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Lee RM, Rajaram R. Improving care in lung cancer surgery: a review of quality measures and evolving standards. Curr Opin Pulm Med 2024; 30:368-374. [PMID: 38587082 DOI: 10.1097/mcp.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW Lung cancer is the leading cause of cancer-related death in the United States. Pulmonary resection, in addition to perioperative systemic therapies, is a cornerstone of treatment for operable patients with early-stage and locoregional disease. In recent years, increased emphasis has been placed on surgical quality metrics: specific and evidence-based structural, process, and outcome measures that aim to decrease variation in lung cancer care and improve long term outcomes. These metrics can be divided into potential areas of intervention or improvement in the preoperative, intraoperative, and postoperative phases of care and form the basis of guidelines issued by organizations including the National Cancer Center Network (NCCN) and Society of Thoracic Surgeons (STS). This review focuses on established quality metrics associated with lung cancer surgery with an emphasis on the most recent research and guidelines. RECENT FINDINGS Over the past 18 months, quality metrics across the peri-operative care period were explored, including optimal invasive mediastinal staging preoperatively, the extent of intraoperative lymphadenectomy, surgical approaches related to minimally invasive resection, and enhanced recovery pathways that facilitate early discharge following pulmonary resection. SUMMARY Quality metrics in lung cancer surgery is an exciting and important area of research. Adherence to quality metrics has been shown to improve overall survival and guidelines supporting their use allows targeted quality improvement efforts at a local level to facilitate more consistent, less variable oncologic outcomes across centers.
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Affiliation(s)
- Rachel M Lee
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Liao KM, Lu HY, Chen CY, Kuo LT, Tang BR. The impact of comorbidities on prolonged mechanical ventilation in patients with chronic obstructive pulmonary disease. BMC Pulm Med 2024; 24:257. [PMID: 38796444 PMCID: PMC11128105 DOI: 10.1186/s12890-024-03068-9] [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: 10/29/2023] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND In patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure, approximately 10% of them are considered to be at high risk for prolonged mechanical ventilation (PMV, > 21 days). PMV have been identified as independent predictors of unfavorable outcomes. Our previous study revealed that patients aged 70 years older and COPD severity were at a significantly higher risk for PMV. We aimed to analyze the impact of comorbidities and their associated risks in patients with COPD who require PMV. METHODS The data used in this study was collected from Kaohsiung Medical University Hospital Research Database. The COPD subjects were the patients first diagnosed COPD (index date) between January 1, 2012 and December 31, 2020. The exclusion criteria were the patients with age less than 40 years, PMV before the index date or incomplete records. COPD and non-COPD patients, matched controls were used by applying the propensity score matching method. RESULTS There are 3,744 eligible patients with COPD in the study group. The study group had a rate of 1.6% (60 cases) patients with PMV. The adjusted HR of PMV was 2.21 (95% CI 1.44-3.40; P < 0.001) in the COPD patients than in non-COPD patients. Increased risks of PMV were found significantly for patients with diabetes mellitus (aHR 4.66; P < 0.001), hypertension (aHR 3.20; P = 0.004), dyslipidemia (aHR 3.02; P = 0.015), congestive heart failure (aHR 6.44; P < 0.001), coronary artery disease (aHR 3.11; P = 0.014), stroke (aHR 6.37; P < 0.001), chronic kidney disease (aHR 5.81 P < 0.001) and Dementia (aHR 5.78; P < 0.001). CONCLUSIONS Age, gender, and comorbidities were identified as significantly higher risk factors for PMV occurrence in the COPD patients compared to the non-COPD patients. Beyond age, comorbidities also play a crucial role in PMV in COPD.
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Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
- Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan.
| | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Bo-Ren Tang
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
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3
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Yang H, Kong L, Lan W, Yuan C, Huang Q, Tang Y. Risk factors and clinical prediction models for prolonged mechanical ventilation after heart valve surgery. BMC Cardiovasc Disord 2024; 24:250. [PMID: 38745119 PMCID: PMC11092048 DOI: 10.1186/s12872-024-03923-x] [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: 11/18/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Prolonged mechanical ventilation (PMV) is a common complication following cardiac surgery linked to unfavorable patient prognosis and increased mortality. This study aimed to search for the factors associated with the occurrence of PMV after valve surgery and to develop a risk prediction model. METHODS The patient cohort was divided into two groups based on the presence or absence of PMV post-surgery. Comprehensive preoperative and intraoperative clinical data were collected. Univariate and multivariate logistic regression analyses were employed to identify risk factors contributing to the incidence of PMV. Based on the logistic regression results, a clinical nomogram was developed. RESULTS The study included 550 patients who underwent valve surgery, among whom 62 (11.27%) developed PMV. Multivariate logistic regression analysis revealed that age (odds ratio [OR] = 1.082, 95% confidence interval [CI] = 1.042-1.125; P < 0.000), current smokers (OR = 1.953, 95% CI = 1.007-3.787; P = 0.047), left atrial internal diameter index (OR = 1.04, 95% CI = 1.002-1.081; P = 0.041), red blood cell count (OR = 0.49, 95% CI = 0.275-0.876; P = 0.016), and aortic clamping time (OR = 1.031, 95% CI = 1.005-1.057; P < 0.017) independently influenced the occurrence of PMV. A nomogram was constructed based on these factors. In addition, a receiver operating characteristic (ROC) curve was plotted, with an area under the curve (AUC) of 0.782 and an accuracy of 0.884. CONCLUSION Age, current smokers, left atrial diameter index, red blood cell count, and aortic clamping time are independent risk factors for PMV in patients undergoing valve surgery. Furthermore, the nomogram based on these factors demonstrates the potential for predicting the risk of PMV in patients following valve surgery.
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Affiliation(s)
- Heng Yang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Leilei Kong
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Wangqi Lan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Chen Yuan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Qin Huang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Yanhua Tang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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4
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Harik L, Habib RH, Dimagli A, Rahouma M, Perezgrovas-Olaria R, Jr Soletti G, Alzghari T, An KR, Rong LQ, Sandner S, Bairey-Merz CN, Redfors B, Girardi L, Gaudino M. Intraoperative Anemia Mediates Sex Disparity in Operative Mortality After Coronary Artery Bypass Grafting. J Am Coll Cardiol 2024; 83:918-928. [PMID: 38418006 DOI: 10.1016/j.jacc.2023.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND Women undergoing coronary artery bypass grafting (CABG) have higher operative mortality than men. OBJECTIVES The purpose of this study was to evaluate the relationship between intraoperative anemia (nadir intraoperative hematocrit), CABG operative mortality, and sex. METHODS This was a cohort study of 1,434,225 isolated primary CABG patients (344,357 women) from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2022). The primary outcome was operative mortality. The attributable risk (AR) (the risk-adjusted strength of the association of female sex with CABG outcomes) for the primary outcome was calculated. Causal mediation analysis derived the total effect of female sex on operative mortality risk and the proportion of that effect mediated by intraoperative anemia. RESULTS Women had lower median nadir intraoperative hematocrit (22.0% [Q1-Q3: 20.0%-25.0%] vs 27.0% [Q1-Q3: 24.0%-30.0%], standardized mean difference 97.0%) than men. Women had higher operative mortality than men (2.8% vs 1.7%; P < 0.001; adjusted OR: 1.36; 95% CI: 1.30-1.41). The AR of female sex for operative mortality was 1.21 (95% CI: 1.17-1.24). After adjusting for nadir intraoperative hematocrit, AR was reduced by 43% (1.12; 95% CI: 1.09-1.16). Intraoperative anemia mediated 38.5% of the increased mortality risk associated with female sex (95% CI: 32.3%-44.7%). Spline regression showed a stronger association between operative mortality and nadir intraoperative hematocrit at hematocrit values <22.0% (P < 0.001). CONCLUSIONS The association of female sex with increased CABG operative mortality is mediated to a large extent by intraoperative anemia. Avoiding nadir intraoperative hematocrit values below 22.0% may reduce sex differences in CABG operative mortality.
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Affiliation(s)
- Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Robert H Habib
- The Society of Thoracic Surgeons Research and Analytic Center, Chicago, Illinois, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Giovanni Jr Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Kevin R An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - C Noel Bairey-Merz
- Barbara Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
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Kobayashi Y, Peng YC, Yu E, Bush B, Jung YH, Murphy Z, Goeddel L, Whitman G, Venkataraman A, Brown CH. Prediction of lactate concentrations after cardiac surgery using machine learning and deep learning approaches. Front Med (Lausanne) 2023; 10:1165912. [PMID: 37790131 PMCID: PMC10543087 DOI: 10.3389/fmed.2023.1165912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/23/2023] [Indexed: 10/05/2023] Open
Abstract
Background Although conventional prediction models for surgical patients often ignore intraoperative time-series data, deep learning approaches are well-suited to incorporate time-varying and non-linear data with complex interactions. Blood lactate concentration is one important clinical marker that can reflect the adequacy of systemic perfusion during cardiac surgery. During cardiac surgery and cardiopulmonary bypass, minute-level data is available on key parameters that affect perfusion. The goal of this study was to use machine learning and deep learning approaches to predict maximum blood lactate concentrations after cardiac surgery. We hypothesized that models using minute-level intraoperative data as inputs would have the best predictive performance. Methods Adults who underwent cardiac surgery with cardiopulmonary bypass were eligible. The primary outcome was maximum lactate concentration within 24 h postoperatively. We considered three classes of predictive models, using the performance metric of mean absolute error across testing folds: (1) static models using baseline preoperative variables, (2) augmentation of the static models with intraoperative statistics, and (3) a dynamic approach that integrates preoperative variables with intraoperative time series data. Results 2,187 patients were included. For three models that only used baseline characteristics (linear regression, random forest, artificial neural network) to predict maximum postoperative lactate concentration, the prediction error ranged from a median of 2.52 mmol/L (IQR 2.46, 2.56) to 2.58 mmol/L (IQR 2.54, 2.60). The inclusion of intraoperative summary statistics (including intraoperative lactate concentration) improved model performance, with the prediction error ranging from a median of 2.09 mmol/L (IQR 2.04, 2.14) to 2.12 mmol/L (IQR 2.06, 2.16). For two modelling approaches (recurrent neural network, transformer) that can utilize intraoperative time-series data, the lowest prediction error was obtained with a range of median 1.96 mmol/L (IQR 1.87, 2.05) to 1.97 mmol/L (IQR 1.92, 2.05). Intraoperative lactate concentration was the most important predictive feature based on Shapley additive values. Anemia and weight were also important predictors, but there was heterogeneity in the importance of other features. Conclusion Postoperative lactate concentrations can be predicted using baseline and intraoperative data with moderate accuracy. These results reflect the value of intraoperative data in the prediction of clinically relevant outcomes to guide perioperative management.
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Affiliation(s)
| | - Yu-Chung Peng
- Johns Hopkins University, Baltimore, MD, United States
| | - Evan Yu
- Johns Hopkins University, Baltimore, MD, United States
| | - Brian Bush
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Youn-Hoa Jung
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zachary Murphy
- Department of Anesthesiology & Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lee Goeddel
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Glenn Whitman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Archana Venkataraman
- Department of Electrical and Computer Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, MD, United States
| | - Charles H. Brown
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Ghandour H, Weiss AJ, Gaudino M, Halkos M, Chu D, Taylor BS, Puskas J, Bhatt DL, Zenati M, Stulak J, Rosengart T, Balkhy HH, Blackstone EH, Svensson LG, Bakaeen FG, Erten O, Karamlou T, Soltesz EG, Gillinov AM, Warmuth A, Roselli EE, Smedira NG. Public reporting for coronary artery bypass graft surgery: The quest for the optimal scorecard. J Thorac Cardiovasc Surg 2023; 166:805-815.e1. [PMID: 35525802 DOI: 10.1016/j.jtcvs.2022.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A number of publicly available rating algorithms are used to assess hospital performance in coronary artery bypass grafting (CABG). However, concerns remain that these algorithms fail to correlate with each other and inadequately capture the case complexity of individual center practices. METHODS Composite star ratings for isolated CABG from the Society of Thoracic Surgeons public reporting database were extracted for 2018-2019. U.S. News & World Report Best Hospitals was used to extract CABG ratings as well as overall cardiology and heart surgery ranking, and the Centers for Medicare & Medicaid Services Hospital Compare was used to extract CABG volume and 30-day mortality. Spearman correlation coefficients were used to assess possible relationships. Expert opinion on risk adjustment and program evaluation was incorporated. RESULTS Correlations between Society of Thoracic Surgeons star rating and U.S. News & World Report overall ranking in cardiology and heart surgery (r = 0.15) and Centers for Medicare & Medicaid Services 30-day mortality (r = -0.27) were poor. Society of Thoracic Surgeons star rating correlated weakly with U.S. News & World Report CABG ratings (r = 0.33) and with Centers for Medicare & Medicaid Services CABG volume (r = 0.32), whereas the latter 2 correlated moderately (r = 0.52) with each other. Of the 75 centers with accredited cardiac surgery training programs, 13 (17%) did not participate in Society of Thoracic Surgeons public reporting. Important gaps were identified in risk assessment, and potential solutions are proposed. CONCLUSIONS Correlations between current CABG public reporting systems are weak. Further work is needed to refine and standardize CABG rating systems to more adequately capture the scope and complexity of an individual center's clinical practice and to better inform patients.
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Affiliation(s)
- Hiba Ghandour
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aaron J Weiss
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York, NY
| | - Michael Halkos
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | | | - John Puskas
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass
| | - Marco Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, Mass
| | - John Stulak
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Todd Rosengart
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago, Chicago, Ill
| | - Eugene H Blackstone
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Ozgun Erten
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tara Karamlou
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward G Soltesz
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - A Marc Gillinov
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Eric E Roselli
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nicholas G Smedira
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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Weiss AJ, Bakaeen FG. Commentary: Measuring and reporting cardiac surgery: Healthy debate and welcome progress. J Thorac Cardiovasc Surg 2023; 166:826-827. [PMID: 35396124 DOI: 10.1016/j.jtcvs.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Aaron J Weiss
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Faisal G Bakaeen
- Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Gaudino M, Chadow D, Rahouma M, Soletti GJ, Sandner S, Perezgrovas-Olaria R, Audisio K, Cancelli G, Bratton BA, Fremes S, Kurlansky P, Girardi L, Habib RH. Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020. JAMA Surg 2023; 158:494-502. [PMID: 36857059 PMCID: PMC9979009 DOI: 10.1001/jamasurg.2022.8156] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/29/2022] [Indexed: 03/02/2023]
Abstract
Importance It has been reported that women undergoing coronary artery bypass have higher mortality and morbidity compared with men but it is unclear if the difference has decreased over the last decade. Objective To evaluate trends in outcomes of women undergoing coronary artery bypass in the US from 2011 to 2020. Design, Setting, and Participants This retrospective cohort study at hospitals contributing to the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons included 1 297 204 patients who underwent primary isolated coronary artery bypass from 2011 to 2020. Exposure Coronary artery bypass. Main Outcomes and Measures The primary outcome was operative mortality. The secondary outcome was the composite of operative mortality and morbidity (including operative mortality, stroke, kidney failure, reoperation, deep sternal wound infection, prolonged mechanical ventilation, and prolonged hospital stay). The attributable risk (the association of female sex with coronary artery bypass grafting outcomes) for the primary and secondary outcomes was calculated. Results Between 2011 and 2020, 1 297 204 patients underwent primary isolated coronary artery bypass grafting with a mean age of 66.0 years, 317 716 of which were women (24.5%). Women had a higher unadjusted operative mortality (2.8%; 95% CI, 2.8-2.9 vs 1.7%; 95% CI, 1.7-1.7; P < .001) and overall unadjusted incidence of the composite of operative mortality and morbidity compared with men (22.9%; 95% CI, 22.7-23.0 vs 16.7%; 95% CI, 16.6-16.8; P < .001). The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period (P for trend = 0.38). The attributable risk for the composite of operative mortality and morbidity was 1.08 in both 2011 and 2020 with no significant change over the study period (P for trend = 0.71). Conclusions and Relevance Women remain at significantly higher risk for adverse outcomes following coronary artery bypass grafting and no significant improvement has been seen over the course of the last decade. Further investigation into the determinants of operative outcomes in women is urgently needed.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - David Chadow
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Giovanni Jr Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Brenden A. Bratton
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Stephen Fremes
- Schulich Heart Centre, Sunnybrook Health Science University of Toronto, Toronto, Ontario, Canada
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Robert H. Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
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Mehaffey JH, Charles EJ, Berens M, Clark MJ, Bond C, Fonner CE, Kron I, Gelijns AC, Miller MA, Sarin E, Romano M, Prager R, Badhwar V, Ailawadi G. Barriers to atrial fibrillation ablation during mitral valve surgery. J Thorac Cardiovasc Surg 2023; 165:650-658.e1. [PMID: 33840467 PMCID: PMC8446105 DOI: 10.1016/j.jtcvs.2021.03.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/08/2021] [Accepted: 03/08/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Nearly 40% of patients with atrial fibrillation (AF) undergoing mitral valve surgery do not receive concomitant ablation despite societal guidelines. We assessed barriers to implementation of this evidence-based practice through a survey of cardiac surgeons in 2 statewide quality collaboratives. METHODS Adult cardiac surgeons across 2 statewide collaboratives were surveyed on their knowledge and practice regarding AF ablation. Questions concerning experience, clinical practice, case scenarios, and barriers to implementation were included. RESULTS Among 66 respondents (66 of 135; 48.9%), the majority reported "very comfortable/frequently use" cryoablation (53 of 66; 80.3%) and radiofrequency (55 of 66; 83.3%). Only 12.1% (8/66) were not aware of the recommendations. Approximately one-half of the respondents reported learning AF ablation in fellowship (50.0%; 33 of 66) or attending courses (47.0%; 31 of 66). Responses to clinical scenarios demonstrated wide variability in practice patterns. One-half of the respondents reported no barriers; others cited increased cross-clamp time, excessive patient risk, and arrhythmia incidence as obstacles. Desired interventions included cardiology/electrophysiology support, protocols, pacemaker rate information, and education in the form of site visits, videos and proctors. CONCLUSIONS Knowledge of evidence-based recommendations and practice patterns vary widely. These data identify several barriers to implementation of concomitant AF ablation and suggest specific interventions (mentorship/support, protocols, research, and education) to overcome these barriers.
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Affiliation(s)
- J Hunter Mehaffey
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va.
| | - Eric J Charles
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va
| | - Michaela Berens
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va
| | - Melissa J Clark
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
| | - Chris Bond
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Department of Cardiac Surgery, Queen Elizabeth University Hospital, Birmingham, United Kingdom
| | | | - Irving Kron
- Division of Cardiac Surgery, University of Virginia, Charlottesville, Va; Virginia Cardiac Services Quality Initiative, Falls Church, Va
| | - Annetine C Gelijns
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marissa A Miller
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md
| | - Eric Sarin
- Inova Heart and Vascular Institute, Falls Church, Va
| | - Matthew Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Richard Prager
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Gorav Ailawadi
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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10
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Bishawi M, Hattler B, Almassi GH, Quin JA, Grover FL, Collins JF, Ebrahimi R, Wolbrom DH, Shroyer AL. Health-related quality of life impacts upon 5-year survival after coronary artery bypass surgery. J Card Surg 2022; 37:4899-4905. [PMID: 36423254 DOI: 10.1111/jocs.17165] [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: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft (CABG) surgery; however, its impact on long-term mortality is unknown. This study's objective was to determine if baseline HRQoL status predicts 5-year post-CABG mortality. METHODS This prespecified, randomized on/off bypass follow-up study (ROOBY-FS) subanalysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans RAND Short Form-36 (VR-36), between 5-year post-CABG survivors and nonsurvivors. Standardized subscores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey subcomponents independently predicted 5-year mortality (p ≤ .05). RESULTS Of the 2203 ROOBY-FS enrollees, 2104 (95.5%) completed baseline surveys. Significant differences between 5-year post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-White race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 physical component summary score (p = .01), VR-36 mental component summary score (p < .001), and SAQ physical limitation score (p = .003) were all associated with 5-year all-cause mortality. CONCLUSIONS Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision-making and enhancing pre-CABG informed consent.
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Affiliation(s)
- Muath Bishawi
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Brack Hattler
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - G Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacquelyn A Quin
- Department of Surgery, Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Frederick L Grover
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, USA
| | - Ramin Ebrahimi
- Department of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel H Wolbrom
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
| | - A Laurie Shroyer
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
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11
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Phillips RL, George BC, Holmboe ES, Bazemore AW, Westfall JM, Bitton A. Measuring Graduate Medical Education Outcomes to Honor the Social Contract. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:643-648. [PMID: 35020616 PMCID: PMC9028305 DOI: 10.1097/acm.0000000000004592] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The graduate medical education (GME) system is heavily subsidized by the public in return for producing physicians who meet society's needs. Under the terms of this implicit social contract, decisions about how this funding is allocated are deferred to the individual training sites. Institutions receiving public funding face potential conflicts of interest, which have at times prioritized institutional purposes and needs over societal needs, highlighting that there is little public accountability for how such funding is used. The cost and institutional burden of assessing many fundamental GME outcomes, such as specialty, geographic physician distribution, training-imprinted cost behaviors, and populations served, could be mitigated as data sources and methods for assessing GME outcomes and guiding training improvement already exist. This new capacity to assess system-level outcomes could help institutions and policymakers strategically address the greatest public needs. Measurement of educational outcomes can also be used to guide training improvement at every level of the educational system (i.e., the individual trainee, individual teaching institution, and collective GME system levels). There are good examples of institutions, states, and training consortia that are already assessing and using GME outcomes in these ways. The ultimate outcome could be a GME system that better meets the needs of society and better honors what is now only an implicit social contract.
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Affiliation(s)
- Robert L. Phillips
- R.L. Phillips Jr is executive director, Center for Professionalism & Value in Health Care, American Board of Family Medicine Foundation, Washington, DC; ORCID: https://orcid.org/0000-0001-7882-1560
| | - Brian C. George
- B.C. George is director, Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan, executive director, Society for Improving Medical Professional Learning, Boston, Massachusetts, and senior scholar, Center for Professionalism & Value in Health Care, American Board of Family Medicine Foundation, Washington, DC
| | - Eric S. Holmboe
- E.S. Holmboe is chief, Research, Milestones Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Andrew W. Bazemore
- A.W. Bazemore is senior vice president for research and policy, American Board of Family Medicine, and co-director, Center for Professionalism & Value in Health Care, American Board of Family Medicine Foundation, Washington, DC
| | - John M. Westfall
- J.M. Westfall is director, Robert Graham Center, American Academy of Family Physicians, Washington, DC
| | - Asaf Bitton
- A. Bitton is executive director, Ariadne Labs, associate professor of medicine, Division of General Medicine, Brigham and Women’s Hospital, associate professor of health care policy, Harvard Medical School, Boston, Massachusetts, and part-time senior advisor for primary care policy, Center for Medicare & Medicaid Innovation, Baltimore, Maryland
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12
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Prolonged mechanical ventilation after cardiac surgery: substudy of the Transfusion Requirements in Cardiac Surgery III trial. Can J Anaesth 2022; 69:1493-1506. [PMID: 36123418 PMCID: PMC9484719 DOI: 10.1007/s12630-022-02319-9] [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: 11/20/2021] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Prolonged mechanical ventilation (MV) is a major complication following cardiac surgery. We conducted a secondary analysis of the Transfusion Requirements in Cardiac Surgery (TRICTS) III trial to describe MV duration, identify factors associated with prolonged MV, and examine associations of prolonged MV with mortality and complications. METHODS Four thousand, eight hundred and nine participants undergoing cardiac surgery at 71 hospitals worldwide were included. Prolonged MV was defined based on the Society of Thoracic Surgeons definition as MV lasting 24 hr or longer. Adjusted associations of patient and surgical factors with prolonged MV were examined using multivariable logistic regression. Associations of prolonged MV with complications were assessed using odds ratios, and adjusted associations between prolonged MV and mortality were evaluated using multinomial regression. Associations of shorter durations of MV with survival and complications were explored. RESULTS Prolonged MV occurred in 15% (725/4,809) of participants. Prolonged MV was associated with surgical factors indicative of complexity, such as previous cardiac surgery, cardiopulmonary bypass duration, and separation attempts; and patient factors such as critical preoperative state, left ventricular impairment, renal failure, and pulmonary hypertension. Prolonged MV was associated with perioperative but not long-term complications. After risk adjustment, prolonged MV was associated with perioperative mortality; its association with long-term mortality among survivors was weaker. Shorter durations of MV were not associated with increased risk of mortality or complications. CONCLUSION In this substudy of the TRICS III trial, prolonged MV was common after cardiac surgery and was associated with patient and surgical risk factors. Although prolonged MV showed strong associations with perioperative complications and mortality, it was not associated with long-term complications and had weaker association with long-term mortality among survivors. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT02042898); registered 23 January 2014. This is a substudy of the Transfusion Requirements in Cardiac Surgery (TRICS) III trial.
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13
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Ibrahim M, Szeto WY, Gutsche J, Weiss S, Bavaria J, Ottemiller S, Williams M, Gallagher JF, Fishman N, Cunningham R, Brady L, Brennan PJ, Acker M. Transparency, Public Reporting and a Culture of Change to Quality and Safety in Cardiac Surgery. Ann Thorac Surg 2021; 114:626-635. [PMID: 34843698 DOI: 10.1016/j.athoracsur.2021.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
Academic medical centers have a duty to serve as hospitals of last resort for advanced cardiac surgical care and therefore manage patients at elevated risk of post-operative morbidity and mortality. They must also meet state and professional quality targets devised to protect the public. The tension between these imperatives can be managed by a multi-dimensional quality improvement program which aims to manage risk, optimize outcomes and exclude futile operations. We here share our approach to this process, its impact on our institution and discuss pertinent issues relevant to institutions in a similar situation.
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Affiliation(s)
- Michael Ibrahim
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacob Gutsche
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve Weiss
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Bavaria
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephanie Ottemiller
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew Williams
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jo Fante Gallagher
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil Fishman
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Regina Cunningham
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Luann Brady
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick J Brennan
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Acker
- Division of Cardiovascular Surgery, Penn Cardiovascular Institute, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Tsukihara H, Motomura N, Takamoto S. Audit-Based Quality Validation of the Japan Cardiovascular Surgery Database. Circ J 2021; 85:2014-2018. [PMID: 34421106 DOI: 10.1253/circj.cj-21-0444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Japan Cardiovascular Surgery Database (JCVSD) is a nationwide registry of patients undergoing cardiovascular surgery in Japan. To investigate and improve data quality, we have been conducting on-site institutional audits since 2004. This study aimed to investigate the accuracy of the registered data by comparing it to site visit data.Methods and Results:The subjects of this study were the 95 facilities at which a site visit was conducted. The case registration accuracy was 98.74%. Furthermore, we confirmed high data input accuracy of >90% for almost all fields. Approximately 99% of cases had been correctly entered for diabetes, aortic stenosis, and mortality. We also discovered which fields were more likely to be incorrectly captured and the causes thereof, as well as problems regarding some definitions and the input system itself. CONCLUSIONS We were able to confirm high registration accuracy in the JCVSD. Appropriately resourced, focused site visits as part of a national audit are capable of accurate data collection on which continual nationwide quality control can be based. Continued work and development to further improve the quality of the database are mandatory to maintain a high standard of cardiovascular surgery in Japan.
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Affiliation(s)
- Hiroyuki Tsukihara
- Department of Cardiothoracic Surgery, The University of Tokyo.,Japan Cardiovascular Surgery Database
| | - Noboru Motomura
- Japan Cardiovascular Surgery Database.,Department of Cardiovascular Surgery, Toho University Sakura Medical Center
| | - Shinichi Takamoto
- Japan Cardiovascular Surgery Database.,Department of Health Policy and Management, School of Medicine, Keio University
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15
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Dukleska K, Vinocur CD, Brenn BR, Lim DJ, Keith SW, Dirnberger DR, Berman L. Preoperative Blood Transfusions and Morbidity in Neonates Undergoing Surgery. Pediatrics 2020; 146:peds.2019-3718. [PMID: 33087550 DOI: 10.1542/peds.2019-3718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Blood transfusions in the neonatal patient population are common, but there are no established guidelines regarding transfusion thresholds. Little is known about postoperative outcomes in neonates who receive preoperative blood transfusions (PBTs). METHODS Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Participant Use Data Files from 2012 to 2015, we identified all neonates who underwent surgery. Mortality and composite morbidity (defined as any postoperative complication) in neonates who received a PBT within 48 hours of surgery were compared with that in neonates who did not receive a transfusion. RESULTS A total of 12 184 neonates were identified, of whom 1209 (9.9%) received a PBT. Neonates who received a PBT had higher rates of preoperative comorbidities and worse postoperative outcomes when compared with those who did not receive a transfusion (composite morbidity: 46.2% vs 16.2%; P < .01). On multivariable regression analysis, PBTs were independently associated with increased 30-day morbidity (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 1.63-2.22; P < .01) and mortality (OR = 1.98; 95% CI: 1.55-2.55; P < .01). In a propensity score-matched analysis, PBTs continued to be associated with increased 30-day morbidity (OR = 1.53; 95% CI: 1.29-1.81; P < .01) and mortality (OR = 1.58; 95% CI: 1.24-2.01; P = .01). CONCLUSIONS In a propensity score-matched model, PBTs are independently associated with increased morbidity and mortality in neonates who undergo surgery. Prospective data are needed to better understand the potential effects of a red blood cell transfusion in this patient population.
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Affiliation(s)
- Katerina Dukleska
- Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Charles D Vinocur
- Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.,Departments of Surgery and
| | - B Randall Brenn
- Department of Anesthesiology, Monroe Carrell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Doyle J Lim
- Anesthesiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
| | - Scott W Keith
- Division of Biostatistics, Departments of Pharmacology and Experimental Therapeutics and
| | | | - Loren Berman
- Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; .,Departments of Surgery and
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16
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Smith JR, Layrisse V, Medina-Inojosa JR, Berg JD, Ommen SR, Olson TP. Predictors of exercise capacity following septal myectomy in patients with hypertrophic cardiomyopathy. Eur J Prev Cardiol 2020; 27:1066-1073. [PMID: 31967491 DOI: 10.1177/2047487319898106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIMS Patients with hypertrophic obstructive cardiomyopathy (HOCM) have impaired exercise capacity. The gold standard therapy for patients with HOCM is septal myectomy surgery; however, changes in maximum oxygen uptake (VO2peak) following myectomy are variable, with VO2peak decreasing in some patients. Therefore, we evaluated changes in VO2peak following surgical myectomy to determine clinical predictors of those exhibiting decreased VO2peak post-myectomy. METHODS HOCM patients (N = 295) who performed symptom limited cardiopulmonary exercise testing prior to and following surgical myectomy were included for analysis. The VO2peak non-responder group (n = 128) was defined as <0% change in VO2peak from pre- to post-myectomy. Step-wise regression models using demographics, clinical, and physiologic characteristics were created to determine predictors of hypertrophic cardiomyopathy patients in the VO2peak non-responder group. RESULTS Independent predictors of the VO2peak non-responder group included higher pre-myectomy VO2peak (% predicted), older age, women, history of dyslipidemia, lack of cardiac rehabilitation enrollment, and lower body mass index (all p < 0.03). Forty-three (14.6%) patients reached the primary end-point of all-cause mortality during a median follow up of 11.25 years (interquartile range 6.94 to 16.40). After adjustment for age, sex, beta-blocker use, coronary artery disease history, and body mass index, the VO2peak non-responder group had greater risk of death compared with the VO2peak responder group (adjusted hazard ratio: 1.77, 95% confidence interval: 1.06-3.34, p = 0.01). CONCLUSION This large hypertrophic cardiomyopathy cohort demonstrated that demographic (i.e. female sex), lack of cardiac rehabilitation enrollment, and cardiovascular risk factors (i.e. history of dyslipidemia) are predictive of those patients that did not exhibit increases in VO2peak following septal myectomy surgery.
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Affiliation(s)
- Joshua R Smith
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
| | - Veronica Layrisse
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA.,San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | | | - Jessica D Berg
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, USA
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17
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Gregory AJ, Grant MC, Manning MW, Cheung AT, Ender J, Sander M, Zarbock A, Stoppe C, Meineri M, Grocott HP, Ghadimi K, Gutsche JT, Patel PA, Denault A, Shaw A, Fletcher N, Levy JH. Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step-But There Is Much Work to Be Done. J Cardiothorac Vasc Anesth 2020; 34:39-47. [PMID: 31570245 DOI: 10.1053/j.jvca.2019.09.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Alexander J Gregory
- Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Albert T Cheung
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA
| | - Joerg Ender
- Department of Anesthesiology and Intensive Care Medicine, Herzzentrum Leipzig, Leipzig, Germany
| | - Michael Sander
- Department of Anaesthesiology and Intensive Care Medicine, UKGM University Hospital Gießen, Justus-Liebig-University Giessen, Gießen, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Christian Stoppe
- Department of Intensive Care Medicine, University Hospital of the RWTH Aachen, Aachen, Germany
| | | | - Hilary P Grocott
- Department of Anesthesiology, Perioperative and Pain Medicine and Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Kamrouz Ghadimi
- Department of Anesthesiology, Duke University, Durham, NC; Department of Critical Care, Duke University School of Medicine, Durham, NC
| | - Jacob T Gutsche
- Division of Cardiac Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA
| | - Andre Denault
- Département d'Anesthésiologie et de Médecine de la Douleur, Institut de Cardiologie de Montréal, Montréal, Quebec Canada; Division des Soins Intensifs, Département de Chirurgie Cardiaque, Institut de Cardiologie de Montréal, Montréal, Quebec Canada; Département de Pharmacologie et de Physiologie, Institut de Cardiologie de Montréal, Montréal, Quebec Canada
| | - Andrew Shaw
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nick Fletcher
- Department of Cardiothoracic Anesthesia and Critical Care, St. Georges University Hospital, London, United Kingdom; Institute of Anesthesia and Critical Care, Cleveland Clinic London, London, United Kingdom
| | - Jerrold H Levy
- Department of Anesthesiology, Duke University, Durham, NC; Department of Critical Care, Duke University School of Medicine, Durham, NC
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18
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Mehaffey JH, Hawkins RB, Charles EJ, Kron IL, Ailawadi G, Kern JA, Roeser ME, Kozower B, Teman NR. Impact of Complications After Cardiac Operation on One-Year Patient-Reported Outcomes. Ann Thorac Surg 2020; 109:43-48. [DOI: 10.1016/j.athoracsur.2019.05.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022]
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19
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de By TMMH, Muslem R, Caliskan K, Bortolussi G, Philipsen T, Friberg Ö, Bogers AJJC, Pagano D. Consolidated quality improvements following benchmarking with cardiothoracic surgery registries—a systematic review. Eur J Cardiothorac Surg 2019; 57:817-825. [DOI: 10.1093/ejcts/ezz330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022] Open
Abstract
Abstract
The influence of registries in medicine is large. However, there has been no systematic assessment conducted to quantify the impact of benchmarking with registries focused on cardiothoracic surgery. Numerous publications conclude that registry participation leads to improvement of outcomes for patients. A large number of registries provide evidence sub-structured by statistics that show decreases in morbidity and mortality in the participants’ clinical units. Many authors praise the benchmarking method making use of databases of registries as having a positive effect on outcome of care. However, studies proving the direct causal relation between the use of cardiothoracic surgery-oriented registries and improvement of clinical in-hospital outcomes are extremely scarce. We aimed to analyse the causal relation between the use of cardiothoracic surgery-oriented registries and improvement of clinical outcomes. In a systematic literature review, publications demonstrating the use of registry data to obtain consolidated quality improvements were selected. After analysis of 2990 scientific publications, 6 studies filled the inclusion criteria. The selected studies acknowledged that benchmarking of data against registries was used for a focused and methodologically organized improvement in cardiothoracic departments. In conjunction with the impact of the applied methods on healthcare, their results demonstrate quantifiable enhanced local outcomes over time.
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Affiliation(s)
- Theo M M H de By
- European Association for Cardio-Thoracic Surgery, Windsor, UK
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Rahatullah Muslem
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Giacomo Bortolussi
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Padua University Hospital, Padua, Italy
| | - Tine Philipsen
- Department of Cardiac Surgery, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Domenico Pagano
- Department of Cardiothoracic Surgery, University of Birmingham, University Hospital Birmingham, Birmingham, UK
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20
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Hu QL, Liu JY, Hobson DB, Cohen ME, Hall BL, Wick EC, Ko CY. Best Practices in Data Use for Achieving Successful Implementation of Enhanced Recovery Pathway. J Am Coll Surg 2019; 229:626-632.e1. [DOI: 10.1016/j.jamcollsurg.2019.08.1448] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 07/30/2019] [Accepted: 08/22/2019] [Indexed: 12/20/2022]
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21
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Likosky DS, Harrington SD, Cabrera L, DeLucia A, Chenoweth CE, Krein SL, Thibault D, Zhang M, Matsouaka RA, Strobel RJ, Prager RL. Collaborative Quality Improvement Reduces Postoperative Pneumonia After Isolated Coronary Artery Bypass Grafting Surgery. Circ Cardiovasc Qual Outcomes 2019; 11:e004756. [PMID: 30571334 DOI: 10.1161/circoutcomes.118.004756] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To date, studies evaluating outcome improvements associated with participation in physician-led collaboratives have been limited by the absence of a contemporaneous control group. We examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program. METHODS AND RESULTS We evaluated 911 754 coronary artery bypass operations (July 1, 2011, to June 30, 2017) performed across 1198 hospitals participating in a voluntary national physician reporting program (Society of Thoracic Surgeons [STS]), including 33 that participated in a Michigan-based collaborative (MI-Collaborative). Unlike STS hospitals not participating in the MI-Collaborative (i.e., STSnonMI) that solely received blinded reports, MI-Collaborative hospitals received a multi-faceted intervention starting November 2012 (quarterly in-person meetings showcasing unblinded data, webinars, site visits). Eighteen of the MI-Collaborative hospitals received additional support to implement recommended pneumonia prevention practices ("MI-CollaborativePlus"), whereas 15 did not ("MI-CollaborativeOnly"). We evaluated rates of postoperative pneumonia, adjusting for patient mix and hospital effects. Baseline patient characteristics were qualitatively similar between groups and time. During the preintervention period (Q3/2011 through Q3/2012), there was no statistically significant difference in the adjusted odds of pneumonia for STS hospitals participating in the MI-Collaborative compared to the STS non-MI hospitals. However, during the intervention period (Q4/2012 through Q2/2017), there was a significant 2% reduction per quarter in the adjusted odds of pneumonia for MI-Collaborative hospitals (n=33) relative to the STS-nonMI hospitals. There was a significant 3% per quarter reduction in the adjusted odds of pneumonia for the MI-CollaborativeOnly (n=15) hospitals relative to the STS-nonMI hospitals. Over the course of the overall study period, the STS-nonMI hospitals had a 1.96% reduction in risk-adjusted pneumonia (pre- vs. intervention periods), which was less than the MI-Collaborative (3.23%, P=0.011). Over the same time period, the MI-CollaborativePlus (n=18) reduced adjusted pneumonia rates by 10.29%, P=0.001. CONCLUSIONS Participation in a physician-led collaborative was associated with significant reductions in pneumonia relative to a national quality reporting program. Interventions including collaborative learning may yield superior outcomes relative to solely using physician feedback reporting. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02068716.
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Affiliation(s)
- Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (D.S.L., L.C., R.L.P.).,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., L.C., R.J.S., R.L.P.)
| | - Steven D Harrington
- Heart and Vascular Institute, Henry Ford Macomb Hospitals, Clinton Township, MI (S.D.H.)
| | - Lourdes Cabrera
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (D.S.L., L.C., R.L.P.).,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., L.C., R.J.S., R.L.P.)
| | - Alphonse DeLucia
- Department of Cardiac Surgery, Bronson Methodist Hospital, Kalamazoo, MI (A.D.)
| | - Carol E Chenoweth
- Department of Internal Medicine, University of Michigan, Ann Arbor (C.E.C.)
| | - Sarah L Krein
- VA Ann Arbor Healthcare System and Department of Internal Medicine, University of Michigan, Ann Arbor (S.L.K.)
| | - Dylan Thibault
- Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University, Durham, NC (D.T., R.A.M.)
| | - Min Zhang
- Department of Biostatistics, University of Michigan, Ann Arbor (M.Z.)
| | - Roland A Matsouaka
- Outcomes Research and Assessment Group, Duke Clinical Research Institute, Duke University, Durham, NC (D.T., R.A.M.).,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (R.A.M.)
| | - Raymond J Strobel
- Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., L.C., R.J.S., R.L.P.)
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (D.S.L., L.C., R.L.P.).,Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI (D.S.L., L.C., R.J.S., R.L.P.)
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Commentary: The next giant leap forward-Long-term outcomes after cardiac surgery. J Thorac Cardiovasc Surg 2019; 159:e175. [PMID: 31597615 DOI: 10.1016/j.jtcvs.2019.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 11/20/2022]
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23
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Kumar A, Sato K, Narayanswami J, Banerjee K, Andress K, Lokhande C, Mohananey D, Anumandla AK, Khan AR, Sawant AC, Menon V, Krishnaswamy A, Tuzcu EM, Jaber WA, Mick S, Svensson LG, Kapadia SR. Current Society of Thoracic Surgeons Model Reclassifies Mortality Risk in Patients Undergoing Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2019; 11:e006664. [PMID: 30354591 DOI: 10.1161/circinterventions.118.006664] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Society of Thoracic Surgeons (STS) scores are used to screen patients for transcatheter aortic valve replacement (TAVR). The STS scores were also used to risk stratify patients in major TAVR trials. This study evaluates the reclassification of predicted risk of mortality by the currently available online STS score calculator compared with the 2008 STS risk model in patients undergoing TAVR. METHODS AND RESULTS All patients who underwent TAVR from 2006 to 2016 were included in the study. The STS scores for all included patients were calculated by applying the 2008 STS risk model and again using the current STS online calculator. Among 1209 patients who underwent TAVR, 30-day mortality was 27 (2.2%). The overall predicted risk of mortality estimated by using the current online STS risk calculator was significantly lower than the 2008 STS risk model (6.3±4.4 vs 7.3±4.9; P<0.001). A total of 235 (19%) patients were reclassified into a lower risk category per the current STS risk model. In a multivariable logistic regression analysis, patients with persistent atrial fibrillation (odds ratio, 1.4; 95% CI, 1.0-1.9; P=0.03), chronic heart failure (odds ratio, 6.0; 95% CI, 3.8-10.1; P<0.001), and New York Heart Association class IV heart failure (odds ratio, 2.4; 95% CI, 1.3-4.4; P=0.007) were more likely to be reclassified into a lower risk category per the current STS risk model. CONCLUSIONS The current STS calculation method produces significantly lower predicted risk of mortality than the 2008 calculator, more pronounced in patients with certain comorbid conditions. These results should be considered while evaluating data from prior studies of TAVR.
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Affiliation(s)
- Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Kimi Sato
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Jyoti Narayanswami
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Krystof Andress
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Chetan Lokhande
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Anil Kumar Anumandla
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Abdur Rahman Khan
- Division of Cardiovascular Medicine, University of Louisville, KY (A.R.K.)
| | - Abhishek C Sawant
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Vivek Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - E Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Stephanie Mick
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Lars G Svensson
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (A.K., K.S., J.N., K.B., K.A., C.L., D.M., A.K.A., A.C.S., V.M., A.K., E.M.T., W.A.J., S.M., L.G.S., S.R.K.)
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24
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Risk Prediction in Clinical Practice: A Practical Guide for Cardiothoracic Surgeons. Ann Thorac Surg 2019; 108:1573-1582. [PMID: 31255609 DOI: 10.1016/j.athoracsur.2019.04.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 01/05/2023]
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25
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Tagliari AP, da-Silveira LMV, de-Souza AC, Gib MC, de-Freitas TM, Martins CB, Wender OCB, Cavazzola LT. Design and implementation of a fully electronic surgery database based on Google tools: an initial experience in cardiovascular surgery. ACTA ACUST UNITED AC 2019; 46:e2123. [PMID: 31141031 DOI: 10.1590/0100-6991e-20192123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to describe, in a practical and step-by-step manner, the construction of a fully electronic platform for data collection, storage, and analysis, initially proposed for cardiovascular surgery, with interfaces that are reproducible and applicable to other surgical specialties, as well as to present the initial work experience with this instrument in cardiac surgery and the preliminary results obtained after its implementation in a Brazilian tertiary university hospital. METHODS the platform was developed based on Google tools, which are free, easy to use, and widely accessible. From the beginning of this initiative, in May 2015, to the preliminary analysis, in February 2017, data from 271 consecutive patients submitted to cardiovascular surgery were prospectively recorded and preliminarily analyzed. RESULTS the initiative was implemented with full success, with 100% of patients included and without loss of any variable, in a database composed of more than 500 variables. The most frequent immediate postoperative complications were: atrial fibrillation (22.5%), bronchopneumonia (10.7%), delirium (10.3%), acute renal failure (10%), stroke (5%), and death (7%). Comparing mortality rates in the first and second years of the initiative, a reduction from 10.8% to 4% (p=0.042), respectively, was evidenced. CONCLUSION the new proposal of data collection and storage presented in this work was fully feasible and effective. It may be useful to other surgical specialties that wish to develop methods to evaluate success and postoperative complication rates, as well as quality improvement programs.
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Affiliation(s)
- Ana Paula Tagliari
- Hospital de Clínicas de Porto Alegre, Serviço de Cirurgia Cardiovascular, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brasil
| | | | | | - Marcelo Curcio Gib
- Hospital de Clínicas de Porto Alegre, Serviço de Cirurgia Cardiovascular, Porto Alegre, RS, Brasil
| | | | - Cristiano Blaya Martins
- Hospital de Clínicas de Porto Alegre, Serviço de Cirurgia Cardiovascular, Porto Alegre, RS, Brasil
| | | | - Leandro Totti Cavazzola
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Serviço de Cirurgia Geral, Porto Alegre, RS, Brasil
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Tran L, Williams-Spence J, Shardey GC, Smith JA, Reid CM. The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database Program - Two Decades of Quality Assurance Data. Heart Lung Circ 2019; 28:1459-1462. [PMID: 30962063 DOI: 10.1016/j.hlc.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/02/2019] [Indexed: 11/18/2022]
Abstract
Over two decades, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) cardiac surgery database program has evolved from a single state-based database to a national clinical quality registry program and is now the most comprehensive cardiac surgical registry in Australia. We report the current structure and governance of the program and its key activities.
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Affiliation(s)
- Lavinia Tran
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jenni Williams-Spence
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
| | | | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University and Department of Cardiothoracic Surgery, Monash Health, Melbourne, Vic, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
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27
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D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, Shahian DM. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2019 Update on Outcomes and Quality. Ann Thorac Surg 2019; 107:24-32. [DOI: 10.1016/j.athoracsur.2018.10.004] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
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28
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Hobbs RD, Paone G, D'Agostino RS, Jacobs JP, McDonald DE, Prager RL, Shahian DM. Myocardial revascularization: the evolution of the STS database and quality measurement for improvement. Indian J Thorac Cardiovasc Surg 2018; 34:222-229. [PMID: 33060942 DOI: 10.1007/s12055-018-0726-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 01/03/2023] Open
Abstract
The Society of Thoracic Surgeons (STS) is a not-for-profit organization dedicated to helping clinicians and researchers provide optimal outcomes for patients undergoing heart, lung, and esophageal surgery. The organization was founded in 1964 and has grown to now include over 7300 members in over 90 countries. The STS created a national database that collects detailed clinical information on patients undergoing adult cardiac, pediatric and congenital cardiac, and general thoracic operations. The data collected are used to produce risk-adjusted, nationally benchmarked performance assessments and feedback; facilitate voluntary public reporting; support quality initiatives; develop evidence-based guidelines; monitor long-term clinical outcomes; track device performance; and promote high-quality research collaboratives.
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Affiliation(s)
| | - Gaetano Paone
- Division of Cardiac Surgery, Henry Ford Hospital, Detroit, MI USA
| | | | - Jeffrey Phillip Jacobs
- The Congenital Heart Institute of Florida (CHIF), All Children's Hospital, University of South Florida College of Medicine, Saint Petersburg, FL USA
- The Congenital Heart Institute of Florida (CHIF), All Children's Hospital, University of South Florida College of Medicine, Tampa, FL USA
| | | | | | - David Michael Shahian
- Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital, Boston, MA USA
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Gammie JS, Chikwe J, Badhwar V, Thibault DP, Vemulapalli S, Thourani VH, Gillinov M, Adams DH, Rankin JS, Ghoreishi M, Wang A, Ailawadi G, Jacobs JP, Suri RM, Bolling SF, Foster NW, Quinn RW. Isolated Mitral Valve Surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis. Ann Thorac Surg 2018; 106:716-727. [DOI: 10.1016/j.athoracsur.2018.03.086] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/28/2018] [Accepted: 03/20/2018] [Indexed: 10/28/2022]
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30
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DeMellow J, Kim TY. Technology-enabled performance monitoring in intensive care: An integrative literature review. Intensive Crit Care Nurs 2018; 48:42-51. [PMID: 30054118 DOI: 10.1016/j.iccn.2018.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/20/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Implementation of evidence-based bundles in intensive care units is integral to improving quality of care and patient outcomes. However, it increases the burden of data collection and analysis required for performance monitoring and feedback of an inter-disciplinary care team. Health information technology including electronic health records and data analytic tools could automate this process and provide real-time feedback to the team. AIM This integrative literature review aimed to examine the extent to which technology-enabled performance monitoring and feedback contributed to improving quality of care and patient outcomes when implementing evidence-based bundles. METHODS A literature search of scientific databases was conducted using PubMed, Embase, Scopus, CINHAL and Ovid Medline. RESULTS Of nine studies included in this review, all reported improved compliance of the team with evidence-based bundles, ranging from 3% to 60% post implementation of technology-enabled performance monitoring and feedback. Significant reductions (p < .05) in hospital acquired infections were also reported in five studies. CONCLUSIONS Overall, the addition of documentation fields to electronic health records was essential in providing real-time feedback to teams and improving their compliance with evidence-based bundles. Further research is needed to assess the effectiveness of technology-enabled performance monitoring and feedback in improving patient outcomes on a larger scale, especially in resource-limited settings such as community hospitals.
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Affiliation(s)
- Jacqueline DeMellow
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA 95817, United States.
| | - Tae Youn Kim
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48th Street, Suite 2600, Sacramento, CA 95817, United States
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Badhwar V, Rankin JS, Thourani VH, D’Agostino RS, Habib RH, Shahian DM, Jacobs JP. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Research: Outcomes Analysis, Quality Improvement, and Patient Safety. Ann Thorac Surg 2018; 106:8-13. [DOI: 10.1016/j.athoracsur.2018.04.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/17/2018] [Indexed: 11/27/2022]
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Single- Versus Multicenter Surgeons’ Risk-Adjusted Coronary Artery Bypass Graft Procedural Outcomes. Ann Thorac Surg 2018; 105:1308-1314. [DOI: 10.1016/j.athoracsur.2018.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/30/2017] [Accepted: 01/03/2018] [Indexed: 11/23/2022]
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Redefining kidney disease progression after cardiac surgery: Now what? J Thorac Cardiovasc Surg 2018; 155:2464-2465. [PMID: 29551539 DOI: 10.1016/j.jtcvs.2018.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 02/10/2018] [Indexed: 11/24/2022]
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Freundlich RE, Ehrenfeld JM. Perioperative Information Systems: Opportunities to Improve Delivery of Care and Clinical Outcomes in Cardiac and Vascular Surgery. J Cardiothorac Vasc Anesth 2017; 32:1458-1463. [PMID: 29229258 DOI: 10.1053/j.jvca.2017.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Indexed: 12/18/2022]
Abstract
A variety of existing perioperative informatics tools offer clinicians and researchers the opportunity to improve the delivery of care and clinical outcomes for patients undergoing cardiac and vascular surgery. Many of these tools can be used to improve the reliability of the care delivery process through the application of clinical decision support tools and/or quality improvement methodologies at a number of junctures. In this review, the authors will offer a concise overview of the existing perioperative informatics literature, with a focus on tools considered to be of utility in confronting the unique challenges inherent to cardiac and vascular surgery. The authors also highlight areas that they believe are of interest for future targeted inquiry.
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Affiliation(s)
- Robert E Freundlich
- Department of Anesthesiology, Division of Critical Care, Vanderbilt University Medical Center, Nashville, TN.
| | - Jesse M Ehrenfeld
- Departments of Anesthesiology, Surgery, Biomedical Informatics, and Health Policy, Vanderbilt University Medical Center, Nashville, TN
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The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Research. Ann Thorac Surg 2017; 104:22-28. [DOI: 10.1016/j.athoracsur.2017.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/03/2017] [Indexed: 01/13/2023]
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Abstract
Administrative data are less accurate and relevant than specialty-specific, procedure-specific, risk-adjusted data collected in voluntary registries such as the Society of Thoracic Surgeons-General Thoracic Surgery Database (GTSD). Voluntary clinical databases must be proven accurate and complete before they are accepted as credible information sources. With substantial growth of the GTSD, an annual audit was initiated in 2010 to assess the completeness, accuracy, and quality of the data collected. The audit process is essential in validating data quality and adding credibility and value to volunteer clinical registries. It serves as an important tool for improvement of patient care.
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Allen KB, Thourani VH, Naka Y, Grubb KJ, Grehan J, Patel N, Guy TS, Landolfo K, Gerdisch M, Bonnell M, Cohen DJ. Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage. J Thorac Cardiovasc Surg 2017; 153:888-896.e1. [DOI: 10.1016/j.jtcvs.2016.10.093] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 11/26/2022]
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38
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D'Agostino RS, Jacobs JP, Badhwar V, Paone G, Rankin JS, Han JM, McDonald D, Edwards FH, Shahian DM. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Outcomes and Quality. Ann Thorac Surg 2017; 103:18-24. [DOI: 10.1016/j.athoracsur.2016.11.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022]
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KinCor, a national registry for paediatric patients with congenital and other types of heart disease in the Netherlands: aims, design and interim results. Neth Heart J 2016; 24:628-639. [PMID: 27632192 PMCID: PMC5065536 DOI: 10.1007/s12471-016-0892-9] [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] [Indexed: 11/27/2022] Open
Abstract
Objective Studies in children with heart disease have been hampered by a lack of easily identifiable patient groups. Currently, there are few prospective population-based registries covering the entire spectrum of heart disease in children. KinCor is a Dutch national registry for children with heart diseases. This paper presents the aims, design and interim results of the KinCor project. Methods All children presenting at a Dutch university medical centre with a diagnosis of heart disease from 2012 onwards were eligible for registration in the KinCor database. Data entry is through a web-based portal. Entry codes have been synchronised with the European Paediatric Cardiac Coding system, allowing coupling with similar databases for adults, such as CONCOR. Results Between June 2012 and July 2015, 8421 patients were registered (76 % of those eligible). Median age of the patients was 9.8 years, 44.7 % were female; 6782 patients had morphological congenital heart disease. The most prevalent morphological congenital heart defects were ventricular septal defects (18 %), Tetralogy of Fallot (10 %) and transposition of great arteries (9 %). For 42 % of the patients additional diagnoses were registered. Sixty percent of patients had undergone at least one intervention (catheter intervention or surgery). Conclusion The KinCor database has developed into a large registry of data of children with all types of heart disease and continues to grow. This database will provide the opportunity for epidemiological research projects on congenital and other types of heart disease in children. Entry codes are shared with the CONCOR database, which may provide a unique dataset.
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Moffatt-Bruce SD, Nguyen MC, Fann JI, Westaby S. Our New Reality of Public Reporting: Shame Rather Than Blame? Ann Thorac Surg 2016; 101:1255-61. [PMID: 27000567 DOI: 10.1016/j.athoracsur.2016.02.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/25/2022]
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The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Research. Ann Thorac Surg 2016; 102:7-13. [DOI: 10.1016/j.athoracsur.2016.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 11/20/2022]
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Espiritu D, Onohara D, Kalra K, Sarin EL, Padala M. Transcatheter Mitral Valve Repair Therapies: Evolution, Status and Challenges. Ann Biomed Eng 2016; 45:332-359. [DOI: 10.1007/s10439-016-1655-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/14/2016] [Indexed: 12/21/2022]
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