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Toppen W, Cho NY, Sareh S, Kjellberg A, Medak A, Benharash P, Lindholm P. Contemporary national outcomes of hyperbaric oxygen therapy in necrotizing soft tissue infections. PLoS One 2024; 19:e0300738. [PMID: 38512943 PMCID: PMC10956790 DOI: 10.1371/journal.pone.0300738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The role of hyperbaric oxygen therapy (HBOT) in necrotizing soft tissue infections (NSTI) is mainly based on small retrospective studies. A previous study using the 1998-2009 National Inpatient Sample (NIS) found HBOT to be associated with decreased mortality in NSTI. Given the argument of advancements in critical care, we aimed to investigate the continued role of HBOT in NSTI. METHODS The 2012-2020 National Inpatient Sample (NIS) was queried for NSTI admissions who received surgery. 60,481 patients between 2012-2020 were included, 600 (<1%) underwent HBOT. Primary outcome was in-hospital mortality. Secondary outcomes included amputation, hospital length of stay, and costs. A multivariate model was constructed to account for baseline differences in groups. RESULTS Age, gender, and comorbidities were similar between the two groups. On bivariate comparison, the HBOT group had lower mortality rate (<2% vs 5.9%, p<0.001) and lower amputation rate (11.8% vs 18.3%, p<0.001) however, longer lengths of stay (16.9 days vs 14.6 days, p<0.001) and higher costs ($54,000 vs $46,000, p<0.001). After multivariate analysis, HBOT was associated with decreased mortality (Adjusted Odds Ratio (AOR) 0.22, 95% CI 0.09-0.53, P<0.001) and lower risk of amputation (AOR 0.73, 95% CI 0.55-0.96, P = 0.03). HBO was associated with longer stays by 1.6 days (95% CI 0.4-2.7 days) and increased costs by $7,800 (95% CI $2,200-$13,300), they also had significantly lower risks of non-home discharges (AOR 0.79, 95%CI 0.65-0.96). CONCLUSIONS After correction for differences, HBOT was associated with decreased mortality, amputations, and non-home discharges in NSTI with the tradeoff of increase to costs and length of stay.
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Affiliation(s)
- William Toppen
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States of America
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Anders Kjellberg
- Dept. Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
- Hyperbaric Medicine, Medical Unit Intensive Care and Thoracic Surgery, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anthony Medak
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Peter Lindholm
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States of America
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Sakowitz S, Bakhtiyar SS, Sareh S, Ali K, Verma A, Chervu N, Sanaiha Y, Benharash P. Acute clinical and financial outcomes of on- versus off-pump coronary artery bypass grafting in octogenarians. Surgery 2023:S0039-6060(23)00168-X. [PMID: 37202306 DOI: 10.1016/j.surg.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/03/2023] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Coronary artery bypass surgery in octogenarians is associated with increased postoperative morbidity. Off-pump coronary artery bypass surgery eliminates potential complications of cardiopulmonary bypass, but its use remains controversial. This study aimed to evaluate the clinical and financial impact of off-pump coronary artery bypass surgery compared to conventional coronary artery bypass surgery among this high-risk population. METHODS Patients ≥80 years undergoing first-time, isolated, elective coronary artery bypass surgery were identified using the 2010-2019 Nationwide Readmissions Database. Patients were grouped into off-pump or conventional coronary artery bypass surgery cohorts. Multivariable models were developed to assess the independent associations between off-pump coronary artery bypass surgery and key outcomes. RESULTS Of ∼56,158 patients, 13,940 (24.8%) underwent off-pump coronary artery bypass surgery. On average, the off-pump cohort was more likely to undergo single-vessel bypass (37.3 vs 19.7%, P < .001). After adjustment, undergoing off-pump coronary artery bypass surgery was associated with similar odds of in-hospital mortality (adjusted odds ratio 0.90, 95% confidence interval 0.73-1.12) relative to conventional bypass. Additionally, the off-pump and conventional coronary artery bypass surgery groups were comparable in odds of postoperative stroke (adjusted odds ratio 1.03, 95% confidence interval 0.78-1.35), cardiac arrest (adjusted odds ratio 0.99, 95% confidence interval 0.71-1.37), ventricular fibrillation (adjusted odds ratio 0.89, 95% confidence interval 0.60-1.31), tamponade (adjusted odds ratio 1.21, 95% confidence interval 0.74-1.97), and cardiogenic shock (adjusted odds ratio 0.94, 95% confidence interval 0.75-1.17). However, the off-pump coronary artery bypass surgery cohort was linked with an increased likelihood of ventricular tachycardia (adjusted odds ratio 1.23, 95% confidence interval 1.01-1.49) and myocardial infarction (adjusted odds ratio 1.34, 95% confidence interval 1.16-1.55). Furthermore, those undergoing off-pump coronary artery bypass surgery demonstrated reduced odds of non-home discharge (adjusted odds ratio 0.91, 95% confidence interval 0.83-0.99) and a decrement in hospitalization expenditures ($-1,290, 95% confidence interval -$2,370 to $200). CONCLUSION Off-pump coronary artery bypass surgery was linked with increased odds of ventricular tachycardia and myocardial infarction, but no difference in mortality. Our findings point to the safety of conventional coronary artery bypass surgery in octogenarians. Yet, future work is needed to consider long-term outcomes in this complex surgical cohort.
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Affiliation(s)
- Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA. https://twitter.com/sarasakowitz
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of Colorado, Aurora, CO. https://twitter.com/Aortologist
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA.
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Seo YJ, Sareh S, Hadaya J, Sanaiha Y, Ziaeian B, Shemin RJ, Benharash P. Factors Associated With High Resource Use in Elective Adult Cardiac Surgery From 2005 to 2016. Ann Thorac Surg 2022; 113:58-65. [PMID: 33689737 PMCID: PMC8419207 DOI: 10.1016/j.athoracsur.2021.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 11/02/2020] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lack of consensus remains about factors that may be associated with high resource use (HRU) in adult cardiac surgical patients. This study aimed to identify patient-related, hospital, and perioperative characteristics associated with HRU admissions involving elective cardiac operations. METHODS Data from the National Inpatient Sample was used to identify patients who underwent coronary artery bypass graft, valve replacement, and valve repair operations between 2005 and 2016. Admissions with HRU were defined as those in the highest decile for total hospital costs. Multivariable regressions were used to identify factors associated with HRU. RESULTS An estimated 1,750,253 hospitalizations coded for elective cardiac operations. The median hospitalization cost was $34,700 (interquartile range, $26,800- to $47,100), with the HRU (N = 175,025) cutoff at $66,029. Although HRU patients comprised 10% of admissions, they accounted for 25% of cumulative costs. On multivariable regression, patient-related characteristics predictive of HRU included female sex, older age, higher comorbidity burden, non-White race, and highest income quartile. Hospital factors associated with HRU were low-volume hospitals for both coronary artery bypass graft and valvular operations. Among postoperative outcomes, mortality, infectious complications, extracorporeal membrane oxygenation use, and hospitalization for more than 8 days were associated with greater odds of HRU. CONCLUSIONS In this nationwide study of elective cardiac surgical patients, several important patient-related and hospital factors, including patients' race, comorbidities, postoperative infectious complications, and low hospital operative volume were identified as predictors of HRU. These highly predictive factors may be used for benchmarking purposes and improvement in surgical planning.
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Affiliation(s)
- Young-Ji Seo
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Boback Ziaeian
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Richard J Shemin
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California.
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Gandjian M, Sareh S, Premji A, Ugarte R, Tran Z, Bowens N, Benharash P. Racial disparities in surgical management and outcomes of acute limb ischemia in the United States. Surg Open Sci 2021; 6:45-50. [PMID: 34632355 PMCID: PMC8487073 DOI: 10.1016/j.sopen.2021.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/22/2021] [Accepted: 08/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background Although significant racial disparities in the surgical management of lower extremity critical limb threatening ischemia have been previously reported, data on disparities in lower extremity acute limb ischemia are lacking. Methods The 2012–2018 National Inpatient Sample was queried for all adult hospitalizations for acute limb ischemia (N = 225,180). Hospital-specific observed-to-expected rates of major lower extremity amputation were tabulated. Multivariable logistic and linear models were developed to assess the impact of race on amputation and revascularization. Results Nonwhite race was associated with significantly increased odds of overall (adjusted odds ratio: 1.16, 95% confidence interval 1.06–1.28) and primary (adjusted odds ratio: 1.34, 95% confidence interval 1.17–1.53) major amputation, decreased odds of revascularization (adjusted odds ratio 0.79, 95% confidence interval 0.73–0.85), but decreased in-hospital mortality (adjusted odds ratio: 0.86, 95% confidence interval 0.74–0.99). The nonwhite group incurred increased adjusted index hospitalization costs (β: +$4,810, 95% confidence interval 3,280-6,350), length of stay (β: + 1.09 days, 95% confidence interval 0.70–1.48), and nonhome discharge (adjusted odds ratio: 1.15, 95% confidence interval 1.06–1.26). Conclusion Significant racial disparities exist in the management of and outcomes of lower extremity acute limb ischemia despite correction for variations in hospital amputation practices and other relevant hospital and patient characteristics. Whether the etiology lies primarily in patient, institution, or healthcare provider–specific factors has not yet been determined. Further studies of race-based disparities in management and outcomes of acute limb ischemia are warranted to provide effective and equitable care to all.
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Affiliation(s)
- Matthew Gandjian
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA.,Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA.,Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA
| | - Alykhan Premji
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ramsey Ugarte
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Nina Bowens
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA
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Dobaria V, Hadaya J, Sanaiha Y, Aguayo E, Sareh S, Benharash P. The Pragmatic Impact of Frailty on Outcomes of Coronary Artery Bypass Grafting. Ann Thorac Surg 2021; 112:108-115. [DOI: 10.1016/j.athoracsur.2020.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/12/2020] [Accepted: 08/18/2021] [Indexed: 12/14/2022]
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Sareh S, Hadaya J, Sanaiha Y, Aguayo E, Dobaria V, Shemin RJ, Omari B, Benharash P. Predictors and In-Hospital Outcomes Among Patients Using a Single Versus Bilateral Mammary Arteries in Coronary Artery Bypass Grafting. Am J Cardiol 2020; 134:41-47. [PMID: 32900469 DOI: 10.1016/j.amjcard.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/18/2022]
Abstract
The benefit of bilateral mammary artery (BIMA) use during coronary artery bypass grafting (CABG) continues to be debated. This study examined nationwide trends in BIMA use and factors influencing its utilization. Using the National Inpatient Sample, adults undergoing isolated multivessel CABG between 2005 and 2015 were identified and stratified based on the use of a single mammary artery or BIMA. Regression models were fit to identify patient and hospital level predictors of BIMA use and characterize the association of BIMA on outcomes including sternal infection, mortality, and resource utilization. An estimated 4.5% (n = 60,698) of patients underwent CABG with BIMA, with a steady increase from 3.8% to 5.0% over time (p<0.001). Younger age, male gender, and elective admission, were significant predictors of BIMA use. Moreover, private insurance was associated with higher odds of BIMA use (adjusted odds ratio 1.24) compared with Medicare. BIMA use was not a predictor of postoperative sternal infection, in-hospital mortality, or hospitalization costs. Overall, BIMA use remains uncommon in the United States despite no significant differences in acute postoperative outcomes. Several patient, hospital, and socioeconomic factors appear to be associated with BIMA utilization.
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Affiliation(s)
- Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California; Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Esteban Aguayo
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Richard J Shemin
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California
| | - Bassam Omari
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, California.
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Sareh S, Ugarte R, Dobaria V, Hadaya J, Sirody J, McCallum JC, de Virgilio C, Benharash P. Impact of Frailty on Clinical and Financial Outcomes Following Minor Lower Extremity Amputation: A Nationwide Analysis. Am Surg 2020; 86:1312-1317. [PMID: 33103459 DOI: 10.1177/0003134820964230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Frailty has been shown to portend worse outcomes in surgical patients. Our goal was to identify the impact of frailty on outcomes and resource utilization among patients undergoing minor lower extremity amputation in the United States. Using the Nationwide Readmission Database, we identified all adults undergoing a minor amputation between 2010 and 2015, and assessed 90-day outcomes, including readmission, reamputation, mortality, and cumulative hospitalization costs. Frailty was defined by International Classification of Diseases codes consistent with the ten frailty clusters as defined by the Johns Hopkins Adjusted Clinical Group System. Multivariable regression models were developed for risk adjustment. An estimated 302 798 patients (mean age = 61.8 years) were identified, of which 15.2% were categorized as Frail. Before adjustment, frailty was associated with increased rates of readmission (44% vs. 36%, P < .001) and in-hospital mortality (4% vs. 2%, P < .001). Frailty was also associated with increased cumulative costs of care ($39 417 vs. $27 244, P < .001). After risk adjustment, frailty remained an independent predictor of readmission (Adjusted odds ratio [AOR] 1.18, CI 1.14-1.23), in-hospital mortality (AOR 1.48, CI 1.34-1.65), and incremental costs (+$7 646, CI $6927-$8365). Frailty is an independent marker of worse outcomes following minor foot amputation, and may be utilized to direct quality improvement efforts.
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Affiliation(s)
- Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ramsey Ugarte
- Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Sirody
- Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - John C McCallum
- Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Dobaria V, Aguayo E, Sanaiha Y, Tran Z, Hadaya J, Sareh S, Cho NY, Benharash P. National Trends and Cost Burden of Surgically Treated Gunshot Wounds in the US. J Am Coll Surg 2020; 231:448-459.e4. [DOI: 10.1016/j.jamcollsurg.2020.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/17/2022]
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Sareh S, Toppen W, Ugarte R, Sanaiha Y, Hadaya J, Seo YJ, Aguayo E, Shemin R, Benharash P. Impact of Early Tracheostomy on Outcomes After Cardiac Surgery: A National Analysis. Ann Thorac Surg 2020; 111:1537-1544. [PMID: 32979372 DOI: 10.1016/j.athoracsur.2020.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/03/2020] [Accepted: 07/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite evidence supporting its early use in respiratory failure, tracheostomy is often delayed in cardiac surgical patients given concerns for sternal infection. This study assessed national trends in tracheostomy creation among cardiac patients and evaluated the impact of timing to tracheostomy on postoperative outcomes. METHODS We used the 2005 to 2015 National Inpatient Sample to identify adults undergoing coronary revascularization or valve operations and categorized them based on timing of tracheostomy: early tracheostomy (ET) (postoperative days 1-14) and delayed tracheostomy (DT) (postoperative days 15-30). Temporal trends in the timing of tracheostomy were analyzed, and multivariable models were created to compare outcomes. RESULTS An estimated 33,765 patients (1.4%) required a tracheostomy after cardiac operations. Time to tracheostomy decreased from 14.8 days in 2005 to 13.9 days in 2015, sternal infections decreased from 10.2% to 2.9%, and in-hospital death also decreased from 23.3% to 15.9% over the study period (all P for trend <.005). On univariate analysis, the ET cohort had a lower rate of sternal infection (5.2% vs 7.8%, P < .001), in-hospital death (16.7% vs 22.9%, P < .001), and length of stay (33.7 vs 43.6 days, P < .001). On multivariable regression, DT remained an independent predictor of sternal infection (adjusted odds ratio, 1.35; P < .05), in-hospital death (odds ratio, 1.36; P < .001), and length of stay (9.1 days, P < .001), with no difference in time from tracheostomy to discharge between the 2 cohorts (P = .40). CONCLUSIONS In cardiac surgical patients, ET yielded similar postoperative outcomes, including sternal infection and in-hospital death. Our findings should reassure surgeons considering ET in poststernotomy patients with respiratory failure.
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Affiliation(s)
- Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California; Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California
| | - William Toppen
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California
| | - Ramsey Ugarte
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California
| | - Young Ji Seo
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California
| | - Esteban Aguayo
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California
| | - Richard Shemin
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California.
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10
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Shellito AD, Sareh S, Hart HC, Keeley JA, Tung C, Neville AL, Putnam B, Kim DY. Trauma patients returning to the emergency department after discharge. Am J Surg 2020; 220:1492-1497. [PMID: 32921401 DOI: 10.1016/j.amjsurg.2020.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/10/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND While readmission rates of trauma patients are well described, little has been reported on rates of re-presentation to the emergency department (ED) after discharge. This study aimed to determine rates and contributing factors of re-presentation of trauma patients to the ED. METHODS One-year retrospective analysis of discharged adult trauma patients at a county-funded safety-net level one trauma center. RESULTS Of 1416 trauma patients, 195 (13.8%) re-presented to the ED within 30 days. Of those that re-presented, 47 (24.1%) were re-admitted (3.3% overall). The most common reasons for re-presentation were pain control and wound complications. Patients with Medicare (AOR 2.6, 95% CI 1.3 to 5.2) or other government insurance (AOR 2.5, 95% CI 1.6 to 4.1) were more likely to re-present than patients with private insurance. CONCLUSION A considerable number of trauma patients re-presented to the ED after discharge for reasons that did not require hospitalization. Discharge planning for certain vulnerable groups should emphasize wound care, pain control and scheduled follow-up to decrease the reliance on the ED.
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Affiliation(s)
- Adam D Shellito
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA.
| | - Sohail Sareh
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Hayley C Hart
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jessica A Keeley
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Christine Tung
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Angela L Neville
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Brant Putnam
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Dennis Y Kim
- Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, CA, USA
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11
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Sanaiha Y, Hadaya J, Cale M, Cho NY, Madrigal J, Sareh S, Benharash P. Impact of interhospital transfer on clinical outcomes and resource use after cardiac operations: Insights from a national cohort. Surgery 2020; 168:876-881. [PMID: 32641276 DOI: 10.1016/j.surg.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/03/2020] [Accepted: 05/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interhospital transfer is a common clinical practice that has been associated with poor patient outcomes in small series. We aimed to evaluate the impact of transfer status on cardiac surgery patients in a national cohort. METHODS Patients undergoing nonelective coronary artery bypass grafting, valve replacement or repair, or a combination were identified using the 2010 to 2017 Nationwide Readmissions Database. Patients were stratified by transfer status and outcomes were evaluated using adjusted multivariable linear and logistic models. RESULTS Of an estimated 1,023,315 patients, 170,319 (16.6%) were transfers. Transfer was independently associated with increased complications, index hospitalization duration of stay, costs, early (30 day), and intermediate (31-90 day) readmission. Among transferred patients, transfer to a high-volume center predicted reduced odds of mortality (adjusted odds ratio: 0.64, P < .001). Additionally, transfers were less likely to be readmitted back to the index hospital (80.7% vs 44.9%, P < .001). CONCLUSION Transfer status is a significant independent predictor of increased complications, length of stay, cost, and readmission among nonelective cardiac surgery patients. Notably, transfer to higher volume facilities appears to increase odds of survival. Our findings are important when considering the risks involved in the management of transferred patients.
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Affiliation(s)
- Yas Sanaiha
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles
| | - Joseph Hadaya
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles
| | - Mario Cale
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles
| | - Nam Yong Cho
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles
| | - Josef Madrigal
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles
| | - Sohail Sareh
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles
| | - Peyman Benharash
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles.
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Aguayo E, Antonios J, Sanaiha Y, Dobaria V, Kwon OJ, Sareh S, Benharash P, King JC. Readmission and Resource Use After Robotic-Assisted versus Open Pancreaticoduodenectomy: 2010-2017. J Surg Res 2020; 255:517-524. [PMID: 32629334 DOI: 10.1016/j.jss.2020.05.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/27/2020] [Accepted: 05/24/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Unplanned rehospitalization is considered an adverse quality of care indicator. Minimally invasive operations carry the potential to reduce resource use while enhancing recovery. Robotic-assisted pancreaticoduodenectomy (RAPD) has been used to improve outcomes of its morbid open counterpart. We sought to identify factors associated with readmission between RAPD and open pancreaticoduodenectomy (OPD). MATERIALS AND METHODS We used the 2010-17 National Readmissions Database to identify adults who underwent RAPD or OPD. The primary outcome was 30-day readmission. Secondary outcomes included readmission diagnosis: index, readmission, and total (index + readmission) length of stay, costs, and mortality. RESULTS Of an estimated 84,036 patients undergoing pancreaticoduodenectomy, 96.9% survived index hospitalization. Frequency of both RAPD and OPD increased during the study period with similar mortality (2.5% versus 3.2%, P = 0.46). Compared with OPD, RAPD was not an independent predictor of 30-day readmission (adjusted odds ratio (AOR): 1.0, P = 0.98). Disposition with home health care (AOR: 1.1, P < 0.001) or to a skilled nursing facility (AOR: 1.5, P < 0.001) was significantly associated with increased 30-day readmission. CONCLUSIONS Readmission after pancreaticoduodenectomy is common, regardless of surgical approach. Although RAPD saves in-patient days on index admission, readmission rates and length of stay are similar between the two modalities. Neither RAPD nor OPD is a risk factor for readmission, highlighting the complexity of pancreaticoduodenectomy, with complications that may result from factors independent of the operative approach.
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Affiliation(s)
- Esteban Aguayo
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - James Antonios
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Oh Jin Kwon
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Department of Surgery, Harbor UCLA, Torrance, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California
| | - Jonathan C King
- Department of Surgery, University of California Los Angeles, Los Angeles, California.
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13
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Madrigal J, Sanaiha Y, Karunungan K, Sareh S, Benharash P. National trends in postoperative infections across surgical specialties. Surgery 2020; 168:753-759. [PMID: 32611513 DOI: 10.1016/j.surg.2020.04.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/12/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite the introduction of several measures to reduce incidence, postoperative infections have been reported to increase. We aimed to assess trends in the incidence and impact of postoperative infections using a recent national cohort. METHODS Patients undergoing the most commonly performed elective inpatient procedures in 9 surgical specialties were identified from the 2006 to 2014 National Inpatient Sample. Diagnostic coding was utilized to identify patients with postoperative infections. To adjust for patient and operative differences in assessing outcomes, an inverse probability of treatment weighing protocol was used. RESULTS Of an estimated 23,696,588 patients, 1,213,182 (5.1%) developed postoperative infections. Skin and soft tissue operations had the highest burden (12.9%) and endocrine the lowest (1.3%). During the study period, we found decreasing incidence, case fatality, and incremental cost of postoperative infections. Infection was associated with increased in-hospital mortality (1.4 vs 0.4%, P < .001), duration of stay (7.6 vs 3.7 days, P < .001), and costs ($27,597 vs $17,985, P < .001). Annually, postoperative infections led to an average incremental cost burden exceeding $700 million in the United States alone. CONCLUSION During the study period there was a substantial decrease in the burden of postoperative infections. Despite encouraging trends, postoperative infections continue to serve as a suitable quality improvement target, particularly in specialties with a high burden of infections.
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Affiliation(s)
- Josef Madrigal
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Yas Sanaiha
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Krystal Karunungan
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Sohail Sareh
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Peyman Benharash
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA.
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Sanaiha Y, Juo YY, Rudasill SE, Jaman R, Sareh S, de Virgilio C, Benharash P. Percutaneous cholecystostomy for grade III acute cholecystitis is associated with worse outcomes. Am J Surg 2020; 220:197-202. [DOI: 10.1016/j.amjsurg.2019.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/07/2022]
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15
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Aguayo E, Antonios J, Sanaiha Y, Dobaria V, Sareh S, Huynh A, Benharash P, King JC. National Trends in Readmission and Resource Utilization After Pancreatectomy in the United States. J Surg Res 2020; 255:304-310. [PMID: 32592977 DOI: 10.1016/j.jss.2020.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pancreatectomy is a complex operation that has been associated with excess morbidity and mortality. Although acute index outcomes have been characterized, there are limited data available on nonelective readmission after pancreatic surgery. We sought to identify factors associated with 30-day and 30- to 90-day readmission after pancreatectomy. MATERIAL AND METHODS We utilized the National Readmissions Database between 2010 and 2016 to identify adults who underwent a pancreatectomy. The primary outcomes were 30-day (30DR) and 30- to 90-day (90DR) readmission. Secondary outcomes included nonelective readmission trends, diagnosis, length of stay, charges, and mortality. RESULTS Of an estimated 130,267 subjects undergoing pancreatectomy, 97% survived index hospitalization. Eighteen percent of patients had nonelective 30DR while 5.6% experienced 90DR. Readmission at the two time points remained stable during the study period. After adjusting for institution, pancreatectomy volume, mortality (2.0% versus 4.9%, P < 0.001), 30DR length of stay (7.3 d versus 7.8 d, P < 0.001), and 90DR rates (6.9% versus 8.1%, P = 0.003) were significantly decreased at high-volume pancreatectomy centers compared to low-volume hospitals. Discharge to a skilled nursing facility (AOR: 1.52) or with home health care (AOR: 1.2) was associated with 30DR (P < 0.001). Patients undergoing total pancreatectomy (AOR: 1.3) or those with a substance use disorder (AOR: 1.4) among others were associated with 90DR (P ≤ 0.01). CONCLUSIONS Readmissions are common and costly after pancreatectomy. Approximately 20% of patients experience readmission within 30 d. 30DR and 90DR rates remained stable during the study. Pancreatectomy at a high-volume center was associated with decreased mortality and 90DR. The present analysis confirms associations between pancreatectomy volume, postsurgical complications, comorbidities, and readmission.
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Affiliation(s)
- Esteban Aguayo
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - James Antonios
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Department of Surgery, University of California Los Angeles, Los Angeles, California
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Department of Surgery, Harbor UCLA, Torrance, California
| | - Ashley Huynh
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California
| | - Jonathan C King
- Department of Surgery, University of California Los Angeles, Los Angeles, California.
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Christian-Miller N, Hadaya J, Nakhla M, Sanaiha Y, Madrigal J, Emami S, Cale M, Sareh S, Benharash P. The impact of obesity on outcomes in patients receiving extracorporeal life support. Artif Organs 2020; 44:1184-1191. [PMID: 32530120 DOI: 10.1111/aor.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
Abstract
Extracorporeal life support (ECLS) has been increasingly utilized to manage cardiac and pulmonary dysfunction. The impact of obesity on outcomes of ECLS is poorly defined. The purpose of the study was to compare in-hospital mortality, resource use, complications, and readmissions in obese versus non-obese patients receiving ECLS. We performed a retrospective cohort study of all adult ECLS patients with and without an obesity diagnosis using the 2010-2016 Nationwide Readmissions Database (NRD). Mortality, length of stay (LOS), hospital charges, complications, and readmissions were evaluated using multivariable logistic and linear regression. Of 23 876, patients who received ECLS, 1924 (8.1%) were obese. Obese patients received ECLS more frequently for respiratory failure (29.5% vs. 23.7%, P = .001). After adjustment for patient and hospital factors, obesity was not associated with increased odds of mortality (AOR = 1.06, P = .44) and was associated with decreased LOS (13.7 vs. 21.2 days, P < .001), hospital charges ($171 866 vs. $211 445, P < .001), and 30-day readmission (AOR = 0.71, P = .03). Obesity was also associated with reduced odds of hemorrhage (AOR = 0.43, P < .001), neurologic complications (AOR = 0.55, P = .004), and acute kidney injury (AOR=0.83, P = .04). After stratification by ECLS indication, obesity remained predictive of shorter LOS (AOR range: 0.53-0.78, all P < .05 ) and did not impact mortality (all P > .05). Respiratory support remains the most common indication for ECLS among obese patients. Among all patients, as well as by individual ECLS indication, obesity was not associated with increased odds of mortality. These findings suggest that obesity should not be considered a high-risk contraindication to ECLS.
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Affiliation(s)
- Nathaniel Christian-Miller
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Morcos Nakhla
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Josef Madrigal
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sara Emami
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mario Cale
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Aguayo E, Kwon OJ, Dobaria V, Sanaiha Y, Hadaya J, Sareh S, Huynh A, Benharash P. Impact of interhospital transfer on clinical outcomes and costs of extracorporeal life support. Surgery 2020; 168:193-197. [PMID: 32507298 DOI: 10.1016/j.surg.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The impact of interhospital transfers for extracorporeal life support have not been studied in large datasets. The present study sought to determine the impact of such patient transfers on survival, complications, and hospitalization costs. METHODS The 2010 to 2016 database of the National Inpatient Sample was used to identify all adults who underwent extracorporeal life support. Patients were categorized based on whether or not they were transferred to another facility. Trend analysis and multivariable models were used to characterize the impact of inter hospital transfer on in-hospital mortality, complications, duration of stay, and costs. RESULTS Of an estimated 29,298 extracorporeal life support hospitalizations during the study period, 36.8% were transferred from an outside facility. Extracorporeal life support hospitalizations experienced a 7-fold increase with no difference in mortality between transferred and not transferred cohorts in 2016 (4.79% vs 4.79%, P = .97). Mortality rates were less for patients transferred to high volume centers compared to low volume hospitals (48.7% vs 51.6%, P < .001). Transfer to a low volume hospital for cardiogenic shock was associated with greater odds of mortality (adjusted odds Rratio: 2.25, confidence interval 1.01-5.03). CONCLUSION Utilization of extracorporeal life support in both transferred and not transferred patients has statistically significantly increased with a decrement in mortality for those transferred. Survival in the transferred cohort is strongly associated with extracorporeal life support procedure volume of the center and this must be taken into account when considering extracorporeal life support transfer.
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Affiliation(s)
- Esteban Aguayo
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Oh Jin Kwon
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA; Department of Surgery, Harbor University of California-Los Angeles, Torrance, CA
| | - Ashley Huynh
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at University of California, Los Angeles, CA; Division of Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles, CA.
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18
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Hadaya J, Dobaria V, Aguayo E, Kwon OJ, Sanaiha Y, Hyunh A, Sareh S, Benharash P. National trends in utilization and outcomes of extracorporeal support for in- and out-of-hospital cardiac arrest. Resuscitation 2020; 151:181-188. [DOI: 10.1016/j.resuscitation.2020.02.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/09/2020] [Accepted: 02/28/2020] [Indexed: 11/28/2022]
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19
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Aguayo E, Dobaria V, Sareh S, Sanaiha Y, Seo YJ, Hadaya J, Benharash P. National Analysis of Coronary Artery Bypass Grafting in Autoimmune Connective Tissue Disease. Ann Thorac Surg 2020; 110:2006-2012. [PMID: 32439392 DOI: 10.1016/j.athoracsur.2020.03.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/05/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Autoimmune connective tissue diseases (CTDs) are associated with accelerated atherosclerosis and inflammation, while often requiring immunosuppression. Large-scale outcomes of coronary artery bypass graft (CABG) surgery in this population have not been reported thus far. This study characterized trends in use of CABG in patients with CTDs and the impact of the disease on mortality, in-hospital complications, length of stay, and costs. METHODS The 2005 to 2015 National Inpatient Sample was used to identify all adult patients undergoing isolated CABG. The CTDs cohort included rheumatoid arthritis, lupus erythematosus, and antiphospholipid syndrome (APLS), among others. Hierarchical multivariable logistic models were used to calculate the independent impact of CTDs on clinical outcomes and costs. RESULTS Of an estimated 2,101,591 patients, 41,567 (1.8%) were diagnosed with CTDs (rheumatoid arthritis, 58%; systemic lupus erythematosus, 12%; APLS, 11%) Although the overall annual use of CABG decreased, the proportion of patients with CTDs receiving the operation significantly increased. After adjusting for patient and hospital characteristics, CTDs were not associated with increased mortality (adjusted odds ratio [AOR], 0.91; P = .34) but were protective against cardiovascular (AOR, 0.92; P < .003), neurologic (AOR, 0.81; P = .01), and infectious (AOR, 0.80; P = .01) complications. The diagnosis of CTDs was also predictive of reduced length of hospital stay (β-coefficient = -0.40; P < .001) and costs (β-coefficient, -$1200; P = .01). On subgroup analysis patients with APLS had significantly increased odds of mortality (AOR, 1.5) and increased renal (AOR, 1.3), infectious (AOR, 1.7), and thromboembolic (AOR, 4.3) complications (all P < .05). CONCLUSIONS CABG in patients with CTDs provides acceptable outcomes and paradoxically improved resource use. However CABG in patients with APLS warrants careful consideration given inferior outcomes.
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Affiliation(s)
- Esteban Aguayo
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Vishal Dobaria
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Young-Ji Seo
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California.
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20
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Sanaiha Y, Sareh S, Lyons R, Rudasill SE, Mardock A, Shemin RJ, Benharash P. Incidence, Predictors, and Impact of Clostridium difficile Infection on Cardiac Surgery Outcomes. Ann Thorac Surg 2020; 110:1580-1588. [PMID: 32304688 DOI: 10.1016/j.athoracsur.2020.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) has been associated with morbidity and mortality after cardiac operations. The present study examined incidence, predictors, and impact of CDI on inpatient mortality and resource utilization. METHODS An analysis of adult patients undergoing elective coronary artery bypass grafting or valvular operations from 2005 to 2016 was performed using the National Inpatient Sample. Trends in CDI were assessed using a modified Cochran-Armitage analysis. Multivariable multilevel regressions were used to identify predictors of CDI, and propensity-matched pairs were generated using Mahalanobis 1-to-1 matching to compare mortality, length of stay, and costs of CDI patients with the non-CDI cohort. RESULTS The overall rate of CDI for an estimated 2,026,267 patients who underwent elective major cardiac surgery was 0.5% with no change in incidence (P for trend = .99). Predictors of CDI included advanced age (≥65 y; adjusted odds ratio [AOR], 1.88; 95% confidence interval [CI], 1.58-2.24), female gender (AOR, 1.29; 95% CI, 1.15-1.44), heart failure (AOR, 1.57; 95% CI, 1.40-1.76), and combined coronary artery bypass grafting/valve operations (AOR, 1.60; 95% CI, 1.24-2.08). Neither region nor bed size was associated with CDI. In contrast CDI mortality was lower at teaching hospitals compared with rural hospitals. Among matched pairs CDI was independently associated with higher mortality, length of stay, and Gross Domestic Product-adjusted costs. CONCLUSIONS CDI occurs in less than 1% of all elective, major cardiac operations. Patient predictors included advanced age, female gender, and several chronic comorbidities. Teaching institutions had the highest odds of CDI but lowest odds of case fatality. Further investigation of factors contributing to CDI is warranted to disseminate institutional best practices.
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Affiliation(s)
- Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Robert Lyons
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California
| | - Sarah E Rudasill
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Alexandra Mardock
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California
| | - Richard J Shemin
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California; Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California.
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21
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Rudasill SE, Iyengar A, Sanaiha Y, Khoury H, Mardock AL, Sareh S, Benharash P. Donor history of malignancy: A limited risk for heart transplant recipients. Clin Transplant 2019; 34:e13762. [PMID: 31808192 DOI: 10.1111/ctr.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/17/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022]
Abstract
Organ donor contraindications are frequently reassessed for impact on recipient outcomes in attempt to meet demand for transplantation. This study retrospectively analyzed the United Network for Organ Sharing (UNOS) registry for adult heart transplants from 1987 to September 2016 to characterize the impact of donor malignancy history in heart transplantation. Kaplan-Meier estimates illustrated 10-year survival. Propensity score matching was utilized for 1:1 matching of donors with and without history of malignancy, and Cox proportional hazards and logistic regressions were used to analyze the matched population. Of 38 781 heart transplants, 622 (1.6%) had a donor history of malignancy. Cox regressions demonstrated that donor malignancy predicted increased 10-year mortality (HR = 1.16 [1.01-1.33]), but this difference did not persist when conditioned upon 1 year post-transplant survival (log-rank = 0.643). Cox regressions of the propensity score-matched population (455 pairs) found no association between donor malignancy and 10-year mortality (HR = 1.02 [0.84-1.24]). Older age and higher rates of hypertension were observed in donors with a history of malignancy whose recipients died within the first year post-transplant. Therefore, increased recipient mortality is likely due to donor characteristics beyond malignancy, creating the potential for expanded donor selection.
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Affiliation(s)
- Sarah E Rudasill
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Amit Iyengar
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Habib Khoury
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Alexandra L Mardock
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine, University of California, Los Angeles, California
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Khoury H, Sanaiha Y, Rudasill SE, Mardock AL, Sareh S, Benharash P. Readmissions Following Isolated Coronary Artery Bypass Graft Surgery in the United States (from the Nationwide Readmissions Database 2010 to 2014). Am J Cardiol 2019; 124:205-210. [PMID: 31104778 DOI: 10.1016/j.amjcard.2019.04.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 01/23/2023]
Abstract
Readmission following cardiac surgery is associated with poor outcomes and increased healthcare expenditure. However, a nationwide understanding of the incidence, cost, causes, and predictors of 30-day readmission following coronary artery bypass grafting is limited. The Nationwide Readmissions Database was used to identify all adult patients who underwent isolated coronary artery bypass grafting (CABG) with no other concomitant surgery between 2010 and 2014. The primary outcome was all-cause readmission within 30 days of discharge after surgery. Risk-adjusted multivariable analyses were used to develop a model of readmission risk. Of 855,836 patients, 95,504 (11.2%) had an emergent 30-day readmission following CABG. The most common causes of readmission were related to respiratory complications (17.1%), infection (13.5%), and heart failure (11.9%). Readmission cost an average of $13,392 per patient, accounting for an estimated annual cost of over $250 million. Independent predictors of 30-day readmission encompassed female gender (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.24 to 1.31), emergent index admission (OR 1.29; 95% CI 1.25 to 1.33), and preoperative co-morbidities, including atrial fibrillation (OR 1.24; 95% CI 1.21 to 1.28), liver disease (OR 1.29; 95% CI 1.17 to 1.41), renal failure (OR 1.38; 95% CI 1.34 to 1.43), among others. CABG performed at a high CABG volume hospital was protective of readmission (OR 0.95; 95% CI 0.91 to 0.99). In conclusion, we characterized using a national sample the incidence, causes, costs, and predictors of 30-day readmission following CABG. Targeting modifiable risk factors for readmission should be a priority to reduce rates of readmission and decrease healthcare expenditure.
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Sanaiha Y, Rudasill S, Sareh S, Mardock A, Khoury H, Ziaeian B, Shemin R, Benharash P. Impact of hospital safety-net status on failure to rescue after major cardiac surgery. Surgery 2019; 166:778-784. [PMID: 31307773 PMCID: PMC7700062 DOI: 10.1016/j.surg.2019.05.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hospitals with safety-net status have been associated with inferior surgical outcomes and higher costs. The mechanism of this discrepancy, however, is not well understood. We hypothesized that discrepant rates of failure to rescue after complications of routine cardiac surgery would explain the observed inferior outcomes at safety-net hospitals. METHODS The National Inpatient Sample was used to identify adult patients who underwent elective coronary artery bypass grafting and isolated or concomitant valve operations between January 2005 and December 2016. Hospitals were stratified into low-, medium-, or high-burden categories based on the proportion of uninsured or Medicaid patients to emulate safety-net status as defined by the Institute of Medicine. Failure to rescue was defined as mortality after occurrence of neurologic, cardiovascular, respiratory, renal, or infectious complications (major and minor complications). Multivariable regression was used to perform risk-adjusted comparisons of the rate of complications, failures to rescue, and resource use for high-burden hospitals versus low-burden and medium-burden hospitals. RESULTS Of an estimated 2,012,104 patients undergoing elective major cardiac operations, 2% died, whereas 36% suffered major and minor complications. Safety-net hospitals had higher odds of failure to rescue after major comorbidity (adjusted odds ratio 1.12, 95% confidence interval 1.01-1.23). Occurrence of major and minor complications at safety-net hospitals was associated with increased costs ($2,480 [95% confidence interval $1,178-$3,935]) compared with low-burden hospitals. CONCLUSION Safety-net hospitals were associated with higher rates of failure to rescue after occurrence of tamponade, septicemia, and respiratory complications. Implementation of care bundles to tackle cardiovascular, respiratory, and renal complications may affect the discrepancy in incidence of and rescue from complications at safety-net institutions.
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Affiliation(s)
- Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Sarah Rudasill
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Alexandra Mardock
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Habib Khoury
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Boback Ziaeian
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Division of Cardiology, Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Richard Shemin
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
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Mukdad L, Kashani R, Mantha A, Sareh S, Mendelsohn A, Benharash P. The Incidence of Dysphagia Among Patients Undergoing TAVR With Either General Anesthesia or Moderate Sedation. J Cardiothorac Vasc Anesth 2019; 33:45-50. [DOI: 10.1053/j.jvca.2018.05.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Indexed: 01/25/2023]
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25
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Chiu R, Pillado E, Sareh S, De La Cruz K, Shemin RJ, Benharash P. Financial and clinical outcomes of extracorporeal mechanical support. J Card Surg 2017; 32:215-221. [DOI: 10.1111/jocs.13106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ryan Chiu
- UCLA Anderson School of Management; Los Angeles; California
| | - Eric Pillado
- UCLA Division of Cardiac Surgery; Los Angeles; California
| | - Sohail Sareh
- UCLA Division of Cardiac Surgery; Los Angeles; California
| | - Kim De La Cruz
- UCLA Division of Cardiac Surgery; Los Angeles; California
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Genovese B, Yin S, Sareh S, Devirgilio M, Mukdad L, Davis J, Santos VJ, Benharash P. Surgical Hand Tracking in Open Surgery Using a Versatile Motion Sensing System: Are We There Yet? Am Surg 2016; 82:872-875. [DOI: 10.1177/000313481608201002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With changes in work hour limitations, there is an increasing need for objective determination of technical proficiency. Electromagnetic hand-motion analysis has previously shown only time to completion and number of movements to correlation with expertise. The present study was undertaken to evaluate the efficacy of hand-motion-tracking analysis in determining surgical skill proficiency. A nine-degree-of-freedom sensor was used and mounted on the superior aspect of a needle driver. A one-way analysis of variance and Welch's t test were performed to evaluate significance between subjects. Four Novices, four Trainees, and three Experts performed a large vessel patch anastomosis on a phantom tissue. Path length, total number of movements, absolute velocity, and total time were analyzed between groups. Compared to the Novices, Expert subjects exhibited significantly decreased total number of movements, decreased instrument path length, and decreased total time to complete tasks. There were no significant differences found in absolute velocity between groups. In this pilot study, we have identified significant differences in patterns of motion between Novice and Expert subjects. These data warrant further analysis for its predictive value in larger cohorts at different levels of training and may be a useful tool in competence-based training paradigms in the future.
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Affiliation(s)
- Bradley Genovese
- Division of Cardiac Surgery, University of California at Los Angeles, Los Angeles, California
- Center for Advanced Surgical and Interventional Technology, University of California at Los Angeles, Los Angeles, California
| | - Steven Yin
- Electrical Engineering Department, University of California at Los Angeles, Los Angeles, California; and
| | - Sohail Sareh
- Division of Cardiac Surgery, University of California at Los Angeles, Los Angeles, California
| | - Michael Devirgilio
- Division of Cardiac Surgery, University of California at Los Angeles, Los Angeles, California
| | - Laith Mukdad
- Division of Cardiac Surgery, University of California at Los Angeles, Los Angeles, California
| | - Jessica Davis
- Division of Cardiac Surgery, University of California at Los Angeles, Los Angeles, California
| | - Veronica J. Santos
- Center for Advanced Surgical and Interventional Technology, University of California at Los Angeles, Los Angeles, California
- Mechanical and Aerospace Engineering Department, University of California at Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Division of Cardiac Surgery, University of California at Los Angeles, Los Angeles, California
- Center for Advanced Surgical and Interventional Technology, University of California at Los Angeles, Los Angeles, California
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Kashani R, Bowles C, Sareh S, Toppen W, Ou R, Shemin R, Benharash P. Use of preoperative aspirin in combined coronary and valve operations. Surgery 2016; 160:1612-1618. [PMID: 27590618 DOI: 10.1016/j.surg.2016.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/17/2016] [Accepted: 07/23/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to determine the relationship between preoperative aspirin use and postoperative outcomes in patients undergoing combined coronary artery bypass grafting and valve operations. METHODS All combined coronary artery bypass grafting and valve procedures from 2008 to 2015 at our institution were identified. After exclusions, patients were stratified according to those that received preoperative aspirin and those who did not. Propensity score methodology was used to match the 2 groups using baseline and operative characteristics. Logistic regression models were then developed to assess differences in postoperative outcomes between groups. RESULTS Of the 563 patients identified, 534 met inclusion criteria: preoperative aspirin = 327 (61.2%), no preoperative aspirin = 207 (38.8%). After propensity matching, 194 patient pairs were analyzed, with no significant differences in preoperative characteristics. No significant differences were observed between the preoperative aspirin and no preoperative aspirin groups in rates of 30-day mortality (3.6% vs 4.1%, P = 1.00), major adverse cardiovascular events (23.2% vs 24.2%, P = .91), or 30-day readmission (12.4% vs 11.9%, P = 1.00), among others. CONCLUSION Preoperative aspirin use in patients undergoing combined coronary artery bypass grafting and valve operations was not associated with significant differences in major postoperative outcomes. Large-scale, randomized trials are needed to better establish the role of preoperative aspirin in this population.
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Affiliation(s)
- Rustin Kashani
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Cayley Bowles
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Sohail Sareh
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - William Toppen
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Ryan Ou
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Richard Shemin
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Peyman Benharash
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA.
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McElroy I, Sareh S, Zhu A, Miranda G, Wu H, Nguyen M, Shemin R, Benharash P. Use of digital health kits to reduce readmission after cardiac surgery. J Surg Res 2016; 204:1-7. [DOI: 10.1016/j.jss.2016.04.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/19/2016] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
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29
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Toppen W, Sareh S, Johansen D, Genovese B, Satou N, Shemin R, Benharash P. Addition of Statins to Treatment With β-Blockers to Improve Outcomes for Cardiac Surgery Patients: Beyond the Surgical Care Improvement Project. JAMA Surg 2015; 151:389-91. [PMID: 26580138 DOI: 10.1001/jamasurg.2015.4212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- William Toppen
- Division of Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Sohail Sareh
- Division of Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Daniel Johansen
- Division of Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | | | - Nancy Satou
- Division of Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Richard Shemin
- Division of Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Peyman Benharash
- Division of Cardiac Surgery, David Geffen School of Medicine at University of California, Los Angeles
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Kashani RG, Sareh S, Genovese B, Hershey C, Rezentes C, Shemin R, Buch E, Benharash P. Predicting postoperative atrial fibrillation using CHA2DS2-VASc scores. J Surg Res 2015; 198:267-72. [DOI: 10.1016/j.jss.2015.04.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/07/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
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Toppen W, Sareh S, Satou N, Shemin R, Hunter C, Buch E, Benharash P. Do Preoperative β-blockers Improve Postoperative Outcomes in Patients Undergoing Cardiac Surgery? Challenging Societal Guidelines. Am Surg 2014. [DOI: 10.1177/000313481408001023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preoperative β-blockers (BBs) are widely administered to reduce morbidity and mortality among surgical patients. In fact, the Society of Thoracic Surgeons uses the administration of preoperative BBs as a quality metric. Recent reports, however, have questioned the benefit and safety of pre-operative BB administration. The aim of our study was to investigate whether preoperative BBs lead to improved surgical outcomes in patients undergoing cardiac surgery. A review of our prospectively maintained institutional database was done to identify adults undergoing cardiac operations at our institution from 2008 to 2013. Survival to discharge was the primary outcome with several additional secondary measures of morbidity included. A total of 2120 patients were included in the analysis and a multivariate logistic regression model was developed to adjust for differences between patient groups. After adjustment, BB administration was associated with lower odds of both prolonged ventilation (odds ratio [OR], 0.73; P = 0.032) and prolonged length of stay (OR, 0.79; P = 0.044). BB use was not associated with significant differences in other outcomes such as mortality or postoperative atrial fibrillation. Our study found that preoperative BBs may not be associated with sufficiently improved outcomes to justify their use as a quality metric in this population. Thus, prospective studies are warranted.
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Affiliation(s)
- William Toppen
- UCLA Division of Cardiac Surgery, Los Angeles, California
| | - Sohail Sareh
- UCLA Division of Cardiac Surgery, Los Angeles, California
| | - Nancy Satou
- UCLA Division of Cardiac Surgery, Los Angeles, California
| | - Richard Shemin
- UCLA Division of Cardiac Surgery, Los Angeles, California
| | - Curtis Hunter
- UCLA Division of Cardiac Surgery, Los Angeles, California
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, Los Angeles, California
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Toppen W, Sareh S, Satou N, Shemin R, Hunter C, Buch E, Benharash P. Do preoperative β-blockers improve postoperative outcomes in patients undergoing cardiac surgery? Challenging societal guidelines. Am Surg 2014; 80:1018-1021. [PMID: 25264651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Preoperative β-blockers (BBs) are widely administered to reduce morbidity and mortality among surgical patients. In fact, the Society of Thoracic Surgeons uses the administration of preoperative BBs as a quality metric. Recent reports, however, have questioned the benefit and safety of preoperative BB administration. The aim of our study was to investigate whether preoperative BBs lead to improved surgical outcomes in patients undergoing cardiac surgery. A review of our prospectively maintained institutional database was done to identify adults undergoing cardiac operations at our institution from 2008 to 2013. Survival to discharge was the primary outcome with several additional secondary measures of morbidity included. A total of 2120 patients were included in the analysis and a multivariate logistic regression model was developed to adjust for differences between patient groups. After adjustment, BB administration was associated with lower odds of both prolonged ventilation (odds ratio [OR], 0.73; P = 0.032) and prolonged length of stay (OR, 0.79; P = 0.044). BB use was not associated with significant differences in other outcomes such as mortality or postoperative atrial fibrillation. Our study found that preoperative BBs may not be associated with sufficiently improved outcomes to justify their use as a quality metric in this population. Thus, prospective studies are warranted.
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Affiliation(s)
- William Toppen
- UCLA Division of Cardiac Surgery, Los Angeles, California, USA
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Sareh S, Toppen W, Mukdad L, Satou N, Shemin R, Buch E, Benharash P. CHADS2 score predicts atrial fibrillation following cardiac surgery. J Surg Res 2014; 190:407-12. [DOI: 10.1016/j.jss.2014.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 02/02/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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34
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Toppen W, Sareh S, Frank P, Mukdad L, Postel M, Hsiue P, Satou N, Shemin R, Buch E, Benharash P. Surface Electrocardiographic Markers Do Not Predict Atrial Fibrillation in Postoperative Cardiac Surgery Patients. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Sareh S, Toppen W, Hsiue P, Satou N, Shemin R, Buch E, Benharash P. The Validity of CHADS2 Score as a Predictor of De Novo Postoperative Atrial Fibrillation in Adult Cardiac Surgery Patients. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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