- Bristol Heart InstituteUniversity of BristolBristolUK
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18
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Comanici M, Salmasi MY, Schulte KL, Raja SG, Attia RQ. Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons? J Card Surg 2022; 37:3776-3798. [PMID: 36098376 DOI: 10.1111/jocs.16925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. METHODS EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety-two results were obtained, 27 represented best evidence (2-meta-analyses, 1-RCT, and 24 retrospective cohort studies). RESULTS In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on-pump vs. 3206 off-pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty-nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high-risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in-hospital or midterm mortality out to 5-years. DISCUSSION Trainees can perform cardiothoracic surgery in dedicated high-volume units with outcomes comparable to those of fully trained surgeons.
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Affiliation(s)
- Maria Comanici
- Department of Cardiac Surgery, Harefield Hospital, London, UK.,Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, Galați, Romania
| | | | | | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, London, UK
| | - Rizwan Q Attia
- Department of Cardiac Surgery, Harefield Hospital, London, UK
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Bergeron E, Kyrillos R, Laughrea PA. Review of Corneal Graft Registries. Cornea 2022; 41:1196-1202. [PMID: 35942548 DOI: 10.1097/ico.0000000000003076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Corneal graft registries are organized systems that collect and analyze outcome data (such as long-term graft survival and visual outcomes) after keratoplasty procedures. The aim of this review was to identify existing corneal graft registries and to describe their characteristics. METHODS A search of the PubMed database was performed on June 1, 2021, for articles pertaining to corneal graft registries. RESULTS The PubMed literature search yielded 958 publications, of which 116 met all the inclusion and exclusion criteria. Among these articles, 15 corneal graft registries were identified, including 6 regional registries, 8 national registries, and 1 multinational registry. This article provides an overview of their characteristics and discusses the main advantages and pitfalls of clinical registries. CONCLUSIONS Clinical registry data are increasingly recognized as a valuable tool to monitor corneal transplant outcomes to improve health care services and optimize resource management.
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Affiliation(s)
- Emilie Bergeron
- Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec City, Canada
- Service d'ophtalmologie pédiatrique, Centre Hospitalier de l'Université Laval, CHU de Québec-Université Laval, Quebec City, Canada
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Quebec City, Canada
- CUO-Recherche-Clinique, Hôpital du Saint-Sacrement, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada ; and
| | - Ralph Kyrillos
- Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec City, Canada
- Service d'ophtalmologie pédiatrique, Centre Hospitalier de l'Université Laval, CHU de Québec-Université Laval, Quebec City, Canada
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Quebec City, Canada
- CUO-Recherche-Clinique, Hôpital du Saint-Sacrement, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada ; and
- Banque d'yeux du Centre Universitaire d'Ophtalmologie, CHU de Québec-Université Laval, Quebec City, Canada
| | - Patricia-Ann Laughrea
- Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec City, Canada
- Département d'ophtalmologie et d'oto-rhino-laryngologie-chirurgie cervico-faciale, Faculté de médecine, Université Laval, Quebec City, Canada
- CUO-Recherche-Clinique, Hôpital du Saint-Sacrement, Centre de recherche du CHU de Québec-Université Laval, Quebec City, Canada ; and
- Banque d'yeux du Centre Universitaire d'Ophtalmologie, CHU de Québec-Université Laval, Quebec City, Canada
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Fudulu DP, Dimagli A, Sinha S, Ackah J, Narayan P, Chan J, Gemelli M, Dong T, Benedetto U, Angelini GD. Impact of Preoperative Atrial Fibrillation on In-Hospital Outcomes of Coronary Artery Bypass Grafting. Semin Thorac Cardiovasc Surg 2022; 35:261-266. [PMID: 35842204 DOI: 10.1053/j.semtcvs.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 12/13/2022]
Abstract
Perioperative atrial fibrillation (AF) is associated with increased mortality, morbidity, and excess healthcare costs. The objective of our study was to assess if preoperative AF in patients undergoing coronary artery bypass grafting is a predictor of operative mortality, postoperative stroke, and need for postoperative dialysis by interrogating a large registry database. We included all isolated procedures performed between February 1996 and March 2019. We used a generalized linear mixed model to assess the effect of preoperative AF on mortality stroke and the need for postoperative dialysis after adjusting for the relevant confounders derived from EuroSCORE 2. Confounders considered included age, gender, neurological dysfunction, renal dysfunction, recent myocardial infarction, pulmonary disease, unstable angina, NYHA class, pulmonary hypertension, diabetes on insulin and peripheral vascular disease, and urgency of the operation. We treated the hospital and operating consultant as random effect variables. We also performed LV function subgroup analyses to assess the effect of preoperative AF on the outcomes of interest. The incidence of pre-existent AF in the cohort of patients we analyzed (N = 356,040 patients) was 3.5% (N = 12,664). In the unadjusted baseline characteristics, preoperative AF patients had more associated comorbidities. After adjustment, preoperative AF remained a significant predictor of increased mortality (odds ratio [OR]: 1.63, confidence interval [CI] 1.48-1.79, p < 0.001), stroke (OR: 1.33, CI 1.16-1.54, p = 0.001), and need for renal dialysis (OR:1.61, CI 1.46-1.78, p < 0.001). Preoperative AF was a significant predictor of adverse outcomes in patients with moderate and good LV function but not in patients with poor LV function (EF <30%). Our study suggests that preoperative AF is associated with an increased risk for perioperative mortality and stroke in patients undergoing coronary artery bypass grafting.
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Affiliation(s)
- Daniel Paul Fudulu
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK.
| | - Arnaldo Dimagli
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Shubhra Sinha
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - James Ackah
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, India
| | - Jeremy Chan
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Marco Gemelli
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Tim Dong
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
| | - Umberto Benedetto
- Departement of Cardiac Surgery, Bristol Heart Institute, University of Bristol, UK
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21
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Akansel S, Kofler M, Van Praet KM, Unbehaun A, Sündermann SH, Jacobs S, Falk V, Kempfert J. Minimally invasive mitral valve surgery after failed transcatheter mitral valve repair in an intermediate-risk cohort. Interact Cardiovasc Thorac Surg 2022; 35:ivac163. [PMID: 35713519 PMCID: PMC9270869 DOI: 10.1093/icvts/ivac163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Although clinical experience with transcatheter mitral valve interventions is rapidly increasing, there is still a lack of evidence regarding surgical treatment options for the management of recurrent mitral regurgitation (MR). This study provides guidance for a minimally invasive surgical approach following failed transcatheter mitral valve repair, which is based on the underlying mitral valve (MV) pathology and the type of intervention. METHODS A total of 46 patients who underwent minimally invasive MV surgery due to recurrent or residual MR after transcatheter edge-to-edge repair or direct interventional annuloplasty between October 2014 and March 2021 were included. RESULTS The median age of the patients was 78 [interquartile range, 71-82] years and the EuroSCORE II was 4.41 [interquartile range, 2.66-6.55]. At the index procedure, edge-to-edge repair had been performed in 45 (97.8%) patients and direct annuloplasty in 1 patient. All patients with functional MR at the index procedure (n = 36) underwent MV replacement. Of the patients with degenerative MR (n = 10), 5 patients were eligible for MV repair after removal of the MitraClip. The 1-year survival following surgical treatment was 81.3% and 75.0% in patients with functional and degenerative MR, respectively. No residual MR greater than mild during follow-up was observed in patients who underwent MV repair. CONCLUSIONS Minimally invasive surgery following failed transcatheter mitral valve repair is feasible and safe, with promising midterm survival. The surgical management should be tailored to the underlying valve pathology at the index procedure, the extent of damage of the MV leaflets and the type of previous intervention.
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Affiliation(s)
- Serdar Akansel
- German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
| | - Markus Kofler
- German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Karel M Van Praet
- German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Axel Unbehaun
- German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Simon H Sündermann
- German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
| | - Stephan Jacobs
- German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Volkmar Falk
- German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
- Charité – Universitätsmedizin Berlin, Department of Cardiovascular Surgery, Berlin, Germany
- ETH Zurich, Department of Health Sciences and Technology, Zürich, Switzerland
| | - Jörg Kempfert
- German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
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22
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Results of a French pilot database of standard of care of chronic subdural hematoma. Neurochirurgie 2022; 68:409-413. [DOI: 10.1016/j.neuchi.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/18/2022]
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23
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Dimagli A, Guida G, Sinha S, Dixon L, Fudulu D, Gemelli M, Benedetto U, Angelini GD. Surgical outcomes of post-infarct ventricular septal defect repair: Insights from the UK national adult cardiac surgery audit database. J Card Surg 2021; 37:843-852. [PMID: 34910324 DOI: 10.1111/jocs.16178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Ventricular septal defect (VSD) is becoming a progressively less frequent mechanical complication of myocardial infarction (MI). However, this event is still associated with high operative mortality. We aimed to describe the trends and the risk factors associated with surgical VSD repair outcomes and to provide a clinical benchmark for percutaneous VSD closure strategies. METHODS Using the UK National Adult Cardiac Surgery Audit database, we identified 1010 patients undergoing surgical VSD repair from 1996 to 2018. The primary outcome was operative mortality. Mixed-model, multivariable logistic regression was used to identify the risk factors associated with operative mortality taking into account the variation related to the centre, the surgeon and the year of the operation. RESULTS Both the number of surgical VSD repair and the mortality rate did not change significantly over the 23-year timeframe. Operative mortality was 38.9% overall and was higher when patients were operated within the first 6 h (75%) or the first 24 h (61.3%) from the index MI. Risk factors associated with higher odds of mortality were early surgery, older age, cardiogenic shock, renal failure, previous percutaneous coronary intervention and urgent/emergent operations. Moreover, the mortality rate was similar among patients undergoing isolated VSD repair and VSD repaired combined with surgical coronary revascularization alone or with concomitant mitral valve procedures. CONCLUSIONS Post MI VSD remains a dreaded mechanical complication characterized by high surgical operative mortality. A delayed operation, whenever possible, appears to be the most beneficial strategy to reduce mortality.
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Affiliation(s)
| | - Gustavo Guida
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Lauren Dixon
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Daniel Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Marco Gemelli
- Bristol Heart Institute, University of Bristol, Bristol, UK
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24
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Percha B, Pisapati K, Gao C, Schmidt H. Natural language inference for curation of structured clinical registries from unstructured text. J Am Med Inform Assoc 2021; 29:97-108. [PMID: 34791282 DOI: 10.1093/jamia/ocab243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/26/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Clinical registries-structured databases of demographic, diagnosis, and treatment information-play vital roles in retrospective studies, operational planning, and assessment of patient eligibility for research, including clinical trials. Registry curation, a manual and time-intensive process, is always costly and often impossible for rare or underfunded diseases. Our goal was to evaluate the feasibility of natural language inference (NLI) as a scalable solution for registry curation. MATERIALS AND METHODS We applied five state-of-the-art, pretrained, deep learning-based NLI models to clinical, laboratory, and pathology notes to infer information about 43 different breast oncology registry fields. Model inferences were evaluated against a manually curated, 7439 patient breast oncology research database. RESULTS NLI models showed considerable variation in performance, both within and across fields. One model, ALBERT, outperformed the others (BART, RoBERTa, XLNet, and ELECTRA) on 22 out of 43 fields. A detailed error analysis revealed that incorrect inferences primarily arose through models' tendency to misinterpret historical findings, as well as confusion based on abbreviations and subtle term variants common in clinical text. DISCUSSION AND CONCLUSION Traditional natural language processing methods require specially annotated training sets or the construction of a separate model for each registry field. In contrast, a single pretrained NLI model can curate dozens of different fields simultaneously. Surprisingly, NLI methods remain unexplored in the clinical domain outside the realm of shared tasks and benchmarks. Modern NLI models could increase the efficiency of registry curation, even when applied "out of the box" with no additional training.
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Affiliation(s)
- Bethany Percha
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kereeti Pisapati
- Mount Sinai Innovation Partners, Mount Sinai Health System, New York, New York, USA.,Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cynthia Gao
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hank Schmidt
- Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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25
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Jones JM, Loubani M, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Cardiac surgery in older patients: hospital outcomes during a 15-year period from a complete national series. Interact Cardiovasc Thorac Surg 2021; 34:532-539. [PMID: 34788460 PMCID: PMC8972229 DOI: 10.1093/icvts/ivab320] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- James Mark Jones
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Mahmoud Loubani
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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26
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Benedetto U, Sinha S, Dimagli A, Cooper G, Mariscalco G, Uppal R, Moorjani N, Krasopoulos G, Kaura A, Field M, Trivedi U, Kendall S, Angelini GD, Akowuah EF, Tsang G. Decade-long trends in surgery for acute Type A aortic dissection in England: A retrospective cohort study. LANCET REGIONAL HEALTH-EUROPE 2021; 7:100131. [PMID: 34557840 PMCID: PMC8454541 DOI: 10.1016/j.lanepe.2021.100131] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Little is known about variations in care and outcomes of patients undergoing surgical repair for type A aortic dissection(TAAD). We aim to investigate decade-long trends in TAAD surgical repair in England. Methods Retrospective review of the National Adult Cardiac Surgery Audit, which prospectively collects demographic and peri‑operative information for all major adult cardiac surgery procedures performed in the UK. We identified patients undergoing surgery for TAAD from January 2009-December 2018, reviewed trends in operative frequency, patient demographics, and mortality. Findings Over the 10-year period,3,680 TAAD patients underwent surgical repair in England. A doubling in the overall number of operations conducted in England was observed (235 cases in 2009 to 510 in 2018). Number of procedures per hospital per year also doubled(9 in 2009 to 23 in 2018). Overall, in-hospital mortality was 17.4% with a trend toward lower mortality in recent years(23% in 2009 to 14.7% in 2018). There was a significant variation in operative mortality between hospitals and surgeons. We also found that most patients presented towards the middle of the week and during winter. Interpretation Surgery is the only treatment for acute TAAD but is associated with high mortality. Prompt diagnosis and referral to a specialist center is paramount. The number of operations conducted in England has doubled in 10 years and the associated survival has improved. Variations exist in service provision with a trend towards better survival in high volume centers. Funding British Heart Foundation and NIHR Biomedical Research center(University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol).
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Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
| | | | | | | | | | | | - Amit Kaura
- NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
| | - Mark Field
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Simon Kendall
- The James Cook University Hospital, Middlesbrough, UK
| | - Gianni D Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK
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27
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Dawson LP, Biswas S, Lefkovits J, Stub D, Burchill L, Evans SM, Reid C, Eccleston D. Characteristics and Quality of National Cardiac Registries: A Systematic Review. Circ Cardiovasc Qual Outcomes 2021; 14:e007963. [PMID: 34517724 PMCID: PMC8452241 DOI: 10.1161/circoutcomes.121.007963] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: National cardiac registries are increasingly used for informing health policy, improving the quality and cost-effectiveness of patient care, clinical research, and monitoring the safety of novel treatments. However, the quality of registries is variable. We aimed to assess the characteristics and quality of national cardiac registries across all subspecialties of cardiac care. Methods: Publications relating to national cardiac registries across six cardiac subspecialty domains were identified by searching MEDLINE and the Google advanced search function with 26 438 citations and 4812 full-text articles reviewed. Results: A total of 155 registries, representing 49 countries, were included in the study. Of these, 45 related to coronary disease or percutaneous coronary intervention, 28 related to devices, arrhythmia, and electrophysiology, 24 related to heart failure, transplant, and mechanical support, 21 related to structural heart disease, 21 related to congenital heart disease, and 16 related to cardiac surgery. Enrollment was procedure-based in 60% and disease-based in 40%. A total of 73.10 million patients were estimated to have been enrolled in cardiac registries. Quality scoring was performed using a validated registry grading system, with registries performing best in the use of explicit variable definitions and worst in assessment of data reliability. Higher quality scores were associated with government funding, mandated enrollment, linkage to other registries, and outcome risk adjustment. Quality scores and number of registries within a country were positively correlated with each other and with measures of national economic output, health expenditure, and urbanization. Conclusions: There has been remarkable growth in the uptake of national cardiac registries across the last few decades. However, the quality of processes used to ensure data completeness and accuracy remain variable and few countries have integrated registries covering multiple subspecialty domains. Clinicians, funders, and health policymakers should be encouraged to focus on the range, quality, and integration of these registries. Registration: URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42020204224.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia (L.P.D., J.L., L.B., D.E.).,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., S.B., J.L., D.S., S.M.E., C.R.).,Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., D.S.)
| | - Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., S.B., J.L., D.S., S.M.E., C.R.)
| | - Jeffrey Lefkovits
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia (L.P.D., J.L., L.B., D.E.).,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., S.B., J.L., D.S., S.M.E., C.R.)
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., S.B., J.L., D.S., S.M.E., C.R.).,Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia (L.P.D., D.S.).,The Baker Institute, Melbourne, Victoria, Australia (D.S.)
| | - Luke Burchill
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia (L.P.D., J.L., L.B., D.E.).,Department of Medicine, Melbourne University, Victoria, Australia (L.B., D.E.)
| | - Sue M Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., S.B., J.L., D.S., S.M.E., C.R.)
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (L.P.D., S.B., J.L., D.S., S.M.E., C.R.).,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia (C.R.)
| | - David Eccleston
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia (L.P.D., J.L., L.B., D.E.).,Department of Medicine, Melbourne University, Victoria, Australia (L.B., D.E.)
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28
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Abtahi H, Gholamzadeh M, Shahmoradi L, Shariat M. An information-based framework for development national twin registry: Scoping review and focus group discussion. Int J Health Plann Manage 2021; 36:1423-1444. [PMID: 34519094 DOI: 10.1002/hpm.3256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Registries in various clinical domains have been established in the last decades. The specific genetic structure of twins has enabled researchers to find answers to the role of genetics and the environment in medical sciences. Thus, twin registries were developed across the world to support twin studies. Our main objective was to devise a conceptual model for developing the national twin registry to ensure the success of this registry. METHODS In this descriptive and qualitative study, the combination of literature review and focus group discussions was applied to achieve suitable models for developing a national twin registry based on lessons learned from founded registries. The qualitative synthesis and reporting results were conducted based on the COREQ checklist. RESULTS According to a systematic literature review, the characteristics and employed strategies employed by established twin registries were recognized. Moreover, based on our objectives, suitable models for registry development were defined. The source of information, the different levels of data, and the information flow were determined based on this model. CONCLUSION Suggesting a conceptual framework for twin registry development at the national level based on the experiences of other countries could contribute to a greater understanding of twin registry implementation efficiently.
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Affiliation(s)
- Hamidreza Abtahi
- Associate Professor of Pulmonary and Critical Care Department, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Marsa Gholamzadeh
- Ph.D. Student in Medical Informatics, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Shahmoradi
- Associate Professor of Health Information Management, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Shariat
- Family Health Research Institute, Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Science, Tehran, Iran
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29
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Grant SW, Kendall S, Goodwin AT, Cooper G, Trivedi U, Page R, Jenkins DP. Trends and outcomes for cardiac surgery in the United Kingdom from 2002 to 2016. JTCVS OPEN 2021; 7:259-269. [PMID: 36003724 PMCID: PMC9390523 DOI: 10.1016/j.xjon.2021.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Objectives Cardiac surgery has evolved significantly since the turn of the century. The objective of this study was to investigate trends in cardiac surgery activity and outcomes in the United Kingdom utilizing a mandatory national cardiac surgical clinical database in the context of a comprehensive public health care system (ie, the UK National Health Service). Methods Data for all cardiac surgery procedures performed between 2002 and 2016 were extracted from the UK National Adult Cardiac Surgery Audit database. Data are validated and cleaned using reproducible algorithms. Trends in activity and outcomes were analyzed by fiscal year using linear regression. Results A total of 534,067 procedures were performed during the study period with the number of cases per year peaking in 2008/2009 at 41,426. Despite an increase in patient age and mean logistic European System for Cardiac Operative Risk Evaluation score, the in-hospital mortality rate for all cardiac surgery has fallen from 4.0% to 2.8% (P < .001). The number of isolated coronary artery bypass graft procedures has steadily declined but the total number of valve procedures has steadily increased (both P values < .001). The number of thoracic aortic procedures performed each year has doubled (P < .001), but the incidence of redo procedures has steadily declined. The proportion of emergency and salvage procedures has remained stable. Conclusions This study, which covers all cardiac surgery procedures performed in the United Kingdom for fiscal years between 2002 and 2016, demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality. A number of other markers associated with quality have also improved.
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Affiliation(s)
- Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Simon Kendall
- James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Graham Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Uday Trivedi
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Richard Page
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - David P Jenkins
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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30
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Benedetto U, Dimagli A, Kaura A, Sinha S, Mariscalco G, Krasopoulos G, Moorjani N, Field M, Uday T, Kendal S, Cooper G, Uppal R, Bilal H, Mascaro J, Goodwin A, Angelini G, Tsang G, Akowuah E. Determinants of outcomes following surgery for type A acute aortic dissection: the UK National Adult Cardiac Surgical Audit. Eur Heart J 2021; 43:44-52. [PMID: 34468733 PMCID: PMC8720141 DOI: 10.1093/eurheartj/ehab586] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/21/2021] [Accepted: 08/17/2021] [Indexed: 01/16/2023] Open
Abstract
Aims Operability of type A acute aortic dissections (TAAAD) is currently based on non-standardized decision-making process, and it lacks a disease-specific risk evaluation model that can predict mortality. We investigated patient, intraoperative data, surgeon, and centre-related variables for patients who underwent TAAAD in the UK. Methods and results We identified 4203 patients undergoing TAAAD surgery in the UK (2009–18), who were enrolled into the UK National Adult Cardiac Surgical Audit dataset. The primary outcome was operative mortality. A multivariable logistic regression analysis was performed with fast backward elimination of variables and the bootstrap-based optimism-correction was adopted to assess model performance. Variation related to hospital or surgeon effects were quantified by a generalized mixed linear model and risk-adjusted funnel plots by displaying the individual standardized mortality ratio against expected deaths. Final variables retained in the model were: age [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.02–1.03; P < 0.001]; malperfusion (OR 1.79, 95% CI 1.51–2.12; P < 0.001); left ventricular ejection fraction (moderate: OR 1.40, 95% CI 1.14–1.71; P = 0.001; poor: OR 2.83, 95% CI 1.90–4.21; P < 0.001); previous cardiac surgery (OR 2.29, 95% CI 1.71–3.07; P < 0.001); preoperative mechanical ventilation (OR 2.76, 95% CI 2.00–3.80; P < 0.001); preoperative resuscitation (OR 3.36, 95% CI 1.14–9.87; P = 0.028); and concomitant coronary artery bypass grafting (OR 2.29, 95% CI 1.86–2.83; P < 0.001). We found a significant inverse relationship between surgeons but not centre annual volume with outcomes. Conclusions Patient characteristics, intraoperative factors, cardiac centre, and high-volume surgeons are strong determinants of outcomes following TAAAD surgery. These findings may help refining clinical decision-making, supporting patient counselling and be used by policy makers for quality assurance and service provision improvement.
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Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - Amit Kaura
- National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W21NY, UK
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, UK
| | - George Krasopoulos
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Narain Moorjani
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Papworth Rd, Trumpington, Cambridge CB2 0AY, UK
| | - Mark Field
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Thomas Dr, Liverpool L14 3PE, UK
| | - Trivedi Uday
- Sussex Cardiac Center, Brighton and Sussex University Hospitals NHS Trust, Barry Building, Eastern Rd, Brighton BN2 5BE, UK
| | - Simon Kendal
- South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Graham Cooper
- Sheffield Teaching Hospitals Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Broomhall, Sheffield S10 2JF, UK
| | - Rakesh Uppal
- Barts Heart Centre, William Harvey Research Institute, W Smithfield, London EC1A 7BE, UK
| | - Haris Bilal
- Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, UK
| | - Jorge Mascaro
- University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Andrew Goodwin
- South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Gianni Angelini
- Bristol Heart Institute, University of Bristol, Senate House, Tyndall Avenue, Bristol BS8 1TH, UK
| | - Geoffry Tsang
- Wessex Cardiothoracic Center, University Hospital Southampton NHS Trust, Tremona Road Southampton, Hampshire SO16 6YD, UK
| | - Enoch Akowuah
- South Tees Hospitals NHS Trust, Marton Road, Middlesbrough TS4 3BW, UK
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Ohri SK, Benedetto U, Luthra S, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Coronary artery bypass surgery in the UK, trends in activity and outcomes from a 15-year complete national series. Eur J Cardiothorac Surg 2021; 61:449-456. [PMID: 34448848 DOI: 10.1093/ejcts/ezab391] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to review the UK national trends in activity and outcome in coronary artery bypass graft (CABG) over a 15-year period (2002-2016). METHODS Validated data collected (2002-2016) and uploaded to National Institute for Cardiovascular Outcomes Research were used to generate summary data from the National Adult Cardiac Surgery Audit Database for the analysis. Logistic European System of Cardiac Operative Risk Evaluation was used for risk stratification with recalibration applied for governance. Data were analysed by financial year and presented as numerical, categorical, %, mean and standard deviation where appropriate. Mortality was recorded as death in hospital at any time after index CABG operation. RESULTS A total of 347 626 CABG procedures (282 883 isolated CABG, 61 109 CABG and valve and 4132 redo CABG) were recorded. Over this period annual activity reduced from 66.6% of workload to 41.7%. The mean age for isolated CABG was 65.7 years. The mean log European System of Cardiac Operative Risk Evaluation was 3.1, 5.9 and 23.2 for elective, urgent and emergency isolated CABG, respectively. There was a decline in the observed mortality for all procedures. Overall mortality for isolated CABG surgery is now 1.0% and only 0.6% for elective operations. CONCLUSIONS Quality of care and risk-adjusted mortality rates have consistently improved over the last 15 years despite the increasing risk profile of patients. There have been a consistent decline in overall case volumes and a three-fold increase in elderly cases.
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Affiliation(s)
- Sunil K Ohri
- Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Umberto Benedetto
- Division of Cardiac Surgery, University of Bristol and Bristol Royal Infirmary, Bristol, UK
| | - Suvitesh Luthra
- Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, James Cook University Hospital, Middlesborough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, James Cook University Hospital, Middlesborough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Taylor M, Martin GP, Abah U, Sperrin M, Smith M, Bhullar D, Shackcloth M, Woolley S, West D, Shah R, Grant SW. Development and internal validation of a clinical prediction model for 90-day mortality after lung resection: the RESECT-90 score. Interact Cardiovasc Thorac Surg 2021; 33:921-927. [PMID: 34324664 DOI: 10.1093/icvts/ivab200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 06/24/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The ability to accurately estimate the risk of peri-operative mortality after lung resection is important. There are concerns about the performance and validity of existing models developed for this purpose, especially when predicting mortality within 90 days of surgery. The aim of this study was therefore to develop a clinical prediction model for mortality within 90 days of undergoing lung resection. METHODS A retrospective database of patients undergoing lung resection in two UK centres between 2012 and 2018 was used to develop a multivariable logistic risk prediction model, with bootstrap sampling used for internal validation. Apparent and adjusted measures of discrimination (area under receiving operator characteristic curve) and calibration (calibration-in-the-large and calibration slope) were assessed as measures of model performance. RESULTS Data were available for 6600 lung resections for model development. Predictors included in the final model were age, sex, performance status, percentage predicted diffusion capacity of the lung for carbon monoxide, anaemia, serum creatinine, pre-operative arrhythmia, right-sided resection, number of resected bronchopulmonary segments, open approach and malignant diagnosis. Good model performance was demonstrated, with adjusted area under receiving operator characteristic curve, calibration-in-the-large and calibration slope values (95% confidence intervals) of 0.741 (0.700, 0.782), 0.006 (-0.143, 0.156) and 0.870 (0.679, 1.060), respectively. CONCLUSIONS The RESECT-90 model demonstrates good statistical performance for the prediction of 90-day mortality after lung resection. A project to facilitate large-scale external validation of the model to ensure that the model retains accuracy and is transferable to other centres in different geographical locations is currently underway.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Matthew Sperrin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dilraj Bhullar
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Steve Woolley
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Doug West
- Division of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital NHS Foundation Trust, Manchester, UK
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Baghai M, Wendler O, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Aortic valve surgery in the UK, trends in activity and outcomes from a 15-year complete national series. Eur J Cardiothorac Surg 2021; 60:1353-1357. [PMID: 34021313 DOI: 10.1093/ejcts/ezab199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Since the turn of the century, cardiac surgery has evolved quite notably. This study sought to investigate the trends in aortic valve surgery activity and subsequent outcomes in the UK by using a mandatory national cardiac surgical clinical database within the context of a comprehensive public healthcare system (National Health Service). METHODS The UK National Adult Cardiac Surgery Audit database provided data for aortic valve surgery procedures performed between 2002 and 2016, and the data were validated and cleaned using reproducible algorithms. The findings and trends in in activity and outcomes were then analysed by financial year. RESULTS During the study period, a total of 148 862 procedures were performed, with the number of cases per year peaking in 2014/2015 at 12 483. The mean in-hospital mortality rate for all aortic valve surgery has fallen from 5.6% to 3.4%, despite an increase in patient age and mean logistic EuroSCORE. While the number of isolated aortic valve replacements has remained stable at around 5000 per year, aortic valve replacement and coronary artery bypass graft have increased to over 3200 with transcatheter aortic valve implantation activity continuing to increase. CONCLUSIONS This study demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality within all aortic valve surgery procedures performed in the UK over a 15-year period. Increasing catheter-based interventions have not yet resulted in a significant decrease in surgical aortic valve replacements in the UK.
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Affiliation(s)
- Max Baghai
- Cardiovascular Division, Kings College Hospital, London, UK
| | - Olaf Wendler
- Cardiovascular Division, Kings College Hospital, London, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Martin GP, Curzen N, Goodwin AT, Nolan J, Balacumaraswami L, Ludman PF, Kontopantelis E, Wu J, Gale CP, de Belder MA, Mamas MA. Indirect Impact of the COVID-19 Pandemic on Activity and Outcomes of Transcatheter and Surgical Treatment of Aortic Stenosis in England. Circ Cardiovasc Interv 2021; 14:e010413. [PMID: 34003671 PMCID: PMC8126473 DOI: 10.1161/circinterventions.120.010413] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Supplemental Digital Content is available in the text. Aortic stenosis requires timely treatment with either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). This study aimed to investigate the indirect impact of coronavirus disease 2019 (COVID-19) on national SAVR and TAVR activity and outcomes.
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Affiliation(s)
- Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (G.P.M., E.K.)
| | - Nick Curzen
- Wessex Cardiothoracic Unit, Southampton University Hospital Southampton and Faculty of Medicine, University of Southampton, United Kingdom (N.C.)
| | - Andrew T Goodwin
- South Tees Hospital NHS Foundation Trust, Middlesbrough, United Kingdom (A.T.G.).,National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (A.T.G., M.A.d.B.)
| | - James Nolan
- Royal Stoke Hospital, Stoke on Trent and Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom (J.N., L.B., M.A.M.)
| | - Lognathen Balacumaraswami
- Royal Stoke Hospital, Stoke on Trent and Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom (J.N., L.B., M.A.M.)
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (P.F.L.)
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, United Kingdom (G.P.M., E.K.)
| | - Jianhua Wu
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (J.W., C.P.G.)
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom (J.W., C.P.G.)
| | - Mark A de Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, United Kingdom (A.T.G., M.A.d.B.).,Thomas Jefferson University, Philadelphia, PA (M.A.M.)
| | - Mamas A Mamas
- Royal Stoke Hospital, Stoke on Trent and Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, United Kingdom (J.N., L.B., M.A.M.)
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35
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Burns DJ, Rapetto F, Angelini GD, Benedetto U, Caputo M, Ciulli F, Vohra HA. Body mass index and early outcomes following mitral valve surgery for degenerative disease. J Thorac Cardiovasc Surg 2021; 161:1765-1773.e2. [DOI: 10.1016/j.jtcvs.2019.10.193] [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: 03/20/2019] [Revised: 10/02/2019] [Accepted: 10/27/2019] [Indexed: 12/31/2022]
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36
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Cappato R, Ali H. Surveys and Registries on Catheter Ablation of Atrial Fibrillation: Fifteen Years of History. Circ Arrhythm Electrophysiol 2021; 14:e008073. [PMID: 33441001 DOI: 10.1161/circep.120.008073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surveys and registries are widely used in medicine as valuable tools to integrate the information from randomized and observational studies. Early after its introduction in daily practice and parallel to its escalating popularity, catheter ablation of atrial fibrillation has been the subject of several surveys and registries. Over the years, relevant aspects associated with atrial fibrillation ablation have been investigated using these tools, including procedural safety and efficacy, discontinuation of anticoagulation therapy and risk of stroke postablation, and outcomes in special populations. The aim of this article is to provide a comprehensive review of the contributions offered by surveys and registries in catheter ablation of atrial fibrillation over the past 15 years.
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Affiliation(s)
- Riccardo Cappato
- Arrhythmia and Electrophysiology Center, IRCCS - MultiMedica Group, Milan, Italy
| | - Hussam Ali
- Arrhythmia and Electrophysiology Center, IRCCS - MultiMedica Group, Milan, Italy
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37
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van Steenbergen GJ, van Veghel D, Schulz DN, Soliman-Hamad M, Tonino PA, Houterman S, Dekker L. Better survival after transcatheter aortic valve replacement by process improvements. Neth Heart J 2020; 29:193-200. [PMID: 33284420 PMCID: PMC7991044 DOI: 10.1007/s12471-020-01526-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study is to assess the effects on procedural, 30-day, and 1‑year all-cause mortality by a newly introduced quality improvement strategy in patients after transcatheter aortic valve replacement (TAVR). Methods In October 2015, a coherent set of quality improving interventions with respect to patient geriatric screening, general diagnostic examination and safety of the procedure was implemented at a single centre in the Netherlands. Patients undergoing TAVR in 2013–2018 were included for retrospective analysis. Mortality was assessed in the pre-quality improvement strategy cohort (January 2013 to October 2015; cohort A) and in the post-quality improvement strategy cohort (November 2015 to December 2018; cohort B). Logistic regression analysis was used to estimate the influence of patient and procedural characteristics on the results of the quality improvement strategy in terms of procedural, 30-day, and 1‑year all-cause mortality. Results In total, 806 patients were analysed with 274 patients in cohort A and 532 patients in cohort B. After introduction of the quality improvement strategy, procedural (4.4% to 1.3%, p < 0.01), 30-day (8.4% to 2.7%, p < 0.01) and 1‑year (16.4% to 8.5%, p < 0.01) all-cause mortality significantly decreased. Multivariate regression analysis showed that the quality improvement strategy also significantly reduced 30-day (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.09–0.42) and 1‑year (OR 0.38, 95% CI 0.24–0.61) all-cause mortality if corrected for patient characteristics. Conclusion Structural meetings on evaluation of outcomes highlight potential areas for improvement and subsequent outcome-based quality improvement initiatives can result in lower procedural, 30-day, and 1‑year all-cause mortality. Electronic supplementary material The online version of this article (10.1007/s12471-020-01526-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - D van Veghel
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - D N Schulz
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Soliman-Hamad
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - P A Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - S Houterman
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.,Netherlands Heart Registration (NHR), Utrecht, The Netherlands
| | - L Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.,Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
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Taylor M, Szafron B, Martin GP, Abah U, Smith M, Shackcloth M, Granato F, Shah R, Grant SW, Eadington T, Argus L, Michael S, Mason S, Bhullar D, Obale E, Fritsch NC, Shah R, Krysiak P, Rammohan K, Fontaine E, Granato F, Page R, Woolley S, Shackcloth M, Assante-Siaw J, Mediratta N. External validation of six existing multivariable clinical prediction models for short-term mortality in patients undergoing lung resection. Eur J Cardiothorac Surg 2020; 59:1030-1036. [DOI: 10.1093/ejcts/ezaa422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 12/23/2022] Open
Abstract
Abstract
OBJECTIVES
National guidelines advocate the use of clinical prediction models to estimate perioperative mortality for patients undergoing lung resection. Several models have been developed that may potentially be useful but contemporary external validation studies are lacking. The aim of this study was to validate existing models in a multicentre patient cohort.
METHODS
The Thoracoscore, Modified Thoracoscore, Eurolung, Modified Eurolung, European Society Objective Score and Brunelli models were validated using a database of 6600 patients who underwent lung resection between 2012 and 2018. Models were validated for in-hospital or 30-day mortality (depending on intended outcome of each model) and also for 90-day mortality. Model calibration (calibration intercept, calibration slope, observed to expected ratio and calibration plots) and discrimination (area under receiver operating characteristic curve) were assessed as measures of model performance.
RESULTS
Mean age was 66.8 years (±10.9 years) and 49.7% (n = 3281) of patients were male. In-hospital, 30-day, perioperative (in-hospital or 30-day) and 90-day mortality were 1.5% (n = 99), 1.4% (n = 93), 1.8% (n = 121) and 3.1% (n = 204), respectively. Model area under the receiver operating characteristic curves ranged from 0.67 to 0.73. Calibration was inadequate in five models and mortality was significantly overestimated in five models. No model was able to adequately predict 90-day mortality.
CONCLUSIONS
Five of the validated models were poorly calibrated and had inadequate discriminatory ability. The modified Eurolung model demonstrated adequate statistical performance but lacked clinical validity. Development of accurate models that can be used to estimate the contemporary risk of lung resection is required.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Bartłomiej Szafron
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Felice Granato
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, UK
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Huebner H, Kurbacher CM, Kuesters G, Hartkopf AD, Lux MP, Huober J, Volz B, Taran FA, Overkamp F, Tesch H, Häberle L, Lüftner D, Wallwiener M, Müller V, Beckmann MW, Belleville E, Ruebner M, Untch M, Fasching PA, Janni W, Fehm TN, Kolberg HC, Wallwiener D, Brucker SY, Schneeweiss A, Ettl J. Heregulin (HRG) assessment for clinical trial eligibility testing in a molecular registry (PRAEGNANT) in Germany. BMC Cancer 2020; 20:1091. [PMID: 33176725 PMCID: PMC7656772 DOI: 10.1186/s12885-020-07546-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eligibility criteria are a critical part of clinical trials, as they define the patient population under investigation. Besides certain patient characteristics, clinical trials often include biomarker testing for eligibility. However, patient-identification mostly relies on the trial site itself and is often a time-consuming procedure, which could result in missing out on potentially eligible patients. Pre-selection of those patients using a registry could facilitate the process of eligibility testing and increase the number of identified patients. One aim with the PRAEGNANT registry (NCT02338167) is to identify patients for therapies based on clinical and molecular data. Here, we report eligibility testing for the SHERBOC trial using the German PRAEGNANT registry. METHODS Heregulin (HRG) has been reported to identify patients with better responses to therapy with the anti-HER3 monoclonal antibody seribantumab (MM-121). The SHERBOC trial investigated adding seribantumab (MM-121) to standard therapy in patients with advanced HER2-negative, hormone receptor-positive (HR-positive) breast cancer and HRG overexpression. The PRAEGNANT registry was used for identification and tumor testing, helping to link potential HRG positive patients to the trial. Patients enrolled in PRAEGNANT have invasive and metastatic or locally advanced, inoperable breast cancer. Patients eligible for SHERBOC were identified by using the registry. Study aims were to describe the HRG positivity rate, screening procedures, and patient characteristics associated with inclusion and exclusion criteria. RESULTS Among 2769 unselected advanced breast cancer patients, 650 were HER2-negative, HR-positive and currently receiving first- or second-line treatment, thus potentially eligible for SHERBOC at the end of current treatment; 125 patients also met further clinical eligibility criteria (e.g. menopausal status, ECOG). In the first/second treatment lines, patients selected for SHERBOC based on further eligibility criteria had a more favorable prognosis than those not selected. HRG status was tested in 38 patients, 14 of whom (36.8%) proved to be HRG-positive. CONCLUSION Using a real-world breast cancer registry allowed identification of potentially eligible patients for SHERBOC focusing on patients with HER3 overexpressing, HR-positive, HER2-negative metastatic breast cancer. This approach may provide insights into differences between patients eligible or non-eligible for clinical trials. TRIAL REGISTRATION Clinicaltrials, NCT02338167 , Registered 14 January 2015 - retrospectively registered.
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Affiliation(s)
- Hanna Huebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Universitaetsstrasse 21-23, Erlangen, 91054, Germany
| | - Christian M Kurbacher
- Gynecology I (Gynecologic Oncology), Gynecologic Center Bonn-Friedensplatz, Bonn, Germany
| | | | - Andreas D Hartkopf
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Michael P Lux
- Klinik für Gynäkologie und Geburtshilfe Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Kooperatives Brustzentrum, Paderborn, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Bernhard Volz
- Ansbach University of Applied Sciences, Ansbach, Germany
| | | | | | - Hans Tesch
- Oncology Practice at Bethanien Hospital Frankfurt, Frankfurt, Germany
| | - Lothar Häberle
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Universitaetsstrasse 21-23, Erlangen, 91054, Germany.,Biostatistics Unit, Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Diana Lüftner
- Berlin, Campus Benjamin Franklin, Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Berlin, Germany
| | - Markus Wallwiener
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Volkmar Müller
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Universitaetsstrasse 21-23, Erlangen, 91054, Germany
| | | | - Matthias Ruebner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Universitaetsstrasse 21-23, Erlangen, 91054, Germany
| | - Michael Untch
- Department of Gynecology and Obstetrics, Helios Clinics Berlin Buch, Berlin, Germany
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Universitaetsstrasse 21-23, Erlangen, 91054, Germany.
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Tanja N Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Diethelm Wallwiener
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Sara Y Brucker
- Department of Obstetrics and Gynecology, University of Tübingen, Tübingen, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases and Department of Gynecology and Obstetrics, Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Ettl
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Onorati F, Quintana E, El-Dean Z, Perrotti A, Sponga S, Ruggieri VG, Rinaldi M, Milano AD, Santini F, Chocron S, Livi U, Salizzoni S, Loizzo T, Salsano A, Di Cesare A, Faggian G, Castella M, Nicolini F. Aortic Valve Replacement for Aortic Stenosis in Low-, Intermediate-, and High-Risk Patients: Preliminary Results From a Prospective Multicenter Registry. J Cardiothorac Vasc Anesth 2020; 34:2091-2099. [DOI: 10.1053/j.jvca.2020.02.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
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Caliskan E, Sandner S, Misfeld M, Aramendi J, Salzberg SP, Choi YH, Satishchandran V, Iyer G, Perrault LP, Böning A, Emmert MY. A novel endothelial damage inhibitor for the treatment of vascular conduits in coronary artery bypass grafting: protocol and rationale for the European, multicentre, prospective, observational DuraGraft registry. J Cardiothorac Surg 2019; 14:174. [PMID: 31615560 PMCID: PMC6794868 DOI: 10.1186/s13019-019-1010-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background Vein graft disease (VGD) impairs graft patency rates and long-term outcomes after coronary artery bypass grafting (CABG). DuraGraft is a novel endothelial-damage inhibitor developed to efficiently protect the structural and functional integrity of the vascular endothelium. The DuraGraft registry will evaluate the long-term clinical outcomes of DuraGraft in patients undergoing CABG procedures. Methods This ongoing multicentre, prospective observational registry will enrol 3000 patients undergoing an isolated CABG procedure or a combined procedure (ie, CABG plus valve surgery or other surgery) with at least one saphenous vein grafts or one free arterial graft (ie, radial artery or mammary artery). If a patient is enrolled, all free grafts (SVG and arterial will be treated with DuraGraft. Data on baseline, clinical, and angiographic characteristics as well as procedural and clinical events will be collected. The primary outcome measure is the occurrence of a major adverse cardiac event (MACE; defined as death, non-fatal myocardial-infarction, or need for repeat-revascularisation). Secondary outcome measures are the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as death, non-fatal myocardial-infarction, repeat-revascularisation, or stroke), patient-reported quality of life, and health-economic data. Patient assessments will be performed during hospitalisation, at 1-month, 1-year, and annually thereafter to 5 years post-CABG. Events will be adjudicated by an independent clinical events committee. This European, multi-institutional registry will provide detailed insights into clinical outcome associated with DuraGraft. Discussion This European, multi-institutional registry will provide detailed insights into clinical outcome associated with the use of DuraGraft. Beyond that, and given the comprehensive data sets comprising of patient, procedural, and graft parameters that are being collected, the registry will enable for multiple subgroup analyses targeting focus groups or specific clinical questions. These may include analysis of subpopulations such as patients with diabetes or multimorbid high-risk patients (patient level), evaluation of relevance of harvesting technique including endoscopic versus open conduit harvesting (procedural level), or particular graft-specific aspects (conduit level). Trial registration ClinicalTrials.gov NCT02922088. Registered October 3, 2016. Ethics and dissemination The regional ethics committees have approved the registry. Results will be submitted for publication.
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Affiliation(s)
- Etem Caliskan
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Sigrid Sandner
- Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Martin Misfeld
- University Clinic of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Jose Aramendi
- Division of Cardiac Surgery, Hospital de Cruces, Barakaldo, Spain
| | | | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | | | | | - Louis P Perrault
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Andreas Böning
- Department of Cardiovascular Surgery, Justus-Liebig University Gießen, Gießen, Germany
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany. .,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
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Reichart D, Rosato S, Nammas W, Onorati F, Dalén M, Castro L, Gherli R, Gatti G, Franzese I, Faggian G, De Feo M, Khodabandeh S, Santarpino G, Rubino AS, Maselli D, Nardella S, Salsano A, Nicolini F, Zanobini M, Saccocci M, Bounader K, Kinnunen EM, Tauriainen T, Airaksinen J, Seccareccia F, Mariscalco G, Ruggieri VG, Perrotti A, Biancari F. Clinical frailty scale and outcome after coronary artery bypass grafting. Eur J Cardiothorac Surg 2019; 54:1102-1109. [PMID: 29897529 DOI: 10.1093/ejcts/ezy222] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/09/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the impact of frailty on the outcome after coronary artery bypass grafting (CABG) and whether it may improve the predictive ability of European System for Cardiac Operative Risk Evaluation (EuroSCORE II). METHODS The Clinical Frailty Scale (CFS) was assessed preoperatively in patients undergoing isolated CABG from the multicentre E-CABG registry, and patients were stratified into 3 classes: scores 1-2, scores 3-4 and scores 5-7. RESULTS Of the 6156 patients enrolled, 39.2% had CFS scores 1-2, 57.6% scores 3-4, and 3.2% scores 5-7. Logistic regression adjusted for multiple covariates showed that the CFS was an independent predictor of hospital/30-day mortality [CFS scores 3-4, odds ratio (OR) 3.95, 95% confidence interval (CI) 2.19-7.14; CFS scores 5-7, OR 5.90, 95% CI 2.67-13.05] and resulted in an Integrated Improvement Index of 1.3 (P < 0.001) and a Net Reclassification Index of 55.6 (P < 0.001) for prediction of hospital/30-day mortality. Adding the CFS classes to EuroSCORE II resulted in an Integrated Improvement Index of 0.9 (P < 0.001) and Net Reclassification Index of 59.6 (P < 0.001) for prediction of hospital/30-day mortality with a significantly larger area under the receiver operating characteristics curve (0.809 vs 0.781, P = 0.028). The CFS was an independent predictor of mid-term mortality [CFS scores 3-4, hazard ratio (HR) 2.05, 95% CI 1.43-2.85; CFS scores 5-7, HR 3.05, 95% CI 1.83-5.06]. CONCLUSIONS The CFS predicted early- and mid-term mortality in patients undergoing isolated CABG. Further studies are needed to evaluate whether frailty may improve the estimation of the operative risk of patients undergoing adult cardiac surgery. Clinicaltrials.gov number NCT02319083.
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Affiliation(s)
| | - Stefano Rosato
- National Center of Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Wail Nammas
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Francesco Onorati
- Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
| | - Magnus Dalén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Liesa Castro
- Hamburg University Heart Center, Hamburg, Germany
| | - Riccardo Gherli
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
| | - Ilaria Franzese
- Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
| | - Marisa De Feo
- Department of Cardiothoracic Sciences, University of Campania, Naples, Italy
| | - Sorosh Khodabandeh
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Santarpino
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.,Città di Lecce Hospital GVM Care&Research, Lecce, Italy
| | - Antonino S Rubino
- Centro Clinico-Diagnostico "G.B. Morgagni", Centro Cuore, Pedara, Italy
| | - Daniele Maselli
- Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
| | - Saverio Nardella
- Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
| | - Antonio Salsano
- Division of Cardiac Surgery, University of Genoa, Genoa, Italy
| | | | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy
| | - Matteo Saccocci
- Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Eeva-Maija Kinnunen
- Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tuomas Tauriainen
- Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Fulvia Seccareccia
- National Center of Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Vito G Ruggieri
- Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Fausto Biancari
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland.,Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Surgery, University of Turku, Turku, Finland
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Mulder DS, Spicer J. Registry-Based Medical Research: Data Dredging or Value Building to Quality of Care? Ann Thorac Surg 2019; 108:274-282. [DOI: 10.1016/j.athoracsur.2018.12.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 10/31/2018] [Accepted: 12/29/2018] [Indexed: 12/16/2022]
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Bisdas T, Bohan P, Lescan M, Zeebregts CJ, Tessarek J, van Herwaarden J, van den Berg JC, Setacci C, Riambau V. Research methodology and practical issues relating to the conduct of a medical device registry. Clin Trials 2019; 16:490-501. [PMID: 31184490 DOI: 10.1177/1740774519855395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The postmarket research goal is to assess "generalizability" or "external validity" to see if the early results of clinical trials with investigational devices are reproducible in everyday practice in the real world and the longer term. Registries have an important but ambivalent role in achieving this goal. METHODS Although registries are common, in practice they follow the regulatory processes that appear designed primarily for pharmaceutical clinical trials and confirmatory studies. We review the literature to assess different definitions and the role of registries in the hierarchy of scientific evidence. We analyze common characteristics affecting registry design, implementation, and governance as well as safety reporting and off-label use while describing the experience of setting up an international, prospective registry for an endovascular device used to treat abdominal aortic aneurysms. RESULTS Key areas in which to distinguish registries from trials are as follows: eligibility, setting (patients and institutions), device configurations and iterations, the use of design and quality "spaces," a focus on systematic quality checks (rather than source data monitoring), open-ended follow-up, flexibility in the definition of end points and sample sizes, data sharing, and publishing commitments. CONCLUSION Both clinical trials and registries are essential and complementary research methods and the strengths and weaknesses of each need to be recognized. The specific characteristics of registry research deserve to be acknowledged and safeguarded in the regulations governing clinical investigations with medical devices.
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Affiliation(s)
- Theodosios Bisdas
- St. Franziskus-Hospital Münster GmbH, Münster, Germany.,Clinic of Vascular and Endovascular Therapy, Omilos Iatrikou Athinon, Athens, Greece
| | | | - Mario Lescan
- Universitätsklinikum Tübingen Medizinische Universitätsklinik, Tübingen, Germany
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jörg Tessarek
- St. Bonifatius Hospital Lingen gGmbH, Lingen, Germany
| | - Joost van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Carlo Setacci
- AOU Senese, Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Mandavia R, Mehta N, Veer V. Guidelines on the surgical management of sleep disorders: A systematic review. Laryngoscope 2019; 130:1070-1084. [PMID: 31042014 DOI: 10.1002/lary.28028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/28/2019] [Accepted: 04/08/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To facilitate the development of U.K. guidelines for sleep surgery and to guide sleep surgeons to existing guidelines relevant to their practice, we provide a systematic review and quality assessment of all existing guidelines on the surgical management of sleep disorders. METHODS Systematic review using preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Medline and Embase databases were searched from inception to April 2018. Publications were included if they described a guideline for the surgical management of sleep disorders. Three assessors used the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to evaluate included guidelines. RESULTS The systematic search revealed 1,161 publications. Twenty-two guidelines from eight countries were included. Fourteen focused on adults, five on children, and three on both. The guidelines discussed nasal, tonsillar, palatal, tongue, hyoid, maxillomandibular, tracheal, bariatric, and multilevel surgeries. The mean overall AGREE II quality score of included guidelines was 3.5 (range = 2 to 5.3; maximum possible score = 7). CONCLUSION This article provides a summary and quality assessment of all published guidelines on the surgical management of sleep disorders. No U.K. guidelines were identified, and existing guidelines have several shortcomings. This highlights the need for robust U.K. national guidelines on sleep surgery to promote clinical and cost-effective care in this field. Our findings can be used by stakeholders as a foundation for the development of new guidelines and can be used by sleep surgeons to direct them to existing guidelines relevant to their practice, promoting evidence-based clinical care. Laryngoscope, 130:1070-1084, 2020.
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Affiliation(s)
- Rishi Mandavia
- Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Nishchay Mehta
- Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Vik Veer
- Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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Mariscalco G, Bilal H, Catarino P, Hadjinikolaou L, Kuduvalli M, Field M, Mascaro J, Oo AY, Quarto C, Kuo J, Tsang G. Reflection From UK Aortic Group: Frozen Elephant Trunk Technique as Optimal Solution in Type A Acute Aortic Dissection. Semin Thorac Cardiovasc Surg 2019; 31:686-690. [PMID: 30980933 DOI: 10.1053/j.semtcvs.2019.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/18/2019] [Indexed: 12/29/2022]
Abstract
Diseases of the thoracic aorta are increasing in prevalence worldwide. Recent data indicated wide regional variation in the volume and complexity of aortic cases undertaken in United Kingdom cardiac centers, especially in case of acute type A aortic dissection (ATAAD) conditions. Patients treated in high-volume centers with a specific multidisciplinary aortic program had a significant reduction in ATAAD mortality when compared with low-volume centers. Following the initial phase of a national aortic center reorganization, the current study reflects the initial experience of a national collective of cardiothoracic surgeons with expertise in complex aortic surgery, using frozen elephant trunk as standard technique for the surgical treatment of patients affected by ATAAD. Between June 2013 and October 2017, 66 ATAAD patients (45% women) underwent hybrid aortic arch and frozen elephant trunk repair with the Thoraflex hybrid graft at 8 UK high-volume aortic centers. The in-hospital mortality accounted for 8 patients (12%). Postoperative temporary or permanent neurologic events and temporary renal replacement therapy occurred in 17% and 20% of patients, respectively. No spinal cord injury events were documented. Our data were similar to those reported in literature in the 2 largest experiences with the use of frozen elephant technique in ATAAD condition (in-hospital/30-day mortality: 11-12%). This initial experience demonstrated that frozen elephant technique can potentially be adopted as standard approach in life-threatening aortic diseases, with acceptable complication and mortality rates.
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Affiliation(s)
- Giovanni Mariscalco
- Cardiac Surgery Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
| | - Haris Bilal
- Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
| | | | - Leonidas Hadjinikolaou
- Cardiac Surgery Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Field
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Jorge Mascaro
- University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Aung Y Oo
- Department of Cardiac Surgery, Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom
| | - James Kuo
- Southwest Cardiothoracic Center, Derriford Hospital, Plymouth, United Kingdom
| | - Geoff Tsang
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Pop B, Fetica B, Blaga ML, Trifa AP, Achimas-Cadariu P, Vlad CI, Achimas-Cadariu A. The role of medical registries, potential applications and limitations. Med Pharm Rep 2019; 92:7-14. [PMID: 30957080 PMCID: PMC6448488 DOI: 10.15386/cjmed-1015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022] Open
Abstract
Medical registries provide highly reliable data, challenged hierarchically only by randomized controlled trials. Although registries have been used in several fields of medicine for more than a century and a half, their key role is frequently overlooked and poorly recognized. Medical registries have evolved from calculating basic epidemiological data (incidence, prevalence, mortality) to diverse applications in disease prevention, early diagnosis and screening programs, treatment response, health care planning, decision making and disease control programs. Implementing, maintaining and running a medical registry requires substantial effort. Developing the registry represents a complex task and is one of the major barriers in widespread use of registries. Medical registries have potential to evolve to a next generation by taking benefit from recent semantic web technology developments. This paper is aimed at providing a summary of the basic information available on medical registries and to highlight the progress and potential applications in this field.
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Affiliation(s)
- Bogdan Pop
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Pathology, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania
| | - Bogdan Fetica
- Department of Pathology, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania
| | - Mihaiela Luminita Blaga
- Department of Information Technology, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca Cluj-Napoca, Romania
| | - Adrian Pavel Trifa
- Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Genetic Explorations, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca Cluj-Napoca, Romania
| | - Patriciu Achimas-Cadariu
- Department of Surgical and Gynecological Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Surgery, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania
| | - Catalin Ioan Vlad
- Department of Surgical and Gynecological Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Surgery, "Prof. Dr. Ion Chiricuta" Oncology Institute, Cluj-Napoca, Romania
| | - Andrei Achimas-Cadariu
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Sádaba R. El tránsito hacia un nuevo registro español de cirugía cardiaca. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Kampstra NA, Zipfel N, van der Nat PB, Westert GP, van der Wees PJ, Groenewoud AS. Health outcomes measurement and organizational readiness support quality improvement: a systematic review. BMC Health Serv Res 2018; 18:1005. [PMID: 30594193 PMCID: PMC6311059 DOI: 10.1186/s12913-018-3828-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/17/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Using outcome measures to advance healthcare continues to be of widespread interest. The goal is to summarize the results of studies which use outcome measures from clinical registries to implement and monitor QI initiatives. The second objective is to identify a) facilitators and/or barriers that contribute to the realization of QI efforts, and b) how outcomes are being used as a catalyst to change outcomes over time. METHODS We searched the PubMed, EMBASE and Cochrane databases for relevant articles published between January 1995 and March 2017. We used a standardized data abstraction form. Studies were included when the following three criteria were fulfilled: 1) they relied on structural data collection, 2) when a structural and comprehensive QI intervention had been implemented and evaluated, and 3) impact on improving clinical and/or patient-reported outcomes was described. Data on QI strategies, QI initiatives and the impact on outcomes was extracted using standardized assessment tools. RESULTS We included 21 articles, of which eight showed statistically significant improvements on outcomes using data from clinical registries. Out of these eight studies, the Chronic Care Model, IT application as feedback, benchmarking and the Collaborative Care Model were used as QI methods. Encouraging trends in realizing improved outcomes through QI initiatives were observed, ranging from improving teamwork, implementation of clinical guidelines, implementation of physician alerts and development of a decision support system. Facilitators for implementing QI initiatives included a high quality database, audits, frequent reporting and feedback, patient involvement, communication, standardization, engagement, and leadership. CONCLUSION This review suggests that outcomes collected in clinical registries are supportive to realize QI initiatives. Organizational readiness and an active approach are key in achieving improved outcomes.
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Affiliation(s)
- Nynke A Kampstra
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, the Netherlands. .,Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, the Netherlands.
| | - Nina Zipfel
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, the Netherlands.,Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, the Netherlands
| | - Paul B van der Nat
- Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Gert P Westert
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, the Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, the Netherlands
| | - A Stef Groenewoud
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Radboud university medical center, Nijmegen, the Netherlands
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50
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Tan JCK, Ferdi AC, Gillies MC, Watson SL. Clinical Registries in Ophthalmology. Ophthalmology 2018; 126:655-662. [PMID: 30572076 DOI: 10.1016/j.ophtha.2018.12.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/21/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
Abstract
TOPIC Clinical registries in ophthalmology. CLINICAL RELEVANCE In recent years, advancements in digital technology and increasing use of electronic medical records in health systems have led to the dramatic growth in large clinical data sets. Clinical data registries are organized systems that collect data on patients diagnosed with a disease or condition or who undergo a certain procedure. METHODS A search of the PUBMED database was conducted in January 2018 for clinical registries in ophthalmology. RESULTS Ninety-seven clinical eye registries were found, with significant growth in numbers in the last 4 decades. The most common conditions captured were blindness or low vision, corneal transplantation, glaucoma, and cataract surgery. Most registries originate in the European region, North America, and Australia. Nine registries had multinational coverage, whereas 48 were national registries. As the numbers and scope of clinical registries have expanded, valuable observational data have been used to study real-world clinical outcomes in healthcare quality measurement and improvement and to develop new guidelines and standards. Pertinent areas of its use include studying treatments and outcomes in cataract surgery, corneal transplantation, and macular degeneration. CONCLUSIONS The use of clinical registries for quality improvement and research has grown significantly in the last few decades, and this trend will continue as information technology infrastructures develop.
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Affiliation(s)
- Jeremy C K Tan
- Save Sight Institute, University of Sydney, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia.
| | | | - Mark C Gillies
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Stephanie L Watson
- Save Sight Institute, University of Sydney, Sydney, Australia; Sydney Eye Hospital, Sydney, Australia
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