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Berdajs D, Miazza J, Koechlin L, Gahl B, Reuthebuch O, Eckstein F. Minimally Invasive Nonresectional Mitral Valve Repair Long-term Results. Can J Cardiol 2023; 39:990-996. [PMID: 37062486 DOI: 10.1016/j.cjca.2023.03.027] [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: 01/07/2023] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND We aimed to assess the outcomes of the minimally invasive nonresectional technique over 10 years in patients with severe mitral valve insufficiency. METHODS A retrospective analysis of 365 patients undergoing a minimally invasive complete endoscopic mitral valve repair for mitral valve insufficiency was conducted between May 2009 and September 2021. All patients underwent the nonresectional repair approach using artificial neochordae implantation or ring annuloplasty. Clinical and echocardiographic follow-ups were performed. RESULTS The minimal invasive procedure was successfully performed in all patients. The mean age was 61 ± 11, and 36% were female patients. The surgical success was 99.7%, with no conversion to sternotomy or to mitral valve replacement at 30 days. In 1 case (0.27%), mitral valve related reoperation was performed during the hospital stay. The procedural safety was 92%, with in-hospital mortality in 0.55% (n = 2), stroke in 0.55% (n = 2), and perioperative myocardial infarction in 0.82% (n = 3) patients. The mean follow up was 5.3 ± 2.9 years. Survival at 5 and 10 years was 96% (95% confidence interval [CI], 94%-98%) and 83% (95% CI, 72%-90%). Freedom of myocardial infarction, stroke, and congestive heart failure at 10 years was 95% (95% CI, 88%-98%), 86% (95% CI, 75%-92%), and 93% (95% CI, 89%-96%), respectively. Recurrent mitral valve insufficiency ≥ + 2 was diagnosed in 4.9% of cases. CONCLUSIONS Minimally invasive nonresectional mitral valve repair technique can be performed for severe mitral valve regurgitation with excellent long-term results. The procedure is safe, with minimal risk of reoperation and recurrent mitral valve insufficiency at long term.
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Affiliation(s)
- Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, Switzerland.
| | - Jules Miazza
- Department of Cardiac Surgery, University Hospital Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, Switzerland
| | - Brigita Gahl
- Department of Cardiac Surgery, University Hospital Basel, Switzerland; Surgical Outcome Research Center Basel, University Hospital Basel, University Basel, Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, Switzerland
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Bonaros N, Hoefer D, Oezpeker C, Gollmann-Tepekoeylue C, Holfeld J, Dumfarth J, Kilo J, Ruttmann-Ulmer E, Hangler H, Grimm M, Mueller L. Predictors of safety and success in minimally invasive surgery for degenerative mitral disease. Eur J Cardiothorac Surg 2021; 61:637-644. [PMID: 34738105 DOI: 10.1093/ejcts/ezab438] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify predictors of periprocedural success and safety in minimally invasive mitral valve surgery and to determine the impact of pathology localization and repair technique on reoperation-free survival. METHODS We isolated 686 patients (mean age 60.5, standard deviation 12.3 years, 69.4% male) who underwent surgery for mitral valve prolapse between 2002 and 2020 in a single institution. Patients with concomitant disease, redo or mitral pathology other than degenerative mitral disease were excluded from the analysis. Periprocedural safety was defined as: freedom from perioperative death, myocardial infarction, stroke, use of extracorporeal membrane oxygenation or reoperation for bleeding. Operative success was defined as: successful primary mitral repair without conversion to replacement or to larger thoracic incisions, without residual mitral regurgitation > mild at discharge or reoperation within 30 days. Predictors for perioperative success and safety were identified using univariable and multivariable analyses. The impact of prolapse localization and repair technique on reoperation-free survival was assessed by Cox regression. RESULTS The mitral repair rate and the need for concomitant tricuspid repair were 94.6% and 16.5%, respectively. Perioperative mortality occurred in 5 patients (0.7%). The criteria for perioperative safety and success were met in 646/686 (94.2%) and 648/686 (94.5%) patients, respectively. The absence of tricuspid disease requiring repair was the only independent predictor of safety in this cohort [hazard ratio (HR) 0.460 (0.225-0.941), P = 0.033]. The only independent predictor of operative success was the use of chordal replacement [0.27 (0.09-0.83), P = 0.022]. Reoperation-free survival was 98.5%, 94.5% and 86.9% at 1, 5 and 10 years, respectively. Posterior leaflet pathology demonstrated a higher reoperation-free survival as compared to other localizations (log-rank P = 0.002). The localization of leaflet pathology but not the repair method was an independent predictor for reoperation-free survival (HR 1.455, 95% confidence interval 1.098-1.930; P = 0.009). CONCLUSIONS In minimally invasive mitral surgery for degenerative disease, chordal replacement yields higher rates of periprocedural success than leaflet resection. Posterior leaflet pathology is an independent predictor of reoperation-free survival.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Hoefer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Cenk Oezpeker
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia Dumfarth
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Juliane Kilo
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Herbert Hangler
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ludwig Mueller
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Sandhu SA, Angel CA, Campbell KL, Hickman IJ, MacLaughlin HL. Standardised Outcome Reporting for the Nutrition Management of Complex Chronic Disease: A Rapid Review. Nutrients 2021; 13:3388. [PMID: 34684389 PMCID: PMC8538850 DOI: 10.3390/nu13103388] [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: 08/30/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/05/2022] Open
Abstract
Individuals with coexisting chronic diseases or with complex chronic disease are among the most challenging and costly patients to treat, placing a growing demand on healthcare systems. Recommending effective treatments, including nutrition interventions, relies on standardised outcome reporting from randomised controlled trials (RCTs) to enable data synthesis. This rapid review sought to determine how the scope and consistency of the outcomes reported by RCTs investigating nutrition interventions for the management of complex chronic disease compared to what is recommended by the core outcome sets (COS) for individual disease states. Peer-reviewed RCTs published between January 2010 and July 2020 were systematically sourced from PubMed, CINAHL and Embase, and COS were sourced from the International Consortium for Health Outcomes Measurements (ICHOM) and the Core Outcome Measures in Effectiveness Trials (COMET) database. A total of 45 RCTs (43 studies) and 7 COS were identified. Outcomes were extracted from both the RCTs and COS and were organised using COMET Taxonomy Core Areas. A total of 66 outcomes and 439 outcome measures were reported by the RCTs. The RCTs demonstrated extensive outcome heterogeneity, with only five outcomes (5/66, 8%) being reported with relative consistency (cited by ≥50% of publications). Furthermore, the scope of the outcomes reported by studies was limited, with a notable paucity of patient-reported outcomes. Poor agreement (25%) was observed between the outcomes reported in the RCTs and those recommended by the COS. This review urges greater uptake of the existing COS and the development of a COS for complex chronic disease to be considered so that evidence can be better synthesised regarding effective nutrition interventions.
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Affiliation(s)
- Savita A Sandhu
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
| | - Chloe A Angel
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane 4029, Australia;
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane 4102, Australia;
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
- Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
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Tyson N, Kutywayo K. Outcome Reporting in Cardiac Surgery Systematic Reviews. Ann Thorac Surg 2021; 114:353. [PMID: 33592186 DOI: 10.1016/j.athoracsur.2020.12.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Nathan Tyson
- Department of Cardiac Surgery, Nottingham University Hospitals, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, UK.
| | - Kudzayi Kutywayo
- Department of Thoracic Surgery, University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
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Stoppe C, Hill A, Day AG, Kristof AS, Hundeshagen G, Kneser U, Beier J, Lumenta D, Kim BS, Plock J, Collins DP, Gille J, Jiang X, Heyland DK. The initial validation of a novel outcome measure in severe burns- the Persistent Organ Dysfunction +Death: Results from a multicenter evaluation. Burns 2020; 47:765-775. [PMID: 33288334 DOI: 10.1016/j.burns.2020.09.003] [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: 05/05/2020] [Revised: 08/25/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A need exists to improve the efficiency of clinical trials in burn care. The objective of this study was to validate "Persistent Organ Dysfunction" plus death as endpoint in burn patients and to demonstrate its statistical efficiency. METHODS This secondary outcome analysis of a dataset from a prospective international multicenter RCT (RE-ENERGIZE) included patients with burned total body surface area >20% and a 6-month follow-up. Persistent organ dysfunction was defined as persistence of organ dysfunction with life-supportiing technologies and ICU care. RESULTS In the 539 included patients, the prevalence of 0p p+ pdeath was 40% at day 14 and of 27% at day 28. At both timepoints, survivors with POD (vs. survivors without POD) had a higher mortality rate, longer ICU- and hospital-stays, and a reduced quality of life. POD + death as an endpoint could result in reduced sample size requirements for clinical trials. Detecting a 25% relative risk reduction in 28-day mortality would require a sample size of 4492 patients, whereas 1236 patients would be required were 28-day POD + death used. CONCLUSIONS POD + death represents a promising composite outcome measure that may reduce the sample size requirements of clinical trials in severe burns patients. Further validation in larger clinical trials is warranted. STUDY TYPE Prospective cohort study, level of evidence: II.
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Affiliation(s)
- Christian Stoppe
- Department of Intensive Care Medicine, University Hospital RWTH, Aachen, Germany; CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, Aachen, Germany
| | - Aileen Hill
- Department of Intensive Care Medicine, University Hospital RWTH, Aachen, Germany; CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, Aachen, Germany
| | - Andrew G Day
- KGH Research Institute, Kingston Health Sciences Centre, Kingston, Ontario
| | - Arnold S Kristof
- Meakins-Christie Laboratories and Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Faculty of Medicine, Departments of Medicine and Critical Care, Montreal, Canada
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center. BG Trauma Center Ludwigshafen; University of Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center. BG Trauma Center Ludwigshafen; University of Heidelberg, Germany
| | - Justus Beier
- Department of Plastic, Hand and Burn Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - David Lumenta
- Research Unit for Tissue Regeneration, Repair and Reconstruction, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Jan Plock
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Declan P Collins
- Department of Burns and Plastic Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Jochen Gille
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy. Burn Unit. St. Georg Hospital GmbH Leipzig, 04129 Leipzig, Germany
| | - Xuran Jiang
- Department of Critical Care Medicine, Queen´s University, K7L 2V7 Kingston, Canada
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen´s University, K7L 2V7 Kingston, Canada.
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Hébert M, Cartier R, Dagenais F, Langlois Y, Coutu M, Noiseux N, El-Hamamsy I, Stevens LM. Standardizing Postoperative Complications-Validating the Clavien-Dindo Complications Classification in Cardiac Surgery. Semin Thorac Cardiovasc Surg 2020; 33:443-451. [PMID: 32979483 DOI: 10.1053/j.semtcvs.2020.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/19/2020] [Indexed: 11/11/2022]
Abstract
Cardiac surgery lacks a method for quantifying postoperative morbidities. The Clavien-Dindo Complications Classification (CDCC) and the Comprehensive Complication Index (CCI) were successfully implemented as outcome reporting methods in other surgical specialties. This study aims to validate these complication scales in cardiac surgery. Between 2010 and 2019, we prospectively collected data on 41,218 adult patients (73% men, mean age 67 ± 11 years) undergoing cardiac surgery at 6 university hospitals. Complications were graded using the CDCC based on the complication's treatment invasiveness with adaptations for common treatments in cardiac surgery. CCI were calculated, representing multiple complications on a scale of 0 (no complication) to 100 (death). Associations with predictors of poor outcome were assessed using mixed-effects models accounting for center as a random effect. CDCC grade was 0 in 23.0%, I in 11.4%, II in 35.3%, IIIa in 6.4%, IIIb in 2.6%, IVa in 16.1%, IVb in 2.1%, and V in 3.1%. Median CCI was 23 (9, 40). A change from lowest to highest observed CDCC grade was associated with an increase in the Society of Thoracic Surgeons mortality score from 1.1% to 4.7%, surgery duration from 177 to 233 minutes, and hospital stay from 5.2 to 17 days (all P < 0.0001). The CCI also increased with greater procedure complexity (P < 0.0001). Increase in CDCC/CCI is associated with greater comorbidities, surgery durations, lengths of stay, and procedure complexity, accurately reflecting the nuances of the adult cardiac surgery postoperative course. These have great potential for uniform outcome reporting and quality improvement initiatives.
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Affiliation(s)
- Mélanie Hébert
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Raymond Cartier
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada
| | - François Dagenais
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Québec, Canada
| | - Yves Langlois
- Division of Cardiac Surgery, Jewish General Hospital, Montreal, Canada
| | - Marianne Coutu
- Division of Cardiac Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Nicolas Noiseux
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Centre Hospitalier Universitaire de l'Université de Montréal, Montreal, Canada
| | - Ismail El-Hamamsy
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Montreal Heart Institute, Montreal, Canada; Division of Cardiac Surgery, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
| | - Louis-Mathieu Stevens
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Division of Cardiac Surgery, Centre Hospitalier Universitaire de l'Université de Montréal, Montreal, Canada.
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What to expect after open heart valve surgery? Changes in health-related quality of life. Qual Life Res 2019; 29:1247-1258. [DOI: 10.1007/s11136-019-02400-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 11/27/2022]
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Green L, Roberts N, Cooper J, Field J, Gill R, Klein A, Agarwal S, Stanworth S, Johnston A, Monk V, O’Brien B. A pragmatic pilot phase II randomised controlled trial of prothrombin complex concentrates (PCC) versus fresh frozen plasma (FFP) in adult patients who are undergoing heart surgery (PROPHESY). Trials 2019; 20:684. [PMID: 31815658 PMCID: PMC6902595 DOI: 10.1186/s13063-019-3759-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/26/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fresh frozen plasma (FFP) is the accepted standard treatment for clotting factor replacement in bleeding patients during or immediately after cardiac surgery. In the United Kingdom prothrombin complex concentrate (PCC) is not licensed in this setting, although it is being used in Europe because it has a higher concentration of clotting factor levels, and it can be administered rapidly and in small volume, resulting in less volume overload during cardiac surgery. METHODS PROPHESY is a pragmatic, single-centre, open-label, randomised, controlled pilot trial that will assess whether it is feasible to perform a large trial in the future that will compare PCC versus FFP in patients who are bleeding (not on warfarin) and who require blood transfusion. Over a 15-month period, 50 patients will be randomised to PCC versus FFP if they develop active bleeding within 24 h of cardiac surgery and for whom the clinician has decided to administer FFP for treatment of bleeding. Standard laboratory and point-of-care assessments will be performed as per routine practice, and additional research blood samples will be taken at three time points to assess haemostasis. Subjects will be assessed daily up to hospital discharge or 30 days or death (whichever occurs first) and will be seen in follow-up for 90 days after surgery to assess for thromboembolic complications and hospital re-admission since discharge. Quality-of-life assessment will be performed pre-surgery and at 90 days post-surgery. We will also perform qualitative research with clinical experts and patients to explore the understanding of and experience with the interventions, as well as adherence to study procedures and protocol. DISCUSSION There have been no randomised controlled trials that have compared the safety and efficacy of FFP versus PCC in cardiac surgery patients who are bleeding. This pilot study will assess if individual components of a large trial are deliverable to assess the safety and efficacy of the two blood products in the future. TRIAL REGISTRATION EudraCT, 2018-003041-41; ClinicalTrials.gov, NCT03715348. Registered on 29 July 2018.
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Affiliation(s)
- Laura Green
- 0000 0001 2171 1133grid.4868.2Blizard Institute, Queen Mary University of London, NHS Blood and Transplant and Barts Health NHS Trust, 4 Newark Street, Whitechapel, London, E1 2AT UK
| | - Neil Roberts
- 0000 0000 9244 0345grid.416353.6St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
| | - Jackie Cooper
- 0000 0001 2171 1133grid.4868.2Barts Cardiovascular Clinical Trials Unit (CVCTU), William Harvey Research Institute, Heart Centre, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Jane Field
- 0000 0001 2171 1133grid.4868.2Barts Cardiovascular Clinical Trials Unit (CVCTU), William Harvey Research Institute, Heart Centre, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Ravi Gill
- 0000000103590315grid.123047.3Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
| | - Andrew Klein
- Papworth Hospitals NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE UK
| | - Seema Agarwal
- 0000 0004 0641 2823grid.419319.7Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - Simon Stanworth
- 0000 0001 0440 1440grid.410556.3Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9BQ UK
| | - Atholl Johnston
- 0000 0001 2171 1133grid.4868.2William Harvey Research Institute, Heart Centre, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Vivienne Monk
- 0000 0001 2171 1133grid.4868.2Barts Cardiovascular Clinical Trials Unit (CVCTU), William Harvey Research Institute, Heart Centre, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Ben O’Brien
- 0000 0000 9244 0345grid.416353.6St Bartholomew’s Hospital, West Smithfield, London, EC1A 7BE UK
- 0000 0001 0675 4725grid.239578.2Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH USA
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Benstoem C, Wübker R, Lüngen M, Breuer T, Marx G, Autschbach R, Goetzenich A, Schnoering H. [Sense of Coherence Scale according to Antonovsky as a possible predictor for return to work for cardiac surgery intensive care patients]. Anaesthesist 2018; 67:512-518. [PMID: 29761259 DOI: 10.1007/s00101-018-0448-z] [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: 02/05/2018] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND For cardiac surgery patients who were employed prior to surgery, the return to their professional life is of special importance. In addition to medical reasons, such as pre-existing conditions, the success of the operation or postoperative course and patient-intrinsic reasons, which can be assessed with the Sense of Coherence (SOC) scale by Antonovsky, may also play a role in the question of a possible return into working life. METHODS In this study 278 patients (invasive coronary artery bypass graft surgery and/or surgery on heart valves, age < 60 years, employed) were questioned postoperatively via post with the SOC questionnaire. The SOC questionnaire was used in addition to questions about return to work. The cohort was stratified according to the time of return to work. Subsequently, the point of maximum sensitivity and specificity was determined for the total SOC score and the prediction power was considered. RESULTS Of the 278 patients, 61 questionnaires (22%) were considered as eligible and included in the analysis. Of these, 47 participants had returned to work after undergoing cardiac surgery and 14 participants had not. We observed significant differences in SOC values between both groups (146.07 ± 29.76 versus 124.29 ± 28.8, p = 0.020). Patients that returned to work within the first 6 months after surgery showed even higher SOC scores (148.56 ± 28.98, p = 0.034). CONCLUSION Patients with an SOC score < 130 are at greater risk not to return to their professional life after cardiac surgery. The SOC is an easily obtainable score that reliably predicts the probability of return to work after cardiac surgery.
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Affiliation(s)
- C Benstoem
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät RWTH Aachen, Aachen, Deutschland.
| | - R Wübker
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Lüngen
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - T Breuer
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät RWTH Aachen, Aachen, Deutschland
| | - G Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät RWTH Aachen, Aachen, Deutschland
| | - R Autschbach
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - A Goetzenich
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Schnoering
- Klinik für Thorax‑, Herz‑ und Gefäßchirurgie, Medizinische Fakultät RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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Blokzijl F, Dieperink W, Keus F, Reneman MF, Mariani MA, van der Horst IC. Cardiac rehabilitation for patients having cardiac surgery: a systematic review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:817-829. [PMID: 29616525 DOI: 10.23736/s0021-9509.18.10462-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is recommended for all cardiac patients including patients after cardiac surgery. Since the effect of CR after cardiac surgery has not been well established yet, we conducted a systematic review on the effects of CR for patients after cardiac surgery compared to treatment as usual. EVIDENCE ACQUISITION A systematic review of randomized clinical trials (RCTs), quasi-randomized and prospective observational studies in The Cochrane Library, PubMed/MEDLINE and EMBASE was undertaken until October 18th, 2017. Adults after any kind of cardiac surgery were included. Primary outcome was all-cause mortality, other outcomes were serious adverse events, health-related quality of life, work participation, functioning and costs/cost-effectiveness. Risk of bias was evaluated, and the quality of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. EVIDENCE SYNTHESIS Eighteen RCTs and 15 observational studies were included. Low risk of bias was only observed in one observational study. Meta-analysis of RCTs suggested no significant difference of CR compared to control on mortality (random-effects relative risk (RR) 0.93 (95% CI: 0.40-1.81), while observational studies suggested statistically significant beneficial effect associated with CR (random-effects RR=0.49, 95% CI: 0.35 - 0.68). CR did not significantly affect any of the other outcomes. Due to the limited data TSA could not be performed. CONCLUSIONS The body of evidence does not allow us to reach any reliable conclusions about the effectiveness of CR following cardiac surgery. Future trials need to be conducted with low risks of bias and clearly defined outcomes.
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Affiliation(s)
- Fredrike Blokzijl
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands -
| | - Willem Dieperink
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iwan C van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Buggeskov KB, Grønlykke L, Risom EC, Wei ML, Wetterslev J. Pulmonary artery perfusion versus no perfusion during cardiopulmonary bypass for open heart surgery in adults. Cochrane Database Syst Rev 2018; 2:CD011098. [PMID: 29419895 PMCID: PMC6491280 DOI: 10.1002/14651858.cd011098.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Available evidence has been inconclusive on whether pulmonary artery perfusion during cardiopulmonary bypass (CPB) is associated with decreased or increased mortality, pulmonary events, and serious adverse events (SAEs) after open heart surgery. To our knowledge, no previous systematic reviews have included meta-analyses of these interventions. OBJECTIVES To assess the benefits and harms of single-shot or continuous pulmonary artery perfusion with blood (oxygenated or deoxygenated) or a preservation solution compared with no perfusion during cardiopulmonary bypass (CPB) in terms of mortality, pulmonary events, serious adverse events (SAEs), and increased inflammatory markers for adult surgical patients. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Science Citation Index Expanded, and advanced Google for relevant studies. We handsearched retrieved study reports and scanned citations of included studies and relevant reviews to ensure that no relevant trials were missed. We searched for ongoing trials and unpublished trials in the World Health Organization International Clinical Trials Registry Platform (ICTRP) and at clinicaltrials.gov (4 July 2017). We contacted medicinal firms producing preservation solutions to retrieve additional studies conducted to examine relevant interventions. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared pulmonary artery perfusion versus no perfusion during CPB in adult patients (≧ 18 years). DATA COLLECTION AND ANALYSIS Two independent review authors extracted data, conducted fixed-effect and random-effects meta-analyses, and calculated risk ratios (RRs) or odds ratios (ORs) for dichotomous outcomes. For continuous data, we have presented mean differences (MDs) and 95% confidence intervals (CIs) as estimates of the intervention effect. To minimize the risk of systematic error, we assessed risk of bias of included trials. To reduce the risk of random errors caused by sparse data and repetitive updating of cumulative meta-analyses, we applied Trial Sequential Analyses (TSAs). We used GRADE principles to assess the quality of evidence. MAIN RESULTS We included in this review four RCTs (210 participants) reporting relevant outcomes. Investigators randomly assigned participants to pulmonary artery perfusion with blood versus no perfusion during CPB. Only one trial included the pulmonary artery perfusion intervention with a preservation solution; therefore we did not perform meta-analysis. Likewise, only one trial reported patient-specific data for the outcome "pulmonary events"; therefore we have provided no results from meta-analysis. Instead, review authors added two explorative secondary outcomes for this version of the review: the ratio of partial pressure of oxygen in arterial blood (PaO2) to fraction of inspired oxygen (FiO2); and intubation time. Last, review authors found no comparable data for the secondary outcome inflammatory markers.The effect of pulmonary artery perfusion on all-cause mortality was uncertain (Peto OR 1.78, 95% CI 0.43 to 7.40; TSA adjusted CI 0.01 to 493; 4 studies, 210 participants; GRADE: very low quality). Sensitivity analysis of one trial with overall low risk of bias (except for blinding of personnel during the surgical procedure) yielded no evidence of a difference for mortality (Peto OR 1.65, 95% CI 0.27 to 10.15; 1 study, 60 participants). The TSA calculated required information size was not reached and the futility boundaries did not cross; thus this analysis cannot refute a 100% increase in mortality.The effect of pulmonary artery perfusion with blood on SAEs was likewise uncertain (RR 1.12, 95% CI 0.66 to 1.89; 3 studies, 180 participants; GRADE: very low quality). Data show an association between pulmonary artery perfusion with blood during CPB and a higher postoperative PaO2/FiO2 ratio (MD 27.80, 95% CI 5.67 to 49.93; 3 studies, 119 participants; TSA adjusted CI 5.67 to 49.93; GRADE: very low quality), although TSA could not confirm or refute a 10% increase in the PaO2/FiO2 ratio, as the required information size was not reached. AUTHORS' CONCLUSIONS The effects of pulmonary artery perfusion with blood during cardiopulmonary bypass (CPB) are uncertain owing to the small numbers of participants included in meta-analyses. Risks of death and serious adverse events may be higher with pulmonary artery perfusion with blood during CPB, and robust evidence for any beneficial effects is lacking. Future randomized controlled trials (RCTs) should provide long-term follow-up and patient stratification by preoperative lung function and other documented risk factors for mortality. One study that is awaiting classification (epub abstract with preliminary results) may change the results of this review when full study details have been published.
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Affiliation(s)
- Katrine B Buggeskov
- Copenhagen University Hospital, RigshospitaletDepartment of Thoracic AnaesthesiologyBlegdamsvej 9CopenhagenDenmark2100
| | - Lars Grønlykke
- Copenhagen University Hospital, RigshospitaletDepartment of Thoracic AnaesthesiologyBlegdamsvej 9CopenhagenDenmark2100
| | - Emilie C Risom
- Copenhagen University Hospital, RigshospitaletDepartment of Thoracic AnaesthesiologyBlegdamsvej 9CopenhagenDenmark2100
| | - Mao Ling Wei
- West China Hospital, Sichuan UniversityChinese Evidence‐Based Medicine CentreNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Jørn Wetterslev
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Ross A, Young J, Hedin R, Aran G, Demand A, Stafford A, Worley J, Moore M, Vassar M. A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set. Anaesthesia 2018; 73:375-383. [DOI: 10.1111/anae.14211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 12/13/2022]
Affiliation(s)
- A. Ross
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - J. Young
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - R. Hedin
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - G. Aran
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | - A. Demand
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
| | | | - J. Worley
- University of Oklahoma-Tulsa; Tulsa Oklahoma USA
| | - M. Moore
- Oklahoma State University Medical Centre; Tulsa Oklahoma USA
| | - M. Vassar
- Oklahoma State University Centre for Health Sciences; Tulsa Oklahoma USA
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Sims MT, Detweiler BN, Scott JT, Howard BM, Detten GR, Vassar M. Inconsistent selection of outcomes and measurement devices found in shoulder arthroplasty research: An analysis of studies on ClinicalTrials.gov. PLoS One 2017; 12:e0187865. [PMID: 29125866 PMCID: PMC5681263 DOI: 10.1371/journal.pone.0187865] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/27/2017] [Indexed: 02/01/2023] Open
Abstract
Introduction Recent evidence suggests a lack of standardization of shoulder arthroplasty outcomes. This issue is a limiting factor in systematic reviews. Core outcome set (COS) methodology could address this problem by delineating a minimum set of outcomes for measurement in all shoulder arthroplasty trials. Methods A ClinicalTrials.gov search yielded 114 results. Eligible trials were coded on the following characteristics: study status, study type, arthroplasty type, sample size, measured outcomes, outcome measurement device, specific metric of measurement, method of aggregation, outcome classification, and adverse events. Results Sixty-six trials underwent data abstraction and data synthesis. Following abstraction, 383 shoulder arthroplasty outcomes were organized into 11 outcome domains. The most commonly reported outcomes were shoulder outcome score (n = 58), pain (n = 33), and quality of life (n = 15). The most common measurement devices were the Constant-Murley Shoulder Outcome Score (n = 38) and American Shoulder and Elbow Surgeons Shoulder Score (n = 33). Temporal patterns of outcome use was also found. Conclusion Our study suggests the need for greater standardization of outcomes and instruments. The lack of consistency across trials indicates that developing a core outcome set for shoulder arthroplasty trials would be worthwhile. Such standardization would allow for more effective comparison across studies in systematic reviews, while at the same time consider important outcomes that may be underrepresented otherwise. This review of outcomes provides an evidence-based foundation for the development of a COS for shoulder arthroplasty.
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Affiliation(s)
- Matthew Thomas Sims
- Oklahoma State University Center for Health Sciences—Tulsa, OK, United States of America
- * E-mail:
| | - Byron Nice Detweiler
- Oklahoma State University Center for Health Sciences—Tulsa, OK, United States of America
| | - Jared Thomas Scott
- Oklahoma State University Center for Health Sciences—Tulsa, OK, United States of America
| | | | - Grant Richard Detten
- Oklahoma State University Center for Health Sciences—Tulsa, OK, United States of America
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences—Tulsa, OK, United States of America
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14
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Benstoem C, Moza A, Meybohm P, Stoppe C, Autschbach R, Devane D, Goetzenich A. A core outcome set for adult cardiac surgery trials: A consensus study. PLoS One 2017; 12:e0186772. [PMID: 29095881 PMCID: PMC5667757 DOI: 10.1371/journal.pone.0186772] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/06/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Invasive off- or on-pump cardiac surgery (elective and emergency procedures, excluding transplants are routinely performed to treat complications of ischaemic heart disease. Randomised controlled trials (RCT) evaluate the effectiveness of treatments in the setting of cardiac surgery. However, the impact of RCTs is weakened by heterogeneity in outcome measuring and reporting, which hinders comparison across trials. Core outcome sets (COS, a set of outcomes that should be measured and reported, as a minimum, in clinical trials for a specific clinical field) help reduce this problem. In light of the above, we developed a COS for cardiac surgery effectiveness trials. METHODS Potential core outcomes were identified a priori by analysing data on 371 RCTs of 58,253 patients. We reached consensus on core outcomes in an international three-round eDelphi exercise. Outcomes for which at least 60% of the participants chose the response option "no" and less than 20% chose the response option "yes" were excluded. RESULTS Eighty-six participants from 23 different countries involving adult cardiac patients, cardiac surgeons, anaesthesiologists, nursing staff and researchers contributed to this eDelphi. The panel reached consensus on four core outcomes: 1) Measure of mortality, 2) Measure of quality of life, 3) Measure of hospitalisation and 4) Measure of cerebrovascular complication to be included in adult cardiac surgery trials. CONCLUSION This study used robust research methodology to develop a minimum core outcome set for clinical trials evaluating the effectiveness of treatments in the setting of cardiac surgery. As a next step, appropriate outcome measurement instruments have to be selected.
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Affiliation(s)
- Carina Benstoem
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
| | - Ajay Moza
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Stoppe
- Department of Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Rüdiger Autschbach
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Declan Devane
- Department of Nursing and Midwifery, National University of Ireland Galway, School of Nursing and Midwifery, Galway, Ireland
| | - Andreas Goetzenich
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
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15
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Saldanha IJ, Lindsley K, Do DV, Chuck RS, Meyerle C, Jones LS, Coleman AL, Jampel HD, Dickersin K, Virgili G. Comparison of Clinical Trial and Systematic Review Outcomes for the 4 Most Prevalent Eye Diseases. JAMA Ophthalmol 2017; 135:933-940. [PMID: 28772305 PMCID: PMC5625342 DOI: 10.1001/jamaophthalmol.2017.2583] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/09/2017] [Indexed: 12/24/2022]
Abstract
Importance Suboptimal overlap in outcomes reported in clinical trials and systematic reviews compromises efforts to compare and summarize results across these studies. Objectives To examine the most frequent outcomes used in trials and reviews of the 4 most prevalent eye diseases (age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], and glaucoma) and the overlap between outcomes in the reviews and the trials included in the reviews. Design, Setting, and Participants This cross-sectional study examined all Cochrane reviews that addressed AMD, cataract, DR, and glaucoma; were published as of July 20, 2016; and included at least 1 trial and the trials included in the reviews. For each disease, a pair of clinical experts independently classified all outcomes and resolved discrepancies. Outcomes (outcome domains) were then compared separately for each disease. Main Outcomes and Measures Proportion of review outcomes also reported in trials and vice versa. Results This study included 56 reviews that comprised 414 trials. Although the median number of outcomes per trial and per review was the same (n = 5) for each disease, the trials included a greater number of outcomes overall than did the reviews, ranging from 2.9 times greater (89 vs 30 outcomes for glaucoma) to 4.9 times greater (107 vs 22 outcomes for AMD). Most review outcomes, ranging from 14 of 19 outcomes (73.7%) (for DR) to 27 of 29 outcomes (93.1%) (for cataract), were also reported in the trials. For trial outcomes, however, the proportion also named in reviews was low, ranging from 19 of 107 outcomes (17.8%) (for AMD) to 24 of 89 outcomes (27.0%) (for glaucoma). Only 1 outcome (visual acuity) was consistently reported in greater than half the trials and greater than half the reviews. Conclusions and Relevance Although most review outcomes were reported in the trials, most trial outcomes were not reported in the reviews. The current analysis focused on outcome domains, which might underestimate the problem of inconsistent outcomes. Other important elements of an outcome (ie, specific measurement, specific metric, method of aggregation, and time points) might have differed even though the domains overlapped. Inconsistency in trial outcomes may impede research synthesis and indicates the need for disease-specific core outcome sets in ophthalmology.
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Affiliation(s)
- Ian J. Saldanha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kristina Lindsley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Diana V. Do
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Roy S. Chuck
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Catherine Meyerle
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leslie S. Jones
- Department of Ophthalmology, Howard University Hospital, Washington, DC
| | - Anne L. Coleman
- Frank and Ray Stark Foundation, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Henry D. Jampel
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kay Dickersin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gianni Virgili
- Eye Clinic, Department of Translational Surgery and Medicine, University of Florence, Careggi Hospital, Florence, Italy
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16
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Rogozińska E, Marlin N, Yang F, Dodd JM, Guelfi K, Teede H, Surita F, Jensen DM, Geiker NR, Astrup A, Yeo S, Kinnunen TI, Stafne SN, Cecatti JG, Bogaerts A, Hauner H, Mol BW, Scudeller TT, Vinter CA, Renault KM, Devlieger R, Thangaratinam S, Khan KS. Variations in reporting of outcomes in randomized trials on diet and physical activity in pregnancy: A systematic review. J Obstet Gynaecol Res 2017; 43:1101-1110. [DOI: 10.1111/jog.13338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/17/2017] [Accepted: 02/25/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Ewelina Rogozińska
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
- Multidisciplinary Evidence Synthesis Hub (mEsh); Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Nadine Marlin
- Pragmatic Clinical Trials Unit; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Fen Yang
- Human Reproduction; Shanghai Institute of Planned Parenthood and Reproduction; China
| | - Jodie M. Dodd
- The Robinson Research Institute; Department of Obstetrics & Gynaecology, School of Medicine; The University of Adelaide; Adelaide Australia
- Women's and Children's Health Network, Women's and Babies Division; North Adelaide South Australia Australia
| | - Kym Guelfi
- Exercise Physiology and Biochemistry; The University of Western Australia; Crawley Western Australia Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health; Monash University, Australia; Melbourne Australia
| | - Fernanda Surita
- Department of Obstetrics and Gynecology; School of Medical Sciences; The University of Campinas (UNICAMP); São Paulo Brazil
| | - Dorte M. Jensen
- Department of Endocrinology; Odense University Hospital; Odense Denmark
| | - Nina R.W. Geiker
- Clinical Nutrition Research Unit; Nutrition Research Unit; Herlev and Gentofte Hospital; Copenhagen Denmark
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports; University of Copenhagen; Copenhagen Denmark
| | - SeonAe Yeo
- School of Nursing; The University of North Carolina at Chapel Hill; Chapel Hill North Carolina USA
| | - Tarja I. Kinnunen
- School of Health Sciences; The University of Tampere; Tampere Finland
| | - Signe N. Stafne
- Department of Public Health and General Practice, Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Clinical Services, St. Olavs Hospital; Trondheim University Hospital Trondheim; Trondheim Norway
| | - Jose G. Cecatti
- Department of Obstetrics and Gynecology; School of Medical Sciences; The University of Campinas (UNICAMP); São Paulo Brazil
| | - Annick Bogaerts
- Research Unit Healthy Living; University Colleges Leuven-Limburg; Diepenbeek Belgium
- Centre for Research & Innovation in Care; University of Antwerp; Antwerp Belgium
- Department Development and Regeneration; KU Leuven; Leuven Belgium
| | - Hans Hauner
- Center for Nutritional Medicine; Technische Universität München; Munich Germany
| | - Ben W. Mol
- The South Australian Health and Medical Research Institute; South Australia Australia
| | - Tânia T. Scudeller
- Department of Management and Health Care; São Paulo Federal University (UNIFESP); São Paulo Brazil
| | - Christina A. Vinter
- Department of Obstetrics and Gynecology, Odense University Hospital; The University of Southern Denmark; Odense Denmark
| | - Kristina M. Renault
- Department of Obstetrics and Gynecology, Hvidovre Hospital; University of Copenhagen; Copenhagen Denmark
| | - Roland Devlieger
- Division of Mother and Child, Department of Obstetrics and Gynaecology; University Colleges Leuven-Limburg, Hasselt and University Hospitals KU Leuven; Leuven Belgium
| | - Shakila Thangaratinam
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
- Multidisciplinary Evidence Synthesis Hub (mEsh); Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Khalid S. Khan
- Women's Health Research Unit; Barts and the London School of Medicine and Dentistry; London UK
- Multidisciplinary Evidence Synthesis Hub (mEsh); Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
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Benstoem C, Stoppe C, Liakopoulos OJ, Ney J, Hasenclever D, Meybohm P, Goetzenich A. Remote ischaemic preconditioning for coronary artery bypass grafting (with or without valve surgery). Cochrane Database Syst Rev 2017; 5:CD011719. [PMID: 28475274 PMCID: PMC6481544 DOI: 10.1002/14651858.cd011719.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Despite substantial improvements in myocardial preservation strategies, coronary artery bypass grafting (CABG) is still associated with severe complications. It has been reported that remote ischaemic preconditioning (RIPC) reduces reperfusion injury in people undergoing cardiac surgery and improves clinical outcome. However, there is a lack of synthesised information and a need to review the current evidence from randomised controlled trials (RCTs). OBJECTIVES To assess the benefits and harms of remote ischaemic preconditioning in people undergoing coronary artery bypass grafting, with or without valve surgery. SEARCH METHODS In May 2016 we searched CENTRAL, MEDLINE, Embase and Web of Science. We also conducted a search of ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We also checked reference lists of included studies. We did not apply any language restrictions. SELECTION CRITERIA We included RCTs in which people scheduled for CABG (with or without valve surgery) were randomly assigned to receive RIPC or sham intervention before surgery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data and checked them for accuracy. We calculated mean differences (MDs), standardised mean differences (SMDs) and risk ratios (RR) using a random-effects model. We assessed quality of the trial evidence for all primary outcomes using the GRADE methodology. We completed a 'Risk of bias' assessment for all studies and performed sensitivity analysis by excluding studies judged at high or unclear risk of bias for sequence generation, allocation concealment and incomplete outcome data. We contacted authors for missing data. Our primary endpoints were 1) composite endpoint (including all-cause mortality, non-fatal myocardial infarction or any new stroke, or both) assessed at 30 days after surgery, 2) cardiac troponin T (cTnT, ng/L) at 48 hours and 72 hours, and as area under the curve (AUC) 72 hours (µg/L) after surgery, and 3) cardiac troponin I (cTnI, ng/L) at 48 hours, 72 hours, and as area under the curve (AUC) 72 hours (µg/L) after surgery. MAIN RESULTS We included 29 studies involving 5392 participants (mean age = 64 years, age range 23 to 86 years, 82% male). However, few studies contributed data to meta-analyses due to inconsistency in outcome definition and reporting. In general, risk of bias varied from low to high risk of bias across included studies, and insufficient detail was provided to inform judgement in several cases. The quality of the evidence of key outcomes ranged from moderate to low quality due to the presence of moderate or high statistical heterogeneity, imprecision of results or due to limitations in the design of individual studies.Compared with no RIPC, we found that RIPC has no treatment effect on the rate of the composite endpoint with RR 0.99 (95% confidence interval (CI) 0.78 to 1.25); 2 studies; 2463 participants; moderate-quality evidence. Participants randomised to RIPC showed an equivalent or better effect regarding the amount of cTnT release measured at 72 hours after surgery with SMD -0.32 (95% CI -0.65 to 0.00); 3 studies; 1120 participants; moderate-quality evidence; and expressed as AUC 72 hours with SMD -0.49 (95% CI -0.96 to -0.02); 3 studies; 830 participants; moderate-quality evidence. We found the same result in favour of RIPC for the cTnI release measured at 48 hours with SMD -0.21 (95% CI -0.40 to -0.02); 5 studies; 745 participants; moderate-quality evidence; and measured at 72 hours after surgery with SMD -0.37 (95% CI -0.59 to -0.15); 2 studies; 459 participants; moderate-quality evidence. All other primary outcomes showed no differences between groups (cTnT release measured at 48 hours with SMD -0.14, 95% CI -0.33 to 0.06; 4 studies; 1792 participants; low-quality evidence and cTnI release measured as AUC 72 hours with SMD -0.17, 95% CI -0.48 to 0.14; 2 studies; 159 participants; moderate-quality evidence).We also found no differences between groups for all-cause mortality after 30 days, non-fatal myocardial infarction after 30 days, any new stroke after 30 days, acute renal failure after 30 days, length of stay on the intensive care unit (days), any complications and adverse effects related to ischaemic preconditioning. We did not assess many patient-centred/salutogenic-focused outcomes. AUTHORS' CONCLUSIONS We found no evidence that RIPC has a treatment effect on clinical outcomes (measured as a composite endpoint including all-cause mortality, non-fatal myocardial infarction or any new stroke, or both, assessed at 30 days after surgery). There is moderate-quality evidence that RIPC has no treatment effect on the rate of the composite endpoint including all-cause mortality, non-fatal myocardial infarction or any new stroke assessed at 30 days after surgery, or both. We found moderate-quality evidence that RIPC reduces the cTnT release measured at 72 hours after surgery and expressed as AUC (72 hours). There is moderate-quality evidence that RIPC reduces the amount of cTnI release measured at 48 hours, and measured 72 hours after surgery. Adequately-designed studies, especially focusing on influencing factors, e.g. with regard to anaesthetic management, are encouraged and should systematically analyse the commonly used medications of people with cardiovascular diseases.
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Affiliation(s)
- Carina Benstoem
- University Hospital AachenDepartment of Cardiothoracic SurgeryPauwelsstrasse 30AachenNorth Rhine WestphaliaGermany52074
| | - Christian Stoppe
- RWTH Aachen UniversityDepartment of Intensive Care MedicinePauwelsstrasse 30AachenNorth Rhine WestphaliaGermany52074
| | - Oliver J Liakopoulos
- Heart Center, University of CologneDepartment of Cardiothoracic SurgeryKerpener Str. 62CologneGermany50937
| | - Julia Ney
- University Hospital RWTH AachenDepartment of AnaesthesiologyPauwelsstrasse 30AachenGermany
| | - Dirk Hasenclever
- University of LeipzigInstitute for Medical Informatics, Statistics & Epidemiology (IMISE)Haertelstrasse 16‐18LeipzigGermany
| | - Patrick Meybohm
- University Hospital FrankfurtDepartment of Anaesthesiology, Intensive Care and Pain TherapyTheodor‐Stern‐Kai 7Frankfurt am MainGermany60590
| | - Andreas Goetzenich
- University Hospital AachenDepartment of Cardiothoracic SurgeryPauwelsstrasse 30AachenNorth Rhine WestphaliaGermany52074
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18
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Kuizenga-Wessel S, Steutel NF, Benninga MA, Devreker T, Scarpato E, Staiano A, Szajewska H, Vandenplas Y, Tabbers MM. Development of a core outcome set for clinical trials in childhood constipation: a study using a Delphi technique. BMJ Paediatr Open 2017; 1:e000017. [PMID: 29637094 PMCID: PMC5842998 DOI: 10.1136/bmjpo-2017-000017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Patients, their parents and healthcare professionals (HCPs) have a different perception regarding the symptoms of functional constipation (FC). Consequently, a lack of agreement exists on definitions and outcomes used in therapeutic trials of FC. Therefore, our aim was to develop a core outcome set (COS) for FC for children aged 0-1 year and 1-18 years. DESIGN AND SETTING Prospective study design: primary, secondary and tertiary care settings. METHODS This COS was developed using a Delphi technique. First, HCPs, parents of children with FC and patients aged ≥12-18 years were asked to list up to five outcomes they considered relevant in the treatment of FC. Outcomes mentioned by >10% of participants were included in a shortlist. In the next phase, outcomes on this shortlist were rated and prioritised by HCPs, parents and patients. Outcomes with the highest scores were included in a draft COS. In a face-to-face expert meeting, the final COS was determined. RESULTS The first phase was completed by 109 HCPs, 165 parents and 50 children. Fifty HCPs, 80 parents and 50 children completed the subsequent phase. The response rate was between 63% and 100% in both steps. The final COS for all ages consisted of: defecation frequency, stool consistency, painful defecation, quality of life, side effects of treatment, faecal incontinence, abdominal pain and school attendance. CONCLUSION The use of this COS for FC will decrease study heterogeneity and improve comparability of studies. Therefore, researchers are recommended to use this COS in future therapeutic trials on childhood FC.
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Affiliation(s)
- Sophie Kuizenga-Wessel
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Nina Francesca Steutel
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marc Alexander Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Thierry Devreker
- Department of Paediatrics, Free University of Brussels, Brussels, Belgium
| | - Elena Scarpato
- Department of Translational Medical Sciences - Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences - Section of Paediatrics, University of Naples Federico II, Naples, Italy
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Yvan Vandenplas
- Department of Paediatrics, Free University of Brussels, Brussels, Belgium
| | - Merit Monique Tabbers
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Abstract
OBJECTIVE Standardized outcome measures provide a basis for comparing outcomes of different clinical trials. Consequently, they can serve as the foundation for determining which therapeutic interventions are most effective. The aim of the present study is to systematically assess how definitions and outcome measures are defined in therapeutic randomized controlled trials (RCTs) of children with functional constipation (FC). METHODS PubMed, EMBASE, and Cochrane databases were searched. Studies were included if it was a (systematic review of) therapeutic RCT, concerning children from 1 to 18 years old with FC, a definition of FC was provided, and if they were written in English. The Delphi list was used for quality assessment. RESULTS A total of 4092 articles were found but only 45 studies fulfilled our inclusion criteria. In these 45 trials, 22 different definitions of FC were used (17 studies used the Rome III-criteria), 27 different interventions were investigated, and 29 different definitions of treatment success were used. Thirty RCTs (57%) reported primary outcomes of which treatment success was the most frequently used. Most trials (80%) used parental diaries of which only 2 RCTs stated that their instrument was validated. Twenty-four trials (53%) were of good methodological quality. CONCLUSIONS Inconsistency and heterogeneity exist in definitions and outcome measures used in RCTs on childhood FC. Standard definitions, outcome measures, and also validated instruments are needed. We recommend the development of a minimum core outcome set for clinical research in children with FC to make comparison possible between the effects of different therapeutic interventions across studies.
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Garcia-Cardenas V, Armour C, Benrimoj SI, Martinez-Martinez F, Rotta I, Fernandez-Llimos F. Pharmacists' interventions on clinical asthma outcomes: a systematic review. Eur Respir J 2015; 47:1134-43. [PMID: 26677937 DOI: 10.1183/13993003.01497-2015] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/08/2015] [Indexed: 01/08/2023]
Abstract
The objective of this systematic review was to evaluate the impact of pharmacists' interventions on clinical asthma outcomes on adult patients and to identify the outcome indicators used.PubMed, Scopus, Web of Science and Scielo were searched. Studies addressing pharmacists' interventions on adult asthma patients reporting clinical asthma outcomes were incorporated.11 clinical outcomes were identified in 21 studies. 10 studies measured the impact of the intervention on asthma control. Randomised controlled trials (RCT) and non-RCTs found positive results in percentages of controlled patients and Asthma Control Questionnaire (ACQ) scores. Discordant results were found for Asthma Control Test results. Asthma severity was assessed in four studies. One RCT found a significant decrease in the percentage of severe patients; two non-RCTs found significant improvements in severity scores. 11 studies reported pulmonary function indicators, showing inconsistent results. Eight studies measured asthma symptoms; three RCTs and four non-RCTs showed significant improvements.RCTs and non-RCTs generated similar results for most outcomes. Based on the evidence generated by RCTs, pharmacists' have a positive impact on the percentage of controlled patients, ACQ scores, severity and symptoms. Future research should report using the core outcome set of indicators established for asthma (PROSPERO CRD42014007019).
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Affiliation(s)
| | - Carol Armour
- Woolcock Institute of Medical Research, The University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Shalom I Benrimoj
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | | | - Inajara Rotta
- Hospital Pharmacy Dept, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Fernando Fernandez-Llimos
- Research Institute for Medicines (iMed. ULisboa), Dept of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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Moza A, Benstoem C, Autschbach R, Stoppe C, Goetzenich A. A core outcome set for all types of cardiac surgery effectiveness trials: a study protocol for an international eDelphi survey to achieve consensus on what to measure and the subsequent selection of measurement instruments. Trials 2015; 16:545. [PMID: 26625730 PMCID: PMC4667508 DOI: 10.1186/s13063-015-1072-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major contributor to the burden of disease and the number one cause of death worldwide. From 1990 until today, more people died from coronary heart disease than from any other cause. CVD is regularly treated with minimally or non-minimally invasive off- or on-pump cardiothoracic surgery and several interventions related to the outcome of the surgical procedures have been evaluated in clinical trials, but heterogeneity in outcome reporting hinders comparison of interventions across trials and limits the ability of research synthesis. This problem is encountered with the introduction of core outcome sets (COSs), which should be measured and reported, as a minimum, in all clinical trials for a specific clinical field. METHODS/DESIGN This study protocol describes the methods used to develop a COS for all types of cardiac surgery effectiveness trials. We aim to reach consensus on what to measure in an international three-round eDelphi exercise involving adult patients in need or after cardiothoracic surgery, cardiothoracic surgeons, cardiologists, anaesthesiologists, nursing staff and researchers with expertise in this particular field of medical research. Subsequently, outcome measurement instruments (how to measure) will be determined. Recommendations on COS development given by the Core Outcome Measures in Effectiveness Trials (COMET) Initiative and the Outcome Measures in Rheumatology (OMERACT) Initiative were followed. DISCUSSION The proposed COS aims to provide methodological guidance for future cardiothoracic surgical trials to ensure the comparability of effects of interventions across studies and enable research synthesis. This does not imply that primary outcomes should always and exclusively be those of the COS. However, to ensure the comparability of results across trials, the outcomes included in this COS should be considered for inclusion besides measuring trial-specific clinical endpoints.
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Affiliation(s)
- A Moza
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - C Benstoem
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - R Autschbach
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - C Stoppe
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany. .,Department of Anaesthesiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - A Goetzenich
- Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Stoppe C, McDonald B, Benstoem C, Elke G, Meybohm P, Whitlock R, Fremes S, Fowler R, Lamarche Y, Jiang X, Day AG, Heyland DK. Evaluation of Persistent Organ Dysfunction Plus Death As a Novel Composite Outcome in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2015; 30:30-8. [PMID: 26847748 DOI: 10.1053/j.jvca.2015.07.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Validated composite outcomes after complicated cardiac surgery are poorly established. Therefore, the authors evaluated a novel composite endpoint, persistent organ dysfunction (POD)+death, which is defined as any need for life-sustaining therapies or death at any time within 28 days from surgery. DESIGN Secondary analysis extracted from a large-scale prospective randomized trial of critically ill cardiac surgery patients. SETTING Multi-institutional, university hospitals. PARTICIPANTS Ninety-five cardiac surgery patients with complicated postoperative courses. INTERVENTIONS Cardiac surgery with cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS At 28 days following surgery, the prevalence of POD was 15%, and 23% of patients had died (POD+death = 38%). Patients alive with POD at day 28 exhibited a significantly higher extent of organ injury and longer ICU (33 v 7 days; p<0.001) and hospital lengths of stay (49 v 21 days; p<0.001) compared to patients without POD at day 28. At 3 and 6 months, quality-of-life scores (by Short Form 36 questionnaire) showed a significantly reduced rating for most components in patients with POD at day 28 compared to those without POD. The 6-month mortality rate was 21% among patients alive with POD at day 28 compared to 5% among patients alive without POD (p = 0.05). The calculated number of patients needed per arm to detect a 25% relative risk reduction for mortality alone was 762 compared to 386 per arm for POD+ death. CONCLUSIONS POD+death at day 28 following cardiac surgery may be a valid composite endpoint and offers statistical efficiencies in terms of sample size calculations for cardiac surgical trials.
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Affiliation(s)
- Christian Stoppe
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany;; Department of Thoracic, Cardiac, and Vascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany;.
| | - Bernard McDonald
- Division of Cardiac Anesthesiology and Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Carina Benstoem
- Department of Thoracic, Cardiac, and Vascular Surgery, University Hospital, RWTH Aachen, Aachen, Germany
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Richard Whitlock
- Department of Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Robert Fowler
- Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yoan Lamarche
- Department of Surgery, Institut de cardiologie de Montreal and Critical Care Program, Hospital du Sacré Coeur de Montréal, Montréal, Quebec, Canada
| | - Xuran Jiang
- Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, Kingston, Ontario, Canada
| | - Andrew G Day
- Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, Kingston, Ontario, Canada
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Angada 4, Kingston General Hospital, Kingston, Ontario, Canada
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