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Salas de Armas IA, Holifield L, Janowiak LM, Akay MH, Patarroyo M, Nascimbene A, Akkanti BH, Patel M, Patel J, Marcano J, Kar B, Gregoric ID. The use of veno-arterial extracorporeal membrane oxygenation in the octogenarian population: A single-center experience. Perfusion 2023; 38:1196-1202. [PMID: 35766358 DOI: 10.1177/02676591221111506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Advanced age is a known risk factor for poor outcomes after veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiac support. The use of ECMO support in patients over the age of 80 is controversial, and sometimes its use is contraindicated. We aimed to assess the use of ECMO in octogenarian patients to determine survival and complication rates. METHODS A single-center, retrospective analysis was completed at a large, urban academic medical center. Patients requiring V-A ECMO support between December of 2012 and November of 2019 were included as long as the patient was at least 80 years of age at the time of cannulation. Post cardiotomy shock patients were excluded. RESULTS A total of 46 patients met eligibility criteria; all received V-A ECMO support. Overall, the majority of patients (71.7%; 33/46) survived to decannulation, and 43.5% (20/46) survived to discharge. Patients who were previously rescued from percutaneous interventions tend to have a better survival than other patients (p = .06). The most common complications were renal and hemorrhagic. CONCLUSIONS We demonstrated that advanced age alone should not disqualify patients from cannulating and supporting with V-A ECMO.
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Affiliation(s)
- Ismael A Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Linda Holifield
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Lisa M Janowiak
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Mehmet H Akay
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Maria Patarroyo
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Angelo Nascimbene
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Bindu H Akkanti
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Manish Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Jayeshkumar Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Juan Marcano
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Center for Advanced Heart Failure, Memorial Hermann Hospital, Houston, TX, USA
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Saemann L, Wernstedt L, Pohl S, Stiller M, Willsch J, Hofmann B, Veres G, Simm A, Szabó G. Impact of Age on Endothelial Function of Saphenous Vein Grafts in Coronary Artery Bypass Grafting. J Clin Med 2023; 12:5454. [PMID: 37685521 PMCID: PMC10487541 DOI: 10.3390/jcm12175454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND An intact and functionally preserved endothelial layer in the graft is crucial for myocardial perfusion and graft patency after coronary artery bypass grafting (CABG). We hypothesized that old age is a risk factor for decreased endothelial function of bypass grafts. Thus, we investigated the impact of age in patients treated with CABG on endothelial function in saphenous vein grafts. METHODS We mounted the saphenous vein graft segments of CABG patients < 70 (n = 33) and ≥70 (n = 40) years of age in organ bath chambers and exposed them to potassium chloride (KCl) and phenylephrine (PE) to test the receptor-independent and -dependent contractility, followed by exposure to acetylcholine (ACh) and sodium nitroprusside (SNP) to test the endothelial-dependent and -independent relaxation. RESULTS The maximal contraction induced by KCl (2.3 ± 1.8 vs. 1.8 ± 2 g) was stronger in patients ≥ 70 years of age. The relative contraction induced by PE in % of KCl (167 ± 64 vs. 163 ± 59%) was similar between groups. Patients aged < 70 years showed a higher endothelial-dependent relaxation induced by acetylcholine than patients ≥ 70 years (51 ± 27 vs. 42 ± 18%). The relaxation induced by SNP was similar between both groups. CONCLUSIONS The endothelial function of saphenous vein bypass grafts decreases during aging. Thus, age should be considered when improving graft maintenance.
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Affiliation(s)
- Lars Saemann
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Lena Wernstedt
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Sabine Pohl
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Markus Stiller
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Jan Willsch
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Britt Hofmann
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Gábor Veres
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Andreas Simm
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
| | - Gábor Szabó
- Department of Cardiac Surgery, University Hospital Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany (G.V.); (A.S.); (G.S.)
- Department of Cardiac Surgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
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Xie T, Xin Q, Zhang X, Tong Y, Ren H, Liu C, Zhang J. Construction and validation of a nomogram for predicting survival in elderly patients with cardiac surgery. Front Public Health 2022; 10:972797. [PMID: 36339155 PMCID: PMC9626768 DOI: 10.3389/fpubh.2022.972797] [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: 06/19/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023] Open
Abstract
Background In recent years, the number of elderly patients undergoing cardiac surgery has rapidly increased and is associated with poor outcomes. However, there is still a lack of adequate models for predicting the risk of death after cardiac surgery in elderly patients. This study sought to identify independent risk factors for 1-year all-cause mortality in elderly patients after cardiac surgery and to develop a predictive model. Methods A total of 3,752 elderly patients with cardiac surgery were enrolled from the Medical Information Mart for Intensive Care III (MIMIC-III) dataset and randomly divided into training and validation sets. The primary outcome was the all-cause mortality at 1 year. The Least absolute shrinkage and selection operator (LASSO) regression was used to decrease data dimensionality and select features. Multivariate logistic regression was used to establish the prediction model. The concordance index (C-index), receiver operating characteristic curve (ROC), and decision curve analysis (DCA) were used to measure the predictive performance of the nomogram. Results Our results demonstrated that age, sex, Sequential Organ Failure Assessment (SOFA), respiratory rate (RR), creatinine, glucose, and RBC transfusion (red blood cell) were independent factors for elderly patient mortality after cardiac surgery. The C-index of the training and validation sets was 0.744 (95%CI: 0.707-0.781) and 0.751 (95%CI: 0.709-0.794), respectively. The area under the curve (AUC) and decision curve analysis (DCA) results substantiated that the nomogram yielded an excellent performance predicting the 1-year all-cause mortality after cardiac surgery. Conclusions We developed a novel nomogram model for predicting the 1-year all-cause mortality for elderly patients after cardiac surgery, which could be an effective and useful clinical tool for clinicians for tailored therapy and prognosis prediction.
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Affiliation(s)
- Tonghui Xie
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qi Xin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xing Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yingmu Tong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Ren
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,*Correspondence: Hong Ren
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Chang Liu
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Department of Surgical ICU (SICU), The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,Jingyao Zhang
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Outcomes of Octogenarians with Primary Malignant Cardiac Tumors: National Cancer Database Analysis. J Clin Med 2022; 11:jcm11164899. [PMID: 36013139 PMCID: PMC9410046 DOI: 10.3390/jcm11164899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Data concerning age-related populations affected with primary malignant cardiac tumors (PMCTs) are still scarce. The aim of the current study was to analyze mortality differences amongst different age groups of patients with PMCTs, as reported by the National Cancer Database (NCDB). The NCDB was retrospectively reviewed for PMCTs from 2004 to 2017. The primary outcome was late mortality differences amongst different age categories (octogenarian, septuagenarian, younger age), while secondary outcomes included differences in treatment patterns and perioperative (30-day) mortality. A total of 736 patients were included, including 72 (9.8%) septuagenarians and 44 (5.98%) octogenarians. Angiosarcoma was the most prevalent PMCT. Surgery was performed in 432 (58.7%) patients (60.3%, 55.6%, and 40.9% in younger age, septuagenarian, and octogenarian, respectively, p = 0.04), with a corresponding 30-day mortality of 9.0% (7.0, 15.0, and 38.9% respectively, p < 0.001) and a median overall survival of 15.7 months (18.1, 8.7, and 4.5 months respectively). Using multivariable Cox regression, independent predictors of late mortality included octogenarian, governmental insurance, CDCC grade II/III, earlier year of diagnosis, angiosarcoma, stage III/IV, and absence of surgery/chemotherapy. With increasing age, patients presented a more significant comorbidity burden compared to younger ones and were treated more conservatively. Early and late survival outcomes progressively declined with advanced age.
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Gao Y, Wang C, Wang Y, Li J, Wang J, Wang S, Tian Y, Liu J, Diao X, Zhao W. Establishment and Validation of a Nomogram to Predict Hospital-Acquired Infection in Elderly Patients After Cardiac Surgery. Clin Interv Aging 2022; 17:141-150. [PMID: 35173428 PMCID: PMC8841270 DOI: 10.2147/cia.s351226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/16/2022] [Indexed: 12/29/2022] Open
Abstract
Background Hospital-acquired infection (HAI) after cardiac surgery is a common clinical concern associated with adverse prognosis and mortality. The objective of this study is to determine the prevalence of HAI and its associated risk factors in elderly patients following cardiac surgery and to build a nomogram as a predictive model. Methods We developed and internally validated a predictive model from a retrospective cohort of 6405 patients aged ≥70 years, who were admitted to our hospital and underwent cardiac surgery. The primary outcome was HAI. Multivariable logistic regression analysis was used to identify independent factors significantly associated with HAI. The performance of the established nomogram was assessed by calibration, discrimination, and clinical utility. Internal validation was achieved by bootstrap sampling with 1000 repetitions to reduce the overfit bias. Results Independent factors derived from the multivariable analysis to predict HAI were smoking, myocardial infarction, cardiopulmonary bypass use, intraoperative erythrocytes transfusion, extended preoperative hospitalization days and prolonged duration of mechanical ventilation postoperatively. The derivation model showed good discrimination, with a C-index of 0.706 [95% confidence interval 0.671–0.740], and good calibration [Hosmer–Lemeshow test P = 0.139]. Internal validation also maintained optimal discrimination and calibration. The decision curve analysis revealed that the nomogram was clinically useful. Conclusions We developed a predictive nomogram for postoperative HAIs based on routinely available data. This predictive tool may enable clinicians to achieve better perioperative management for elderly patients undergoing cardiac surgery but still requires further external validation.
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Affiliation(s)
- Yuchen Gao
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Chunrong Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yuefu Wang
- Department of Anesthesiology and Surgical Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Yuefu Wang, Department of Anesthesiology and Surgical Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, 10 Tieyi Road, Haidian District, Beijing, People’s Republic of China, Email
| | - Jun Li
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jianhui Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Sudena Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yu Tian
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jia Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xiaolin Diao
- Department of Information Center, Skate Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wei Zhao
- Department of Information Center, Skate Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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İNCE İ, ALTINAY L. The effect of diabetes on mid-term survival of open heart surgery patients aged over 70 years. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1022665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tsubota H, Sakaguchi G, Arakaki R, Marui A. Contemporary outcomes of mitral valve replacement in octogenarians. J Card Surg 2021; 37:581-587. [PMID: 34953083 DOI: 10.1111/jocs.16195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/27/2022]
Abstract
AIM OF THE STUDY We aimed to determine the outcomes of contemporary mitral valve replacement (MVR) in octogenarians, for rational treatment selection in a patient cohort. METHODS Between 2007 and 2018, 656 consecutive MVRs were performed. Among these cases, 109 patients were aged 80 years or older, and 547 patients were younger than 80 years. Isolated MVRs were performed in 211 patients, of whom 36 were aged 80 years or older. Perioperative mortality and complications were compared between the two groups, adjusted by propensity score. RESULTS In-hospital mortality of the entire MVR (<80: 26 [4.8%] vs. ≥80: 6 [5.5%], p = .81) and isolated MVR (<80: 6 [3.4%] vs. ≥80: 1 [2.8%], p > .99) groups were similar. Age >80 years did not influence in-hospital mortality (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.36-3.14, p = .9), stroke (HR, 1.12; 95% CI, 0.19-6.71, p = .9), hemodialysis (HR, 1.44; 95% CI, 0.45-4.66, p = .54), or prolonged ventilation (HR, 1.61; 95% CI, 0.81-3.23, p = .18), but influenced the incidence of reopening for bleeding (HR, 3.97; 95% CI, 1.11-14.19, p = .03). Cox proportional hazard model results showed that age >80 years did not affect cardiac death (HR, 1.45, 95% CI: 0.67-3.12, p = .35), bleeding events (HR, 1.89, 95% CI: 0.84-4.27, p = .13), or stroke (HR, 1.51, 95% CI: 0.54-4.21, p = .44) during the follow-up period. CONCLUSIONS The perioperative and follow-up outcomes of MVR in octogenarians were not inferior to those of younger patients. We should not hesitate to conduct MVR on the grounds of old age.
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Affiliation(s)
- Hideki Tsubota
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Ryoko Arakaki
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
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Li Y, Cheang I, Zhang Z, Zuo X, Cao Q, Li J. Prognostic Association Between Perioperative Red Blood Cell Transfusion and Postoperative Cardiac Surgery Outcomes. Front Cardiovasc Med 2021; 8:730492. [PMID: 34631829 PMCID: PMC8497961 DOI: 10.3389/fcvm.2021.730492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: To investigate the correlation between red blood cell transfusion and clinical outcome in patients after cardiac surgery. Methods: Demographic, clinical characteristics, treatment with/without transfusion, and outcomes of patients after cardiac surgery from the Medical Information Mart for Intensive Care—III database were collected. Patients were divided into two groups according to perioperative transfusion. A multivariable logistic regression analysis was utilized to adjust for the effect of red blood cell transfusion on outcomes for baseline and covariates and to determine its association with outcomes. Results: In total, 6,752 patients who underwent cardiac surgery were enrolled for the analysis. Among them, 2,760 (40.9%) patients received a perioperative transfusion. Compared with patients without red blood cell transfusion, transfused patients demonstrated worse outcomes in inhospital mortality, 1-year mortality, and all-cause mortality. Adjusting odds ratios (ORs) for the significant characteristic, patients with perioperative transfusion remained significantly associated with an increased risk of inhospital mortality [OR = 2.8, 95% confidence interval (CI) 1.5–5.1, P = 0.001], 1-year mortality (OR = 2.0, 95% CI 1.4–2.7, P < 0.001), and long-term mortality (OR = 2.2, 95% CI 1.8–2.8, P < 0.001). Conclusion: Perioperative red blood cell transfusion is associated with a worse prognosis of cardiac surgery patients. Optimal perioperative management and restricted transfusion strategy might be considered in selected patients.
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Affiliation(s)
- Yanxiu Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhongwen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangrong Zuo
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Quan Cao
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinghang Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Harada G, Andrade MC, Brito JN, Tavares CDAM, Tarasoutchi F, Pomerantzeff PMA, Bortolotto L, Feltrim MIZ. Prevalence of Frailty in Patients Undergoing Cardiac Valve Surgery: Comparison of Frailty Tools. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cardiac Operative Risk in Latin America: A Comparison of Machine Learning Models vs EuroSCORE-II. Ann Thorac Surg 2021; 113:92-99. [PMID: 33689741 DOI: 10.1016/j.athoracsur.2021.02.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 02/08/2021] [Accepted: 02/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Machine learning is a useful tool for predicting medical outcomes. This study aimed to develop a machine learning-based preoperative score to predict cardiac surgical operative mortality. METHODS We developed various models to predict cardiac operative mortality using machine learning techniques and compared each model to European System for Cardiac Operative Risk Evaluation-II (EuroSCORE-II) using the area under the receiver operating characteristic (ROC) and precision-recall (PR) curves (ROC AUC and PR AUC) as performance metrics. The model calibration in our population was also reported with all models and in high-risk groups for gradient boosting and EuroSCORE-II. This study is a retrospective cohort based on a prospectively collected database from July 2008 to April 2018 from a single cardiac surgical center in Bogotá, Colombia. RESULTS Model comparison consisted of hold-out validation: 80% of the data were used for model training, and the remaining 20% of the data were used to test each model and EuroSCORE-II. Operative mortality was 6.45% in the entire database and 6.59% in the test set. The performance metrics for the best machine learning model, gradient boosting (ROC: 0.755; PR: 0.292), were higher than those of EuroSCORE-II (ROC: 0.716, PR: 0.179), with a P value of .318 for the AUC of the ROC and .137 for the AUC of the PR. CONCLUSIONS The gradient boosting model was more precise than EuroSCORE-II in predicting mortality in our population based on ROC and PR analyses, although the difference was not statistically significant.
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Witberg G, Segev A, Barac YD, Raanani E, Assali A, Finkelstein A, Roguin A, Sahar G, Vaknin-Assa H, Bolotin G, Eitan A, Klempfner R, Goldenberg I, Kornowski R. Heart Team/Guidelines Discordance Is Associated With Increased Mortality: Data From a National Survey of Revascularization in Patients With Complex Coronary Artery Disease. Circ Cardiovasc Interv 2021; 14:e009686. [PMID: 33423541 DOI: 10.1161/circinterventions.120.009686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Practice guidelines emphasize the role of the SYNTAX score (SS; Synergy Between PCI With TAXUS and Cardiac Surgery) in choosing between percutaneous coronary intervention and coronary artery bypass graft surgery in cases of complex coronary artery disease. There is paucity of data on the implementation of these recommendations in daily practice, and on the consequences of guideline discordant revascularization. METHODS This was a retrospective analysis of a prospective national survey of consecutive real world patients undergoing coronary revascularization for complex coronary artery disease according to decisions of local heart team at each center. SS was calculated at a dedicated CoreLab, and patients were classified as heart team/guidelines agreement/discordant. RESULTS Nine hundred seventy-nine patients (571 percutaneous coronary intervention and 408 coronary artery bypass graft) were included. Mean age was 65 years and the mean SS was 22. Heart team/guidelines discordance occurred in 170 (17.3%) patients. Independent predictors of heart team/guidelines discordance were age, admission to a center with no cardiac surgery service, SS, and previous percutaneous coronary intervention/myocardial infarction. A multivariate model based on these characteristics had a C statistic of 0.83. Thirty-day outcomes were similar in the agreement/discordance groups, however, heart team/guidelines discordance was associated with a significant increase in 3 year mortality (17.6% versus 8.4%; hazard ratio, 2.05; P=0.002) after multivariate adjustment. CONCLUSIONS Heart team/guidelines discordance is not infrequent in real world patients with complex coronary artery disease undergoing revascularization. This is more likely to occur in elderly patients, those with more complex coronary disease (as determined by the SS), and those treated at centers with no cardiac surgery service. These patients have a higher risk for mid-term mortality.
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Affiliation(s)
- Guy Witberg
- Department of Cardiology (G.W., H.V.-A., R.K.), Rabin Medical Center, Petach-Tikva, Israel.,Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.)
| | - Amit Segev
- Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.).,Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel (A.S., E.R., R.K., I.G.)
| | - Yaron D Barac
- Department of Cardiovascular and Thoracic Surgery (Y.D.B.), Rabin Medical Center, Petach-Tikva, Israel.,Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.)
| | - Ehud Raanani
- Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.).,Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel (A.S., E.R., R.K., I.G.)
| | - Abid Assali
- Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.).,Department of Cardiology, Meir Medical Center, Kfar-Saba, Israel (A.A.)
| | - Ariel Finkelstein
- Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.).,Department of Cardiology, Tel Aviv Medical Center, Israel (A.F.)
| | - Ariel Roguin
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa (A.R., G.B., A.E.).,Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel (A.R.)
| | - Gideon Sahar
- Department of Cardiac Surgery, Soroka Medical Center, Be'er-Sheva, Israel (G.S.).,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel (G.S.)
| | - Hana Vaknin-Assa
- Department of Cardiology (G.W., H.V.-A., R.K.), Rabin Medical Center, Petach-Tikva, Israel.,Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.)
| | - Gil Bolotin
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa (A.R., G.B., A.E.).,Department of Cardiothoracic surgery, Rambam Health Care Campus, Haifa, Israel (G.B.)
| | - Amnon Eitan
- Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa (A.R., G.B., A.E.).,Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel (A.E.)
| | - Robert Klempfner
- Department of Cardiology (G.W., H.V.-A., R.K.), Rabin Medical Center, Petach-Tikva, Israel.,Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.).,Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel (A.S., E.R., R.K., I.G.)
| | - Ilan Goldenberg
- Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.).,Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel (A.S., E.R., R.K., I.G.)
| | - Ran Kornowski
- Sackler school of Medicine, Tel-Aviv University, Israel (G.W., A.S., Y.D.B., E.R., A.A., A.F., H.V.-A., R.K., I.G., R.K.)
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12
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Lau D, Dalle Ore CL, Tarapore PE, Huang M, Manley G, Singh V, Mummaneni PV, Beattie M, Bresnahan J, Ferguson AR, Talbott JF, Whetstone W, Dhall SS. Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury. Neurosurg Focus 2020; 46:E3. [PMID: 30835676 DOI: 10.3171/2018.12.focus18555] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.
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Affiliation(s)
| | | | - Phiroz E Tarapore
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Michael Huang
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | | | - Vineeta Singh
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,4Neurology
| | | | - Michael Beattie
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Jacqueline Bresnahan
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Adam R Ferguson
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Jason F Talbott
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,5Radiology, and
| | - William Whetstone
- 3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,6Emergency Medicine
| | - Sanjay S Dhall
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
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13
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Walger P, Heppner HJ. Calculated parenteral initial therapy of bacterial infections: Antibiotic treatment in the elderly. GMS INFECTIOUS DISEASES 2020; 8:Doc05. [PMID: 32373430 PMCID: PMC7186795 DOI: 10.3205/id000049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This is the fifteenth chapter of the guideline “Calculated initial parenteral treatment of bacterial infections in adults – update 2018” in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. Multimorbidity, an atypical symptomatology of infections in combination with multimedication, the associated interaction risks and serious consequences of synergistic side effects characterize the conditions when deciding on the use of antibiotics in old age. Strict decision regarding the indication itself, choice of the best antibiotic even considering rare side effects which may be dangerous in the elderly, determining the correct dose, dosing interval and the shortest possible duration according to the physiological status of the patient as well as monitoring effectiveness and toxicity detect expected and unexpected side effects early. Recommendations must reflect the peculiarities of antibiotic treatment in elderly patients.
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Affiliation(s)
- Peter Walger
- Hygiene, Infektionsmanagement und ABS, Bonn, Germany.,Johanniter GmbH Berlin, Germany.,Verbund Katholischer Kliniken Düsseldorf, Germany
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14
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Gelsomino S, Bonacchi M, Lucà F, Barili F, Del Pace S, Parise O, Johnson DM, Gulizia MM. Comparison between three different equations for the estimation of glomerular filtration rate in predicting mortality after coronary artery bypass. BMC Nephrol 2019; 20:371. [PMID: 31619211 PMCID: PMC6796478 DOI: 10.1186/s12882-019-1564-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 09/26/2019] [Indexed: 12/03/2022] Open
Abstract
Background This study was undertaken to compare the accuracy of chronic kidney disease-epidemiology collaboration (eGFRCKD-EPI) to modification of diet in renal disease (eGFRMDRD) and the Cockcroft-Gault formulas of Creatinine clearance (CCG) equations in predicting post coronary artery bypass grafting (CABG) mortality. Methods Data from 4408 patients who underwent isolated CABG over a 11-year period were retrieved from one institutional database. Discriminatory power was assessed using the c-index and comparison between the scores’ performance was performed with DeLong, bootstrap, and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics. Results The discriminatory power was higher in eGFRCKD-EPI than eGFRMDRD and CCG (Area under Curve [AUC]:0.77, 0.55 and 0.52, respectively). Furthermore, eGFRCKD-EPI performed worse in patients with an eGFR ≤29 ml/min/1.73m2 (AUC: 0.53) while it was not influenced by higher eGFRs, age, and body size. In contrast, the MDRD equation was accurate only in women (calibration statistics p = 0.72), elderly patients (p = 0.53) and subjects with severe impairment of renal function (p = 0.06) whereas CCG was not significantly biased only in patients between 40 and 59 years (p = 0.6) and with eGFR 45–59 ml/min/1.73m2 (p = 0.32) or ≥ 60 ml/min/1.73m2 (p = 0.48). Conclusions In general, CKD-EPI gives the best prediction of death after CABG with unsatisfactory accuracy and calibration only in patients with severe kidney disease. In contrast, the CG and MDRD equations were inaccurate in a clinically significant proportion of patients.
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Affiliation(s)
- Sandro Gelsomino
- Cardiothoracic Department, Maastricht University Hospital, Florence, Italy. .,Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht University, Universiteitssingel 50, 6229, ER, Maastricht, The Netherlands.
| | - Massimo Bonacchi
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Fabiana Lucà
- Cardiothoracic Department, Maastricht University Hospital, Florence, Italy.,ANMCO Research Center of Heart Care, Florence, Italy
| | - Fabio Barili
- Department of Cardiovascular Surgery, S. Croce Hospital, Cuneo, Italy
| | - Stefano Del Pace
- Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Orlando Parise
- Cardiothoracic Department, Maastricht University Hospital, Florence, Italy
| | - Daniel M Johnson
- Cardiothoracic Department, Maastricht University Hospital, Florence, Italy
| | - Michele Massimo Gulizia
- ANMCO Research Center of Heart Care, Florence, Italy.,Cardiology Garibaldi-Nesima Hospital, Catania, Italy
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15
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Perioperative Outcome in Geriatric Patients. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Lau D, Osorio JA, Deviren V, Ames CP. The relationship of older age and perioperative outcomes following thoracolumbar three-column osteotomy for adult spinal deformity: an analysis of 300 consecutive cases. J Neurosurg Spine 2018; 28:593-606. [PMID: 29624129 DOI: 10.3171/2017.10.spine17374] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Three-column osteotomies are increasingly being used in the elderly population to correct rigid spinal deformities. There is hesitation, however, in performing the technique in older patients because of the high risk for blood loss, longer operative times, and complications. This study assesses whether age alone is an independent risk factor for complications and length of stay. METHODS All patients with thoracolumbar adult spinal deformity (ASD) who underwent 3-column osteotomy (vertebral column resection or pedicle subtraction osteotomy) performed by the senior author from 2006 to 2016 were identified. Demographics, clinical baseline, and surgical details were collected. Outcomes of interest included perioperative complication, ICU stay, and hospital stay. Bivariate and multivariate analyses were used to assess the association of age with outcomes of interest. RESULTS A total of 300 patients were included, and 38.3% were male. The mean age was 63.7 years: 10.3% of patients were younger than 50 years, 36.0% were 50-64 years, 45.7% were 65-79 years, and 8.0% were 80 years or older. The overall mean EBL was 1999 ml. The overall perioperative complication rate was 24.7%: 18.0% had a medical complication and 7.0% had a surgical complication. There were no perioperative or 30-day deaths. Age was associated with overall complications (p = 0.002) and medical-specific complications (p < 0.001); there were higher rates of overall and medical complications with increased age: 9.7% and 6.5%, respectively, for patients younger than 50 years; 16.7% and 10.2%, respectively, for patients 50-64 years; 31.4% and 22.6%, respectively, for patients 65-79 years; and 41.7% and 41.7%, respectively, for patients 80 years or older. However, after adjusting for relevant covariates on multivariate analysis, age was not an independent factor for perioperative complications. Surgical complication rates were similar among the 4 age groups. Longer ICU and total hospital stays were observed in older age groups, and age was an independent factor associated with longer ICU stay (p = 0.028) and total hospital stay (p = 0.003). ICU stays among the 4 age groups were 1.6, 2.3, 2.0, and 3.2 days for patients younger than 50 years, 50-64 years, 65-79 years, and 80 years or older, respectively. The total hospital stays stratified by age were 7.3, 7.7, 8.2, and 11.0 days for patients younger than 50 years, 50-64 years, 65-79 years, and 80 years or older, respectively. CONCLUSIONS Older age was associated with higher perioperative complication rates, but age alone was not an independent risk factor for complications following the 3-column osteotomy for ASD. Comorbidities and other unknown variables that come with age are likely what put these patients at higher risk for complications. Older age, however, is independently associated with longer ICU and hospital stays.
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Affiliation(s)
| | | | - Vedat Deviren
- 2Orthopedic Surgery, University of California, San Francisco, California
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17
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McKellar SH, Fang JC. An Age-Old Question: What Is Too Old for Coronary Artery Bypass Grafting in Heart Failure? Circulation 2016; 134:1325-1327. [PMID: 27799256 DOI: 10.1161/circulationaha.116.024878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephen H McKellar
- From Division of Cardiothoracic Surgery (S.H.M.) and Division of Cardiovascular Medicine (J.C.F.), University of Utah, School of Medicine, Salt Lake City, UT
| | - James C Fang
- From Division of Cardiothoracic Surgery (S.H.M.) and Division of Cardiovascular Medicine (J.C.F.), University of Utah, School of Medicine, Salt Lake City, UT.
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