1
|
Kalsbeek A, Chuckaree I, Khoury MK, Leonard G, Maaraoui K, Liu C, Hackmann A, Huffman LC, Peltz M, Ring WS, Wait MA, Heid CA. Impact of cerebrovascular accidents on lung transplant survival. J Card Surg 2022; 37:4719-4725. [PMID: 36345686 DOI: 10.1111/jocs.17086] [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: 08/06/2022] [Revised: 09/27/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cerebrovascular accidents (CVA) are a source of postoperative morbidity. Existing data on CVA after lung transplantation (LT) are limited. We aimed to evaluate the impact of CVA on LT survival. METHODS A retrospective analysis of LT recipients at the University of Texas Southwestern Medical Center was performed. Data was obtained from the institutional thoracic transplant database between January 2012 and December 2018, which consisted of 476 patients. Patients were stratified by the presence of a postoperative CVA. Univariate comparisons of baseline characteristics, operative variables, and postoperative outcomes between the cohorts were performed. Survival was analyzed by Kaplan-Meier method. Aalen's additive regression model was utilized to assess mortality hazard over time. RESULTS The incidence of CVA was 4.2% (20/476). Lung allocation score was higher in the CVA cohort (46.2 [41.7, 57.3] vs. 41.5 [35.8, 52.2], p = 0.04). There were no significant differences in operative variables. CVA patients had longer initial intensive care unit (ICU) stays (316 h [251, 557] vs. 124 [85, 218], p < 0.001) and longer length of stay (22 days [17, 53] vs. 15 [11, 26], p = 0.007). CVA patients required more ICU readmissions (35% vs. 15%, p = 0.02) and had a lower rates of home discharge (35% vs. 71%, p < 0.001). Thirty-day mortality was higher in the CVA cohort (20% vs. 1.3%, p < 0.001). Overall survival was lower in the CVA cohort (log rank p = 0.044). CONCLUSIONS Postoperative CVA following LT was associated with longer ICU stays, more ICU readmissions, longer length of stay, and fewer home discharges. Thirty day and long-term mortality were significantly higher in the CVA group.
Collapse
Affiliation(s)
- Anya Kalsbeek
- School of Medicine, University of Texas Southwestern School of Medicine, Texas, Dallas, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Ishwar Chuckaree
- School of Medicine, University of Texas Southwestern School of Medicine, Texas, Dallas, USA
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Grey Leonard
- Department of Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Kayla Maaraoui
- School of Medicine, University of Texas Southwestern School of Medicine, Texas, Dallas, USA
| | - Charles Liu
- School of Medicine, University of Texas Southwestern School of Medicine, Texas, Dallas, USA
| | - Amy Hackmann
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Lynn C Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - W Steves Ring
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| | - Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, Dallas, USA
| |
Collapse
|
2
|
Bottiger BA, Klapper J, Pollak A, Welsby I. When Therapy Is Confounded With Approach: Retrospective Studies of Transfusion-Related Outcomes After Lung Transplantation. J Cardiothorac Vasc Anesth 2020; 34:3021-3023. [PMID: 32828654 DOI: 10.1053/j.jvca.2020.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jacob Klapper
- Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Hospital, Durham, NC
| | - Angela Pollak
- Department of Anesthesiology, Duke University Hospital, Durham, NC
| | - Ian Welsby
- Department of Anesthesiology, Duke University Hospital, Durham, NC
| |
Collapse
|
3
|
Nathan AS, Blebea C, Chatterjee P, Thomasson A, Diamond JM, Groeneveld PW, Giri J, Goldberg HJ, Courtwright AM. Mortality trends around the one‐year survival mark after heart, liver, and lung transplantation in the United States. Clin Transplant 2020; 34:e13852. [DOI: 10.1111/ctr.13852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/19/2020] [Accepted: 03/03/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Ashwin S. Nathan
- Cardiovascular Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Penn Cardiovascular Outcomes Quality, and Evaluative Research Center Cardiovascular Institute University of Pennsylvania Philadelphia Pennsylvania USA
| | - Catherine Blebea
- Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Division of General Internal Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Arwin Thomasson
- Pulmonary Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Joshua M. Diamond
- Pulmonary Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| | - Peter W. Groeneveld
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Penn Cardiovascular Outcomes Quality, and Evaluative Research Center Cardiovascular Institute University of Pennsylvania Philadelphia Pennsylvania USA
- Division of General Internal Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
- Corporal Michael J. Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Jay Giri
- Cardiovascular Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
- Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA
- Penn Cardiovascular Outcomes Quality, and Evaluative Research Center Cardiovascular Institute University of Pennsylvania Philadelphia Pennsylvania USA
- Corporal Michael J. Crescenz VA Medical Center Philadelphia Pennsylvania USA
| | - Hilary J. Goldberg
- Pulmonary Division Brigham and Women's Hospital Boston Massachusetts USA
| | - Andrew M. Courtwright
- Pulmonary Division Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA
| |
Collapse
|