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Hinton JV, Xing Z, Fletcher C, Perry LA, Karamesinis A, Shi J, Penny-Dimri JC, Ramson D, Coulson TG, Segal R, Smith JA, Williams-Spence J, Weinberg L, Bellomo R. Association of perioperative transfusion of fresh frozen plasma and outcomes after cardiac surgery. Acta Anaesthesiol Scand 2024; 68:753-763. [PMID: 38467589 DOI: 10.1111/aas.14406] [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: 09/25/2023] [Revised: 02/15/2024] [Accepted: 02/24/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Fresh frozen plasma (FFP) transfusion is used to manage coagulopathy and bleeding in cardiac surgery patients despite uncertainty about its safety and effectiveness. METHODS We performed a propensity score matched analysis of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database including patients from 39 centres from 2005 to 2018. We investigated the association of perioperative FFP transfusion with mortality and other clinical outcomes. RESULTS Of 119,138 eligible patients, we successfully matched 13,131 FFP recipients with 13,131 controls. FFP transfusion was associated with 30-day mortality (odds ratio (OR), 1.41; 99% CI, 1.17-1.71; p < .0001), but not with long-term mortality (hazard ratio (HR), 0.92; 99% CI, 0.85-1.00; p = .007, Holm-Bonferroni α = 0.0004). FFP was also associated with return to theatre for bleeding (OR, 1.97; 99% CI, 1.66-2.34; p < .0001), prolonged intubation (OR, 1.15; 99% CI, 1.05-1.26; p < .0001) and increased chest tube drainage (Mean difference (MD) in mL, 131; 99% CI, 120-141; p < .0001). It was also associated with reduced postoperative creatinine levels (MD in g/L, -6.33; 99% CI, -10.28 to -2.38; p < .0001). CONCLUSION In a multicentre, propensity score matched analysis, perioperative FFP transfusion was associated with increased 30-day mortality and had variable associations with secondary clinical outcomes.
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Affiliation(s)
- Jake V Hinton
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
| | - Zhongyue Xing
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Calvin Fletcher
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Luke A Perry
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Alexandra Karamesinis
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jenny Shi
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jahan C Penny-Dimri
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dhruvesh Ramson
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Tim G Coulson
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Reny Segal
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Julian A Smith
- Department of Cardiothoracic Surgery, Monash Health, Clayton, Victoria, Australia
| | - Jenni Williams-Spence
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Clayton, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Ibrahim KS, Kheirallah KA, Al Manasra ARA, Megdadi MA. Factors affecting duration of stay in the intensive care unit after coronary artery bypass surgery and its impact on in-hospital mortality: a retrospective study. J Cardiothorac Surg 2024; 19:45. [PMID: 38310298 PMCID: PMC10838416 DOI: 10.1186/s13019-024-02527-y] [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: 06/14/2023] [Accepted: 01/28/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Different risk factors affect the intensive care unit (ICU) stay after cardiac surgery. This study aimed to evaluate these risk factors. PATIENTS AND METHODS A retrospective analysis was conducted on clinical, operative, and outcome data from 1070 patients (mean age: 59 ± 9.8 years) who underwent isolated coronary bypass grafting CABG surgery with cardiopulmonary bypass. The outcome variable was prolonged length of stay LOS in the CICU stay (> 3 nights after CABG). RESULTS Univariate predictors of prolonged ICU stays included a left atrial diameter of > 4 cm (P < 0.001),chronic obstructive airway disease COPD (P = 0.005), hypertension (P = 0.006), diabetes mellitus (P = 0.009), having coronary stents (P = 0.006), B-blockers use before surgery (either because the surgery was done on urgent or emergency basis or the patients have contraindication to B-blockers use) (P = 0.005), receiving blood transfusion during surgery (P = 0.001), post-operative acute kidney injury (AKI) (P < 0.001), prolonged inotropic support of > 12 h (P < 0.001), and ventilation support of > 12 h (P < 0.001), post-operative sepsis or pneumonia (P < 0.001), post-operative stroke/TIA (P = 0.001), sternal wound infection (P = 0.002), and postoperative atrial fibrillation POAF (P < 0.001). Multivariate regression revealed that patients with anleft atrial LA diameter of > 4 cm (AOR 2.531, P = 0.003), patients who did not take B-blockers before surgery (AOR 1.1 P = 0.011), patients on ventilation support > 12 h (AOR 3.931, P = < 0.001), patients who developed pneumonia (AOR 20.363, P = < 0.001), and patients who developed post-operative atrial fibrillation (AOR 30.683, P = < 0.001) were more likely to stay in the ICU for > 3 nights after CABG. CONCLUSION Our results showed that LA diameter > 4 cm, patients who did not take beta-blockers before surgery, on ventilation support > 12 h, developed pneumonia post-operatively, and developed POAF were more likely to have stays lasting > 3 nights. Efforts should be directed toward reducing these postoperative complications to shorten the duration of CICU stay, thereby reducing costs and improving bed availability.
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Affiliation(s)
- Khalid S Ibrahim
- Division of Cardiac Surgery, Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology and Princess Muna Heart Center, King Abdullah University Hospital, Irbid, Jordan.
| | - Khalid A Kheirallah
- Department of Public Health and Community Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel Rahman A Al Manasra
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mahmoud A Megdadi
- Department of Public Health and Community Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Fletcher CM, Hinton JV, Xing Z, Perry LA, Karamesinis A, Shi J, Penny-Dimri JC, Ramson D, Liu Z, Smith JA, Segal R, Coulson TG, Bellomo R. Fresh frozen plasma transfusion after cardiac surgery. Perfusion 2023:2676591231221715. [PMID: 38085647 DOI: 10.1177/02676591231221715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Fresh frozen plasma (FFP) transfusion in the intensive care unit (ICU) is commonly used to treat coagulopathy and bleeding in cardiac surgery, despite suggestion that it may increase the risk of morbidity and mortality through mechanisms such as fluid overload and infection. METHODS We retrospectively studied consecutive adults undergoing cardiac surgery from the Medical Information Mart for Intensive Care III and IV databases. We applied propensity score matching to investigate the independent association of within-ICU FFP transfusion with mortality and other key clinical outcomes. RESULTS Of our 12,043 adults who met inclusion criteria, 1585 (13.2%) received perioperative FFP with a median of 2.48 units per recipient (interquartile range [IQR]: 2.04, 4.33) at a median time of 1.83 h (IQR: 0.75, 3.75) after ICU admission. After propensity matching of 952 FFP recipients to 952 controls, we found no significant association between FFP use and hospital mortality (odds ratio (OR): 1.58; 99% confidence interval (CI): 0.57, 3.71), suspected infection (OR: 0.72; 99% CI: 0.49, 1.08), or acute kidney injury (OR: 1.23; 99% CI: 0.91, 1.67). However, FFP was associated with increased days in hospital (adjusted mean difference (AMD): 1.28; 99% CI: 0.27, 2.41; p = .0050), days in intensive care (AMD: 1.28; 99% CI: 0.27, 2.28; p = .0011), and chest tube output in millilitres up to 8 h after transfusion (AMD: 92.98; 99% CI: 52.22, 133.74; p < .0001). CONCLUSIONS After propensity matching, FFP transfusion was not associated with increased hospital mortality, but was associated with increased length of stay and no decrease in bleeding in the early post-transfusion period.
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Affiliation(s)
- Calvin M Fletcher
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Jake V Hinton
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Zhongyue Xing
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Luke A Perry
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
| | - Alexandra Karamesinis
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jenny Shi
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Jahan C Penny-Dimri
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, VIC, Australia
| | - Dhruvesh Ramson
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, VIC, Australia
| | - Zhengyang Liu
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Julian A Smith
- Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, VIC, Australia
- Department of Cardiothoracic Surgery, Monash Health, Clayton, VIC, Australia
| | - Reny Segal
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
| | - Tim G Coulson
- Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
- Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Choi PS, Pines KC, Swaminathan A, Nilkant R, Mendez MA, He H, Woo YJ, Martin BJ. Diversifying cardiac intensive care unit models: Successful example of an operating surgeon-led unit. JTCVS OPEN 2023; 16:524-531. [PMID: 38204639 PMCID: PMC10775107 DOI: 10.1016/j.xjon.2023.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 01/12/2024]
Abstract
Objective The intensivist-led cardiovascular intensive care unit model is the standard of care in cardiac surgery. This study examines whether a cardiovascular intensive care unit model that uses operating cardiac surgeons, cardiothoracic surgery residents, and advanced practice providers is associated with comparable outcomes. Methods This is a single-institution review of the first 400 cardiac surgery patients admitted to an operating surgeon-led cardiovascular intensive care unit from 2020 to 2022. Inclusion criteria are elective status and operations managed by both cardiovascular intensive care unit models (aortic operations, valve operations, coronary operations, septal myectomy). Patients from the surgeon-led cardiovascular intensive care unit were exact matched by operation type and 1:1 propensity score matched with controls from the traditional cardiovascular intensive care unit using a logistic regression model that included age, sex, preoperative mortality risk, incision type, and use of cardiopulmonary bypass and circulatory arrest. Primary outcome was total postoperative length of stay. Secondary outcomes included postoperative intensive care unit length of stay, 30-day mortality, 30-day Society of Thoracic Surgeons-defined morbidity (permanent stroke, renal failure, cardiac reoperation, prolonged intubation, deep sternal infection), packed red cell transfusions, and vasopressor use. Outcomes between the 2 groups were compared using chi-square, Fisher exact test, or 2-sample t test as appropriate. Results A total of 400 patients from the surgeon-led cardiovascular intensive care unit (mean age 61.2 ± 12.8 years, 131 female patients [33%], 346 patients [86.5%] with European System for Cardiac Operative Risk Evaluation II <2%) and their matched controls were included. The most common operations across both units were coronary artery bypass grafting (n = 318, 39.8%) and mitral valve repair or replacement (n = 238, 29.8%). Approximately half of the operations were performed via sternotomy (n = 462, 57.8%). There were 3 (0.2%) in-hospital deaths, and 47 patients (5.9%) had a 30-day complication. The total length of stay was significantly shorter for the surgeon-led cardiovascular intensive care unit patients (6.3 vs 7.0 days, P = .028), and intensive care unit length of stay trended in the same direction (2.5 vs 2.9 days, P = .16). Intensive care unit readmission rates, 30-day mortality, and 30-day morbidity were not significantly different between cardiovascular intensive care unit models. The surgeon-led cardiovascular intensive care unit was associated with fewer postoperative red blood cell transfusions in the cardiovascular intensive care unit (P = .002) and decreased vasopressor use (P = .001). Conclusions In its first 2 years, the surgeon-led cardiovascular intensive care unit demonstrated comparable outcomes to the traditional cardiovascular intensive care unit with significant improvements in total length of stay, postoperative transfusions in the cardiovascular intensive care unit, and vasopressor use. This early success exemplifies how an operating surgeon-led cardiovascular intensive care unit can provide similar outcomes to the standard-of-care model for patients undergoing elective cardiac surgery.
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Affiliation(s)
- Perry S. Choi
- Department of Cardiac Surgery, Stanford University, Palo Alto, Calif
- Department of Cardiac Surgery, Stanford Health Care, Palo Alto, Calif
| | | | | | - Riya Nilkant
- Department of Cardiac Surgery, Stanford University, Palo Alto, Calif
| | - Michael A. Mendez
- Department of Cardiac Surgery, Stanford Health Care, Palo Alto, Calif
| | - Hao He
- Department of Cardiac Surgery, Stanford University, Palo Alto, Calif
| | - Y. Joseph Woo
- Department of Cardiac Surgery, Stanford University, Palo Alto, Calif
- Department of Cardiac Surgery, Stanford Health Care, Palo Alto, Calif
| | - Billie-Jean Martin
- Department of Cardiac Surgery, Stanford University, Palo Alto, Calif
- Department of Cardiac Surgery, Stanford Health Care, Palo Alto, Calif
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Martins RS, Waqar U, Raza HA, Memon MKY, Akhtar S. Assessing Risk Factors for Prolonged Intensive Care Unit Stay After Surgery for Adult Congenital Heart Disease: A Study From a Lower-Middle-Income Country. Cureus 2023; 15:e35606. [PMID: 37007353 PMCID: PMC10063249 DOI: 10.7759/cureus.35606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
Background Prolonged post-surgery intensive care unit (ICU) stay for congenital heart disease (CHD) has been explored in the pediatric population. However, there is limited data for adult CHD (ACHD), also called grown-up congenital heart (GUCH) disease, especially in low-resource countries where intensive care beds are scarce. This study identifies factors associated with prolonged ICU stay following surgery for ACHD in Pakistan, a lower-middle-income country (LMIC). Methods This retrospective study included all adult patients (⩾18 years) who underwent cardiac surgery with cardiopulmonary bypass for their CHD from 2011-2016 at a tertiary-care private hospital in Pakistan. Prolonged ICU stay was defined as stay >6 days (75th percentile). Regression analysis was used to explore risk factors of prolonged ICU stay. Results A total of 166 patients (53.6% males) with a mean age of 32.05 ± 12.11 years were included. Atrial septal defect repair was the most common surgery (42.2%). Most patients were categorized as Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1) Category 1 (51.8%) and Category 2 (30.1%). Forty-three of 166 patients (25.9%) experienced prolonged ICU stay. Complications occurred in 38.6% of patients postoperatively, with the most common being acute kidney injury (29.5%). On multivariable logistic regression adjusted for age, gender, and RACHS-1 categories, intraoperative inotrope score, cardiopulmonary bypass time, aortic cross-clamp time duration of mechanical ventilation, and postoperative acute kidney injury (AKI) were associated with prolonged ICU stay. Conclusion Surgeons managing ACHD in LMICs must strive for shorter operative durations and the judicious use of intraoperative inotropes in addition to anticipating and promptly managing postoperative complications such as AKI, to minimize ICU stay in countries where intensive care beds are a scarce resource.
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6
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Yeşiler Fİ, Akmatov N, Nurumbetova O, Beyazpınar DS, Şahintürk H, Gedik E, Zeyneloğlu P. Incidence of and Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery Among Elderly Patients. Cureus 2022; 14:e31602. [DOI: 10.7759/cureus.31602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
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Norouzi M, Nadjarzadeh A, Maleki M, Khayyatzadeh SS, Hosseini S, Yaseri M, Fattahi H. Evaluation of the recovery after heart surgery following preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, L-arginine, and L-glutamine: a double-blind randomized placebo-controlled clinical trial. Trials 2022; 23:649. [PMID: 35964137 PMCID: PMC9375058 DOI: 10.1186/s13063-022-06621-1] [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: 11/21/2021] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The preoperative period is a good time to improve nutrition status, compensate for nutrient deficiencies, and optimize immune function in patients' underlying surgery. In some medical conditions, supplementation with a combination of L-glutamine (Gln), β-hydroxy-β-methylbutyrate (HMB), and L-arginine (Arg) had promising effects on improving recovery. The present study aimed to evaluate the effect of supplementation with Gln/Arg/HMB in patients undergoing heart surgery. METHODS This randomized clinical trial was conducted on 70 patients undergoing cardiac surgery. Participants were requested to consume 2 sachets of a combination of 7 g L-arginine, 7 g L-glutamine, and 1.5 g daily HMB or placebo 30 days before operation. At the baseline and end of the study, left ventricular ejection fraction and the serum levels of troponin, creatine phosphokinase (CPK), CPK-MB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were measured. Also, the Sequential Organ Failure Assessment (SOFA) score, time of stay in hospital and intensive care unit (ICU), and postoperative complications were recorded after surgery. RESULTS In total, 60 preoperative patients (30 in each group) with a mean age of 53.13 ± 14.35 years completed the study (attrition rate = 85.7%). Subjects in the Gln/Arg/HMB group had lower serum levels of CPK-MB (median [IQR] = 49 [39.75] vs. 83 [64.55]; P = 0.011), troponin (median [IQR] = 2.13 [1.89] vs. 4.34 [1.99]; P < 0.001), bilirubin (median [IQR] = 0.50 [0.20] vs. 0.40 [0.22]; P < 0.001), and SOFA score (median [IQR] = 2 [2] vs. 5 [2]; P < 0.001) at end of the study compared to the placebo. Also, the time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group. CONCLUSION The present study showed that perioperative supplementation with a combination of Gln, Arg, and HMB enhances the recovery, reduces myocardial injury, and decreases the time of hospital and ICU stay in cardiac surgery patients. These results need to be confirmed in a larger trial. TRIAL REGISTRATION IRCT.ir IRCT20120913010826N31. Registered on 13 October 2020.
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Affiliation(s)
- Mona Norouzi
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Shohadaye gomnam BLD., ALEM square, Yazd, Iran.,Department of Nutrition, International Campus of Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Azadeh Nadjarzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Shohadaye gomnam BLD., ALEM square, Yazd, Iran. .,Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sayyed Saeid Khayyatzadeh
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Shohadaye gomnam BLD., ALEM square, Yazd, Iran.,Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Shahid Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran
| | - Hamed Fattahi
- Cardiovascular Medical and Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhang X, Zhang W, Lou H, Luo C, Du Q, Meng Y, Wu X, Zhang M. Risk factors for prolonged intensive care unit stays in patients after cardiac surgery with cardiopulmonary bypass: A retrospective observational study. Int J Nurs Sci 2021; 8:388-393. [PMID: 34631988 PMCID: PMC8488808 DOI: 10.1016/j.ijnss.2021.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/28/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives Patients after cardiac surgery with cardiopulmonary bypass (CPB) require a stay in the ICU postoperatively. This study aimed to investigate the incidence of prolonged length of stay (LOS) in the ICU after cardiac surgery with CPB and identify associated risk factors. Methods The current investigation was an observational, retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017. Data were obtained from the hospital database. Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS. Results Of 395 patients, 137 (34.7%) had a prolonged ICU LOS (>72.0 h), and the median ICU LOS was 50.9 h. Several variables were found associated with prolonged ICU LOS: duration of CPB, prolonged mechanical ventilation and non-invasive assisted ventilation use, PaO2/FiO2 ratios within 6 h after surgery, type of surgery, red blood cell infusion during surgery, postoperative atrial arrhythmia, postoperative ventricular arrhythmia (all P < 0.05). Conclusions These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS, enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.
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Affiliation(s)
- Xueying Zhang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Wenxia Zhang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hongyu Lou
- Digestive Disease Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Chuqing Luo
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Qianqian Du
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Ya Meng
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyu Wu
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Meifen Zhang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
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Komarov RN, Kleshchev PV. [Current problems of simultaneous surgery of the aortic valve and ischaemic heart disease]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:168-174. [PMID: 33332320 DOI: 10.33529/angio2020416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Surgical policy in treatment of patients suffering from concomitant valvular pathology and ischaemic heart disease is an extremely important problem of contemporary cardiac surgery. With the advent of advanced techniques and due to the improvement of old ones, there have over the last decades appeared new approaches to treatment of this cohort of patients. Presented in the article is a review of current publications regarding the problem of surgical treatment of patients with a combination of pronounced valvular pathology requiring surgical correction and ischaemic heart disease necessitating the need for myocardial revascularization. This is followed by providing the data concerning contemporary strategies of treatment of patients with concomitant pathology, as well as the comparison of various approaches and the effect of the chosen technique on the outcome.
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Affiliation(s)
- R N Komarov
- Department of Cardiovascular and Aortic Surgery, University Clinical Hospital #1, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - P V Kleshchev
- Cardiosurgical Department #42, Chief Military Clinical Hospital named after Academician N.N. Burdenko, Moscow, Russia
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10
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The effect of opium addiction on short-term postoperative outcomes after coronary artery bypass graft surgery: A prospective observational cohort study. Biomedicine (Taipei) 2020; 10:23-28. [PMID: 33854931 PMCID: PMC7735979 DOI: 10.37796/2211-8039.1042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/24/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Opium addiction has been recently suggested as a potential risk factor for the occurrence of perioperative complications in patients undergoing coronary artery bypass graft (CABG) surgery. The aim of this study was to evaluate whether opium addiction can potentially affect patients' short-term postoperative outcomes after CABG surgery. Material and methods In a prospective observational cohort study, all consecutive patients who were scheduled for first-time isolated elective on pump CABG surgery were screened during the study period for opium addiction. The study was carried out between September 2015 and November 2016 at Mazandaran Heart Center, Sari, Iran. A total number of 228 patients [110 opium addicted (OA) and 118 non-addicted (NA)] were screened and included. All patients were evaluate, in terms of short-term postoperative outcomes, until hospital discharge or death. Results In the OA patients, the mean amount of estimated postoperative bleeding was significantly more than NA patients (535 ± 304.75 ml vs. 463.56 ± 209.77; P = 0.04). Mean ventilation time were significantly longer in the OA patients than in the NA (9.9 days vs. 8.66 days, P = 0.02). The mean duration of postoperative hospital stay was two days longer in the OA (10.83 days vs. 8.34 days, P < 0.001). Also, the mean use of packed cell during surgery and incidence of postoperative atrial fibrillation were higher in the OA patients than NA (P = 0.005). Conclusion The results of our study provide strong evidence that the opium addiction should be considered as a risk factors for developing perioperative complications, including higher mean postoperative bleeding, need for intraoperative packed red blood cell transfusion, ventilation time and length of hospital stay, in patients undergoing CABG surgery.
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Perros AJ, Esguerra‐Lallen A, Rooks K, Chong F, Engkilde‐Pedersen S, Faddy HM, Hewlett E, Naidoo R, Tung J, Fraser JF, Tesar P, Ziegenfuss M, Smith S, O’Brien D, Flower RL, Dean MM. Coronary artery bypass grafting is associated with immunoparalysis of monocytes and dendritic cells. J Cell Mol Med 2020; 24:4791-4803. [PMID: 32180339 PMCID: PMC7176880 DOI: 10.1111/jcmm.15154] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
Coronary artery bypass grafting (CABG) triggers a systemic inflammatory response that may contribute to adverse outcomes. Dendritic cells (DC) and monocytes are immunoregulatory cells potentially affected by CABG, contributing to an altered immune state. This study investigated changes in DC and monocyte responses in CABG patients at 5 time-points: admission, peri-operative, ICU, day 3 and day 5. Whole blood from 49 CABG patients was used in an ex vivo whole blood culture model to prospectively assess DC and monocyte responses. Lipopolysaccharide (LPS) was added in parallel to model responses to an infectious complication. Co-stimulatory and adhesion molecule expression and intracellular mediator production was measured by flow cytometry. CABG modulated monocyte and DC responses. In addition, DC and monocytes were immunoparalysed, evidenced by failure of co-stimulatory and adhesion molecules (eg HLA-DR), and intracellular mediators (eg IL-6) to respond to LPS stimulation. DC and monocyte modulation was associated with prolonged ICU length of stay and post-operative atrial fibrillation. DC and monocyte cytokine production did not recover by day 5 post-surgery. This study provides evidence that CABG modulates DC and monocyte responses. Using an ex vivo model to assess immune competency of CABG patients may help identify biomarkers to predict adverse outcomes.
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Affiliation(s)
- Alexis J. Perros
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
- Critical Care Research Group (CCRG)The Prince Charles HospitalBrisbaneQLDAustralia
| | - Arlanna Esguerra‐Lallen
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
- Critical Care Research Group (CCRG)The Prince Charles HospitalBrisbaneQLDAustralia
- Adult Intensive Care ServicesThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Kelly Rooks
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
| | - Fenny Chong
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
| | - Sanne Engkilde‐Pedersen
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
- Critical Care Research Group (CCRG)The Prince Charles HospitalBrisbaneQLDAustralia
- Adult Intensive Care ServicesThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Helen M. Faddy
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
- Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
- School of Health and Sport SciencesUniversity of the Sunshine CoastPetrieQLDAustralia
| | - Elise Hewlett
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
| | - Rishendran Naidoo
- Cardiothoracic Surgery ProgramThe Prince Charles HospitalBrisbaneQLDAustralia
| | - John‐Paul Tung
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
- Critical Care Research Group (CCRG)The Prince Charles HospitalBrisbaneQLDAustralia
- Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - John F. Fraser
- School of MedicineUniversity of QueenslandBrisbaneQLDAustralia
- Critical Care Research Group (CCRG)The Prince Charles HospitalBrisbaneQLDAustralia
- Adult Intensive Care ServicesThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Peter Tesar
- Cardiothoracic Surgery ProgramThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Marc Ziegenfuss
- Adult Intensive Care ServicesThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Susan Smith
- Cardiothoracic Surgery ProgramThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Donalee O’Brien
- Cardiothoracic Surgery ProgramThe Prince Charles HospitalBrisbaneQLDAustralia
| | - Robert L. Flower
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
- Faculty of HealthQueensland University of TechnologyBrisbaneQLDAustralia
| | - Melinda M. Dean
- Research and DevelopmentAustralian Red Cross LifebloodBrisbaneQLDAustralia
- Critical Care Research Group (CCRG)The Prince Charles HospitalBrisbaneQLDAustralia
- School of Health and Sport SciencesUniversity of the Sunshine CoastPetrieQLDAustralia
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12
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Wu Q, Wang T, Chen S, Zhou Q, Li H, Hu N, Feng Y, Dong N, Yao S, Xia Z. Cardiac protective effects of remote ischaemic preconditioning in children undergoing tetralogy of fallot repair surgery: a randomized controlled trial. Eur Heart J 2019; 39:1028-1037. [PMID: 28329231 PMCID: PMC6018784 DOI: 10.1093/eurheartj/ehx030] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 01/17/2017] [Indexed: 01/17/2023] Open
Abstract
Aims Remote ischaemic preconditioning (RIPC) by inducing brief ischaemia in distant tissues protects the heart against myocardial ischaemia-reperfusion injury (IRI) in children undergoing open-heart surgery, although its effectiveness in adults with comorbidities is controversial. The effectiveness and mechanism of RIPC with respect to myocardial IRI in children with tetralogy of Fallot (ToF), a severe cyanotic congenital cardiac disease, undergoing open heart surgery are unclear. We hypothesized that RIPC can confer cardioprotection in children undergoing ToF repair surgery. Methods and results Overall, 112 ToF children undergoing radical open cardiac surgery using cardiopulmonary bypass (CPB) were randomized to either a RIPC group (n = 55) or a control group (n = 57). The RIPC protocol consisted of three cycles of 5-min lower limb occlusion and 5-min reperfusion using a cuff-inflator. Serum inflammatory cytokines and cardiac injury markers were measured before surgery and after CPB. Right ventricle outflow tract (RVOT) tissues were collected during the surgery to assess hypoxia-inducible factor (Hif)-1α and other signalling proteins. Cardiac mitochondrial injury was assessed by electron microscopy. The primary results showed that the length of stay in the intensive care unit (ICU) was longer in the control group than in the RIPC group (52.30 ± 13.43 h vs. 47.55 ± 10.34 h, respectively, P = 0.039). Patients in the control group needed longer post-operative ventilation time compared to the RIPC group (35.02 ± 6.56 h vs. 31.96 ± 6.60 h, respectively, P = 0.016). The levels of post-operative serum troponin-T at 12 and 18 h, CK-MB at 24 h, as well as the serum h-FABP levels at 6 h, after CPB were significantly lower, which was coincident with significantly higher protein expression of cardiac Hif-1α, p-Akt, p-STAT3, p-STAT5, and p-eNOS and less vacuolization of mitochondria in the RIPC group compared to the control group. Conclusion In ToF children undergoing open heart surgery, RIPC attenuates myocardial IRI and improves the short-term prognosis.
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Affiliation(s)
- Qingping Wu
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Tingting Wang
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Shiqiang Chen
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Quanjun Zhou
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Haobo Li
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, 21 Sassoon Road, Hong Kong, China.,Department of Anaesthesiology, University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR, China
| | - Na Hu
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Yinglu Feng
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Shanglong Yao
- Department of Anaesthesiology, Institute of Anaesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
| | - Zhengyuan Xia
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, 21 Sassoon Road, Hong Kong, China.,Department of Anaesthesiology, University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR, China
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Cromhout PF, Berg SK, Moons P, Damgaard S, Nashef S, Thygesen LC. Updating EuroSCORE by including emotional, behavioural, social and functional factors to the risk assessment of patients undergoing cardiac surgery: a study protocol. BMJ Open 2019; 9:e026745. [PMID: 31272975 PMCID: PMC6615815 DOI: 10.1136/bmjopen-2018-026745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Conventional risk assessment in cardiac surgery focus on medical and physiological factors and have been developed to predict mortality. Other relevant risk factors associated with increased risk of poor outcomes are not included. Adding non-medical variables as potential prognostic factors to risk assessments direct attention away from specific diagnoses towards a more holistic view of the patients and their predicament. The aim of this paper is to describe the method and analysis plan for the development and validation of a prognostic screening tool as a supplement to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) to predict mortality, readmissions and prolonged length of admission in patients within 90 days after cardiac surgery, as individual outcomes. METHODS AND ANALYSIS The development of a prognostic screening tool with inclusion of emotional, behavioural, social and functional factors complementing risk assessment by EuroSCORE will adopt the methods recommended by the PROGnosis RESearch Strategy Group and report using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement. In the development stage, we will use data derived from three datasets comprising 1143, 3347 and 982 patients for a prospective cohort study of patients undergoing cardiac surgery, respectively. We will construct logistic regression models to predict mortality, prolonged length of admission and 90-day readmissions. In the validation stage, we will use data from a separate sample of 333 patients planned to undergo cardiac surgery to assess the performance of the developed prognostic model. We will produce validation plots showing the overall performance, area under the curve statistic for discrimination and the calibration slope and intercept. ETHICS AND DISSEMINATION The study will follow the requirements from the Ethical Committee System ensuring voluntary participation in accordance with the Helsinki declarations. Data will be filed in accordance with the requirements of the Danish Data Protection Agency.
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Affiliation(s)
| | - Selina Kikkenborg Berg
- Heart Centre, Rigshospitalet, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenborg, Gothenborg, Sweden
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Lau Caspar Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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14
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Wang H, Lyu Y, Liao Q, Jin L, Xu L, Hu Y, Yu Y, Guo K. Effects of Remote Ischemic Preconditioning in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery. Front Physiol 2019; 10:495. [PMID: 31110480 PMCID: PMC6501551 DOI: 10.3389/fphys.2019.00495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/08/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose This study aimed to evaluate effects of remote ischemic preconditioning (RIPC) on myocardial injury in patients undergoing off-pump coronary artery bypass graft surgery (OPCABG). Methods Sixty-five patients scheduled for the OPCABG were randomly assigned to control (n = 32) or RIPC group (n = 33). All patients received general anesthesia. Before the surgical incision, RIPC was induced on an upper limb with repeated 5-min ischemia and 5-min reperfusion for four times. Blood samples were collected from right internal jugular vein. Plasma levels of IL-6, IL-8, IL-10, TNF-α, cTnT, HFABP, IMA, and MDA were detected at pre-operatively and 0, 6, 18, 24, 48, 72, and 120 h after the surgery. Left internal mammary artery (LIMA) and great saphenous vein (GSV) was cut into 2–3 mm for Western blot analysis of Hif-1α. Results In the present study, RIPC treatment significantly reduced plasma levels of cardiac troponin T (p < 0.05), heart-type fatty acid binding protein (p < 0.05), ischemia modified albumin (p < 0.05), malondialdehyde (p < 0.05), as well as plasma levels of pro-inflammatory cytokines including IL-6, IL-8, and TNF-α (P < 0.05, respectively). RIPC treatment significantly increased hypoxia-inducible factor-1α (p < 0.05) expression as well. Mechanical ventilation time for postoperative patients was shortened in RIPC group than those in control group (17.4 ± 3.8 h vs. 19.7 ± 2.9 h, respectively, p < 0.05). Conclusion RIPC by upper limb ischemia shortens mechanical ventilation time in patients undergoing OPCABG. RIPC treatment reduces postoperative myocardial enzyme expression and pro-inflammatory cytokine production. RIPC is a protective therapeutic approach in the coronary artery bypass graft surgery.
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Affiliation(s)
- Huilin Wang
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Lyu
- Department of Anesthesiology, Yunnan Baoshan Anli Hospital, Baoshan, China
| | - Qingwu Liao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lin Jin
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liying Xu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Hu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Yu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kefang Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
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15
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Milić D, Lazarević M, Bogdanović D, Damnjanović Z, Živić S, Perić D, Kamenov A, Stojiljković V, Golubović M. DISORDERS OF COAGULATION STATUS AND HAEMOSTASIS AS PROGNOSTIC PARAMETERS OF IMMEDIATE AND EARLY RESULTS AFTER SURGICAL MYOCARDIAL REVASCULARISATION. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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16
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Stoppe C, Ney J, Lomivorotov VV, Efremov SM, Benstoem C, Hill A, Nesterova E, Laaf E, Goetzenich A, McDonald B, Peine A, Marx G, Fehnle K, Heyland DK. Prediction of Prolonged ICU Stay in Cardiac Surgery Patients as a Useful Method to Identify Nutrition Risk in Cardiac Surgery Patients: A Post Hoc Analysis of a Prospective Observational Study. JPEN J Parenter Enteral Nutr 2018; 43:768-779. [PMID: 30506711 PMCID: PMC7379574 DOI: 10.1002/jpen.1486] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cardiovascular surgery patients with a prolonged intensive care unit (ICU) stay may benefit most from early nutrition support. Using established scoring systems for nutrition assessment and operative risk stratification, we aimed to develop a model to predict a prolonged ICU stay ≥5 days in order to identify patients who will benefit from early nutrition interventions. METHODS This is a retrospective analysis of a prospective observational study of patients undergoing elective valvular, coronary artery bypass grafting, or combined cardiac surgery. The nutrition risk was assessed by well-established screening tools. Patients' preoperative EuroSCORE (European System for Cardiac Operative Risk Evaluation), primary disease, and intraoperative cardiopulmonary bypass (CPB) time were included as independent variables in a multivariate logistic regression analysis to predict a prolonged ICU stay (>4 days). RESULTS The number of cardiac surgery patients included was 1193. Multivariate analysis revealed that for prediction of ICU stay >4 days, both Nutritional Risk Screening 2002 (area under the curve (AUC): 0.716, P = .020) and Mini Nutritional Assessment (MNA) score (AUC: 0.715, P = .037) were significant, whereas for prediction of ICU stay >5 days, only the MNA score showed significant results (AUC: 0.762, P = .011). CONCLUSION Present data provide first evidence about the combined use of EuroSCORE, primary disease, CPB time, and nutrition risk screening tools for prediction of prolonged ICU stay in cardiac surgery patients. If prospectively evaluated in adequately designed studies, this model may help to identify patients with prolonged ICU stay to initiate early postoperative nutrition therapy and thus, facilitate an enhanced recovery.
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Affiliation(s)
- Christian Stoppe
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Julia Ney
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care Medicine, Research Institute of Circulation Pathology, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Sergey M Efremov
- Department of Anesthesiology and Intensive Care Medicine, Research Institute of Circulation Pathology, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Carina Benstoem
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Aileen Hill
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Ekaterina Nesterova
- Department of Anesthesiology and Intensive Care Medicine, National Pirogov Medical Centre, Moscow, Russia
| | - Elena Laaf
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Andreas Goetzenich
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Bernard McDonald
- Division of Cardiac Anesthesia & Critical Care Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Arne Peine
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and 3CARE, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Karl Fehnle
- Algora: Statistics and Clinical Research, Haar, Germany
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
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17
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Tunç M, Şahutoğlu C, Karaca N, Kocabaş S, Aşkar FZ. Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery in Adults. Turk J Anaesthesiol Reanim 2018; 46:283-291. [PMID: 30140535 DOI: 10.5152/tjar.2018.92244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/26/2017] [Indexed: 11/22/2022] Open
Abstract
Objective Prolonged intensive care unit (ICU) stay prevents the use of ICU equipment by other patients and increases hospital cost. This retrospective study aimed to investigate the risk factors for prolonged ICU stay in patients undergoing open heart surgery. Methods The medical records of 513 patients who underwent coronary artery bypass grafting and valvular heart surgery were retrospectively evaluated. Patients were divided into two groups based on their ICU stay: groups I (<48 h) and II (≥48 h). The effect of patient variables on the ICU stay duration was investigated using logistic regression analysis. Results The mean age of the patients was 61.5±10 years, and 69% were males. The ICU stay of ≥48 h was observed in 20.1% of the patients. Diabetes mellitus and low ejection fraction (pre-operative variables); long aortic cross clamp, cardiopulmonary bypass time and intra-aortic balloon pump requirement (intra-operative variables); arrhythmia, myocardial infarction, renal dysfunction and need for haemodialysis, use of ≥2 inotropic agents, infection, sepsis and respiratory complication (post-operative variables) were found to prolong the ICU stay. In multivariate logistic regression analysis, intra-aortic balloon pump requirement, use of ≥2 inotropic agents, post-operative myocardial infarction and need for haemodialysis were found to be independent risk factors for prolonged ICU stay (p<0.05). Early mortality was 0.97% (5 patients). Conclusion Intra-aortic balloon pump requirement, use of ≥2 inotropic agents, post-operative myocardial infarction and need for post-operative haemodialysis are independent risk factors for patients undergoing open heart surgery. Selection of methods for protecting the myocardium and renal functions during the intra-operative period would reduce the duration of ICU stay.
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Affiliation(s)
- Muzaffer Tunç
- Department of Anaesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
| | - Cengiz Şahutoğlu
- Department of Anaesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
| | - Nursen Karaca
- Department of Anaesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
| | - Seden Kocabaş
- Department of Anaesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
| | - Fatma Zekiye Aşkar
- Department of Anaesthesiology and Reanimation, Ege University School of Medicine, İzmir, Turkey
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18
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Yamaguchi T, Terashima M, Takamura C, Sakurai H, Ooishi K, Yoshizaki T, Yamaguchi J, Hijikata S, Iwai T, Sagawa Y, Watanabe K, Miyazaki R, Masuda R, Miwa N, Sekigawa M, Hara N, Nagata Y, Miyamoto T, Obayashi T, Nozato T. Cardiac Magnetic Resonance Imaging of Very Late Intrapericardial Hematoma 8 Years after Coronary Artery Bypass Grafting. Intern Med 2018; 57:975-978. [PMID: 29269664 PMCID: PMC5919856 DOI: 10.2169/internalmedicine.9605-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 55-year-old man presented with dyspnea, edema, and appetite loss. He had undergone coronary artery bypass grafting 8 years previously. He had jugular venous distention and Kussmaul's sign. Contrast-enhanced cardiac magnetic resonance imaging (CMRI) demonstrated an intrapericardial mass compressing the right ventricular (RV) cavity. T1- and T2-weighted black-blood images showed a mass with heterogeneous high signal intensity and a thick and dark rim. The mass was considered to be a chronic hematoma. After pericardiotomy with surgical removal of the hematoma, CMRI showed the marked improvement of the RV function. Late intrapericardial hematoma is rare and CMRI is useful for making a differential diagnosis.
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Affiliation(s)
- Tetsuo Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | | | | | - Hironobu Sakurai
- Department of Cardiovascular Surgery, Japanese Red Cross Musashino Hospital, Japan
| | - Kiyotoshi Ooishi
- Department of Cardiovascular Surgery, Japanese Red Cross Musashino Hospital, Japan
| | - Tomoya Yoshizaki
- Department of Cardiovascular Surgery, Japanese Red Cross Musashino Hospital, Japan
| | - Junji Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Sadahiro Hijikata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Takamasa Iwai
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Keita Watanabe
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Ryoichi Miyazaki
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Ryo Masuda
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Naoyuki Miwa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Masahiro Sekigawa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Nobuhiro Hara
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | | | - Toru Obayashi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Japan
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19
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Joshi MR, Latham J, Okorogheye G. Use of a flowable haemostat versus an oxidised regenerated cellulose agent in primary elective cardiac surgery: economic impact from a UK healthcare perspective. J Cardiothorac Surg 2017; 12:107. [PMID: 29187216 PMCID: PMC5707905 DOI: 10.1186/s13019-017-0660-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022] Open
Abstract
Background Flowable haemostatic agents have been shown to be superior to non-flowable agents in terms of haemostatic control and need for transfusion products in patients undergoing cardiac surgery. We investigated the economic impact of the use of a flowable haemostatic agent (Floseal) compared with non-flowable oxidised regenerated cellulose (ORC) agent in primary elective cardiac surgery from the perspective of the UK National Health Service (NHS). Methods A cost-consequence framework based upon clinical data from a prospective trial and an observational trial and NHS-specific actual reference costs (2016) was developed to compare the economic impact of Floseal with that of ORC. The individual domains of care investigated comprised complications (major and minor) avoided, operating room time savings, surgical revisions for bleeding avoided and transfusions avoided. The cost impact of Floseal versus ORC on ICU days and extended bed days avoided was modelled separately. Results Compared with ORC, the use of Floseal would be associated with overall net savings to the NHS of £178,283 per 100 cardiac surgery patients who experience intraoperative bleeding requiring haemostatic therapy. Cost savings were apparent in all individual domains of care (complications avoided: £83,536; operating room time saved: £63,969; surgical revisions avoided: £34,038; and blood transfusions avoided: £22,317). Cost savings per 100 patients with Floseal over ORC in terms of ICU days avoided (n = 30) and extended bed days avoided (n = 51.7) were £57,960 and £21,965, respectively. A sensitivity analysis indicated that these findings remained robust when the model parameters representing the clinical benefit of Floseal over ORC were reduced by up to 20%. Conclusions Despite higher initial acquisition costs, the use of flowable haemostatic agents achieves substantial cost savings over non-flowable agents in cardiac surgery. These cost savings commence during the operating theatre and appear to continue to be realised throughout the postoperative period. Electronic supplementary material The online version of this article (10.1186/s13019-017-0660-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mayur R Joshi
- Baxter Healthcare Ltd., Wallingford Rd, Compton, Newbury, RG20 7QW, UK
| | - Jacqueline Latham
- Baxter Healthcare Ltd., Wallingford Rd, Compton, Newbury, RG20 7QW, UK.
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Arias-Morales CE, Stoicea N, Gonzalez-Zacarias AA, Slawski D, Bhandary SP, Saranteas T, Kaminiotis E, Papadimos TJ. Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective. F1000Res 2017; 6. [PMID: 28299184 PMCID: PMC5321117 DOI: 10.12688/f1000research.10085.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 12/29/2022] Open
Abstract
In the United States, cardiac surgery-related blood transfusion rates reached new highs in 2010, with 34% of patients receiving blood products. Patients undergoing both complex (coronary artery bypass grafting [CABG] plus valve repair or replacement) and non-complex (isolated CABG) cardiac surgeries are likely to have comorbidities such as anemia. Furthermore, the majority of patients undergoing isolated CABG have a history of myocardial infarction. These characteristics may increase the risk of complications and blood transfusion requirement. It becomes difficult to demonstrate the association between transfusions and mortality because of the fact that most patients undergoing cardiac surgery are also critically ill. Transfusion rates remain high despite the advances in perioperative blood conservation, such as the intraoperative use of cell saver in cardiac surgery. Some recent prospective studies have suggested that the use of blood products, even in low-risk patients, may adversely affect clinical outcomes. In light of this information, we reviewed the literature to assess the clinical outcomes in terms of 30-day and 1-year morbidity and mortality in transfused patients who underwent uncomplicated CABG surgery.
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Affiliation(s)
- Carlos E Arias-Morales
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Diana Slawski
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Sujatha P Bhandary
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Theodosios Saranteas
- Second Department of Anesthesiology, School of Medicine, University of Athens, Athens, Greece
| | - Eva Kaminiotis
- Second Department of Anesthesiology, School of Medicine, University of Athens, Athens, Greece
| | - Thomas J Papadimos
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
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Aborted anterior myocardial infarction vs. takotsubo syndrome: The case of a patient with a stenoticwrap-around left anterior descending coronary artery. Res Cardiovasc Med 2017. [DOI: 10.5812/cardiovascmed.38872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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22
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Yousefinezhadi T, Jannesar Nobari FA, Behzadi Goodari F, Arab M. A Case Study on Improving Intensive Care Unit (ICU) Services Reliability: By Using Process Failure Mode and Effects Analysis (PFMEA). Glob J Health Sci 2016; 8:52635. [PMID: 27157162 PMCID: PMC5064078 DOI: 10.5539/gjhs.v8n9p207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/25/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction: In any complex human system, human error is inevitable and shows that can’t be eliminated by blaming wrong doers. So with the aim of improving Intensive Care Units (ICU) reliability in hospitals, this research tries to identify and analyze ICU’s process failure modes at the point of systematic approach to errors. Methods: In this descriptive research, data was gathered qualitatively by observations, document reviews, and Focus Group Discussions (FGDs) with the process owners in two selected ICUs in Tehran in 2014. But, data analysis was quantitative, based on failures’ Risk Priority Number (RPN) at the base of Failure Modes and Effects Analysis (FMEA) method used. Besides, some causes of failures were analyzed by qualitative Eindhoven Classification Model (ECM). Results: Through FMEA methodology, 378 potential failure modes from 180 ICU activities in hospital A and 184 potential failures from 99 ICU activities in hospital B were identified and evaluated. Then with 90% reliability (RPN≥100), totally 18 failures in hospital A and 42 ones in hospital B were identified as non-acceptable risks and then their causes were analyzed by ECM. Conclusions: Applying of modified PFMEA for improving two selected ICUs’ processes reliability in two different kinds of hospitals shows that this method empowers staff to identify, evaluate, prioritize and analyze all potential failure modes and also make them eager to identify their causes, recommend corrective actions and even participate in improving process without feeling blamed by top management. Moreover, by combining FMEA and ECM, team members can easily identify failure causes at the point of health care perspectives.
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Affiliation(s)
- Taraneh Yousefinezhadi
- Ph.D. Student of Health Policy, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran.
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23
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Almashrafi A, Elmontsri M, Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Serv Res 2016; 16:318. [PMID: 27473872 PMCID: PMC4966741 DOI: 10.1186/s12913-016-1591-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/27/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Intensive care unit (ICU) care is associated with costly and often scarce resources. In many parts of the world, ICUs are being perceived as major bottlenecks limiting downstream services such as operating theatres. There are many clinical, surgical and contextual factors that influence length of stay. Knowing these factors can facilitate resource planning. However, the extent at which this knowledge is put into practice remains unclear. The aim of this systematic review was to identify factors that impact the duration of ICU stay after cardiac surgery and to explore evidence on the link between understanding these factors and patient and resource management. METHODS We conducted electronic searches of Embase, PubMed, ISI Web of Knowledge, Medline and Google Scholar, and reference lists for eligible studies. RESULTS Twenty-nine papers fulfilled inclusion criteria. We recognised two types of objectives for identifying influential factors of ICU length of stay (LOS) among the reviewed studies. These were general descriptions of predictors and prediction of prolonged ICU stay through statistical models. Among studies with prediction models, only two studies have reported their implementation. Factors most commonly associated with increased ICU LOS included increased age, atrial fibrillation/ arrhythmia, chronic obstructive pulmonary disease (COPD), low ejection fraction, renal failure/ dysfunction and non-elective surgery status. CONCLUSION Cardiac ICUs are major bottlenecks in many hospitals around the world. Efforts to optimise resources should be linked to patient and surgical characteristics. More research is needed to integrate patient and surgical factors into ICU resource planning.
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Affiliation(s)
- Ahmed Almashrafi
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Mustafa Elmontsri
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Paul Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstans Road, London, W6 8RP UK
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24
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Walpot J, Sadreddini M. Left Atrial Compression Caused by an Intrapericardial Hematoma after Coronary Artery Bypass Graft Surgery. J Emerg Med 2016; 51:274-7. [PMID: 27353056 DOI: 10.1016/j.jemermed.2016.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/16/2016] [Accepted: 05/05/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left atrial compression (LAC) is an uncommon condition that causes left ventricular inflow obstruction. The clinical and pathologic features are similar to those of mitral stenosis. Impaired left ventricular filling may cause hypotension, syncope, or shock. The increased left atrial pressure causes retrograde increase of the pressure throughout the pulmonary circulation with subsequent signs of congestion. CASE REPORT An 84-year-old man presented with LAC caused by a focal tamponade related to a pericardial hematoma as a complication of coronary artery bypass graft (CABG) surgery. The formation of the hematoma occurred 3 weeks postsurgery. The echocardiographic study before discharge at day 12 after CABG surgery showed neither a focal hematoma nor a tamponade. The diagnosis was made 6 days later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Intrapericardial tamponade caused by bleeding is a known complication of CABG surgery in the early postoperative stage. However, emergency physicians should be aware that a postoperative hematoma may also present as a focal tamponade because of postoperative adhesion by scar formation. The literature of LAC is limited. The most reported causes of LAC are compression caused by structures of the gastrointestinal tract, followed by thoracic aortic pathology. A Medline search for the terms "left atrial compression and hematoma" and "left atrial compression and intrapericardial hematoma" found only 31 and 4 hits, respectively. We also briefly discuss the import role of bedside echocardiography in the diagnostic process of LAC in the emergency medicine department.
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Affiliation(s)
- Jeroen Walpot
- Department of Cardiology, Admiraal De Ruyter Ziekenhuis, Vlissingen and Goes, The Netherlands
| | - Masoud Sadreddini
- Department of Cardiology, Admiraal De Ruyter Ziekenhuis, Vlissingen and Goes, The Netherlands
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25
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Almashrafi A, Alsabti H, Mukaddirov M, Balan B, Aylin P. Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study. BMJ Open 2016; 6:e010764. [PMID: 27279475 PMCID: PMC4908878 DOI: 10.1136/bmjopen-2015-010764] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Two objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive model for prolonged LOS in the cardiac intensive care unit (CICU) based on preoperative factors available at admission and to compare it against two existing cardiac stratification systems. DESIGN Observational retrospective study. SETTINGS A tertiary hospital in Oman. PARTICIPANTS All adult patients who underwent cardiac surgery at a major referral hospital in Oman between 2009 and 2013. RESULTS 30.5% of the patients had prolonged LOS (≥11 days) after surgery, while 17% experienced prolonged ICU LOS (≥5 days). Factors that were identified to prolong CICU LOS were non-elective surgery, current congestive heart failure (CHF), renal failure, combined coronary artery bypass graft (CABG) and valve surgery, and other non-isolated valve or CABG surgery. Patients were divided into three groups based on their scores. The probabilities of prolonged CICU LOS were 11%, 26% and 28% for group 1, 2 and 3, respectively. The predictive model had an area under the curve of 0.75. Factors associated with prolonged overall postoperative LOS included the body mass index, the type of surgery, cardiopulmonary bypass machine use, packed red blood cells use, non-elective surgery and number of complications. The latter was the most important determinant of postoperative LOS. CONCLUSIONS Patient management can be tailored for individual patient based on their treatments and personal attributes to optimise resource allocation. Moreover, a simple predictive score system to enable identification of patients at risk of prolonged CICU stay can be developed using data that are routinely collected by most hospitals.
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Affiliation(s)
- Ahmed Almashrafi
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Hilal Alsabti
- Cardiothoracic Surgery Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mirdavron Mukaddirov
- Cardiothoracic Surgery Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Baskaran Balan
- Cardiothoracic Surgery Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
| | - Paul Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Souza ALS, Salgado CG, Mourilhe-Rocha R, Mesquita ET, Lima LCLC, Mattos NDFGD, Rabischoffsky A, Fagundes FES, Colafranceschi AS, Carvalho LAF. Transcatheter Aortic Valve Implantation and Morbidity and Mortality-Related Factors: a 5-Year Experience in Brazil. Arq Bras Cardiol 2016; 106:519-27. [PMID: 27192383 PMCID: PMC4940151 DOI: 10.5935/abc.20160072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/18/2016] [Indexed: 02/04/2023] Open
Abstract
Background Transcatheter aortic valve implantation has become an option for
high-surgical-risk patients with aortic valve disease. Objective To evaluate the in-hospital and one-year follow-up outcomes of transcatheter
aortic valve implantation. Methods Prospective cohort study of transcatheter aortic valve implantation cases
from July 2009 to February 2015. Analysis of clinical and procedural
variables, correlating them with in-hospital and one-year mortality. Results A total of 136 patients with a mean age of 83 years (80-87) underwent heart
valve implantation; of these, 49% were women, 131 (96.3%) had aortic
stenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prosthetic
valve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%).
The baseline orifice area was 0.67 ± 0.17 cm2 and the mean
left ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with an
STS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expanding
in 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%;
in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Blood
transfusion (relative risk of 54; p = 0.0003) and pulmonary arterial
hypertension (relative risk of 5.3; p = 0.036) were predictive of
in-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p =
0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) were
predictive of 1-year mortality. At 30 days, 97% of patients were in NYHA
functional class I/II; at one year, this figure reached 96%. Conclusion Transcatheter aortic valve implantation was performed with a high success
rate and low mortality. Blood transfusion was associated with higher
in-hospital and one-year mortality. Peak C-reactive protein was associated
with one-year mortality.
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Rezaianzadeh A, Maghsoudi B, Tabatabaee H, Keshavarzi S, Bagheri Z, Sajedianfard J, Gerami H, Rasouli J. Factors associated with extubation time in coronary artery bypass grafting patients. PeerJ 2015; 3:e1414. [PMID: 26644972 PMCID: PMC4671154 DOI: 10.7717/peerj.1414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/29/2015] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives. Cardiovascular diseases are the leading cause of death worldwide, with coronary artery disease being the most common. With increasing numbers of patients, Coronary Artery Bypass Grafting (CABG) has become the most common operation in the world. Respiratory disorder is one of the most prevalent complications of CABG. Thus, weaning off the mechanical ventilation and extubation are of great clinical importance for these patients. Some post-operative problems also relate to the tracheal tube and mechanical ventilation. Therefore, an increase in this leads to an increase in the number of complications, length of hospital stay, and treatment costs. Since a large number of factors affect the post-operative period, the present study aims to identify the predictors of extubation time in CABG patients using casualty network analysis. Method. This longitudinal study was conducted on 800 over 18 year old patients who had undergone CABG surgery in three treatment centers affiliated to Shiraz University of Medical Sciences. The patients’ information, including pre-operative, peri-operative, and post-operative variables, was retrospectively extracted from their medical records. Then, the data was comprehensively analyzed through path analysis using MPLUS-7.1 software. Results. The mean of extubation time was 10.27 + 4.39 h. Moreover, extubation time was significantly affected by packed cells during the Cardiopulmonary Bypass (CPB), packed cells after CPB, inotrope use on arrival at ICU, mean arterial pressure 1st ICU, packed cells 1st ICU, platelets 1st ICU, Blood Urea Nitrogen 1st ICU, and hematocrit 1st ICU. Conclusion. Considering all of the factors under investigation, some peri-operative and post-operative factors had significant effects. Therefore, considering the post-operative factors is important for designing a treatment plan and evaluating patients’ prognosis.
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Affiliation(s)
- Abbas Rezaianzadeh
- Colorectal Research Center, Department of epidemiology, School of Health, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Behzad Maghsoudi
- Department of Anesthesia, Shiraz Medical School, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Hamidreza Tabatabaee
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences , Shiraz Fars , Iran
| | - Sareh Keshavarzi
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences , Shiraz Fars , Iran
| | - Zahra Bagheri
- Department of Biostatistic, Shiraz Medical School, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Javad Sajedianfard
- Department of Physiology, School of Veterinary Medicine, Shiraz University , Shiraz , Iran
| | - Hamid Gerami
- Department of Anesthesia, Shiraz Medical School, Shiraz University of Medical Sciences , Shiraz , Iran
| | - Javad Rasouli
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences , Shiraz Fars , Iran
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Oliveira LBD, Rodrigues ARB, Püschel VADA, Silva FAD, Conceição SLD, Béda LB, Fidelis B, Santana-Santos E, Secoli SR. Avaliação da carga de trabalho no pós-operatório de cirurgia cardíaca segundo o Nursing Activities Score. Rev Esc Enferm USP 2015; 49 Spec No:80-6. [DOI: 10.1590/s0080-623420150000700012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/31/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Identificar os fatores associados à carga de trabalho de enfermagem no cuidado a pacientes no pós-operatório de cirurgia cardíaca. Método Estudo de coorte prospectivo, conduzido com 187 pacientes da Unidade de Terapia Intensiva Cirúrgica (UTI) do Instituto do Coração. Os dados foram coletados nas primeiras 24 e 72 horas do paciente na UTI. A variável dependente foi a carga de trabalho calculada por meio do Nursing Activities Score (NAS) e as independentes foram de natureza demográfico-clínicas e escores de morbimortalidade. Para análise dos dados utilizou-se os testes de Wilcoxon-Mann-Whitney e de correlação de Spearman, e a regressão linear com modelo de efeitos mistos. Resultados A maioria dos pacientes era do sexo masculino (59,4%), com média de idade de 61 anos (±12,7) e 43,9% desenvolveram algum tipo de complicação no pós-operatório. Nas 24 horas, a carga de trabalho foi de 82,4% (±3,4) e foi de 58,1% (±3,4) nas 72 horas. Os fatores associados ao aumento do NAS foram: tempo de internação do paciente na UTI (p=0,036) e a presença de complicações (p<0,001). Conclusão A gravidade do paciente nas 24 horas, em oposição a inúmeros estudos, não influenciou no aumento da carga de trabalho, a qual se mostrou associada ao tempo de internação e às complicações.
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