Introduction: Heart failure is a leading cause of morbidity and mortality in hip fracture surgery. The impact of heart failure with preserved ejection fraction (HFpEF) is poorly understood in this population. We designed a study to evaluate national perioperative outcomes in hip fracture for patients with HFpEF. Methods: Patients with hip fracture undergoing total hip arthroplasty, hemiarthroplasty, or open/closed reduction with internal and external fixation from January 2005 to December 2013 were identified using the Nationwide Inpatient Sample. Inpatient outcomes during the index hospitalization were compared between patients without heart failure and with HFpEF. Heart failure with reduced ejection fraction was included as a secondary comparator. Perioperative major adverse cardiovascular and cerebrovascular events (MACCEs), defined as in-hospital all-cause death, acute myocardial infarction, and in-hospital cardiac arrest or acute ischemic stroke, were evaluated. Results: Among 2,020,712 hospitalizations for hip fracture surgery, perioperative MACCE occurred in 67,554 hospitalizations (3.3%), corresponding to an annual incidence of approximately 7,506 events after applying sample weights. Compared with patients without heart failure, patients with HFpEF experienced increased odds of MACCE, adjusted odds ratio [aOR], 1.69; 95% confidence interval (CI), 1.51 to 1.89. In comparison, the aOR of experiencing a MACCE event in the heart failure with reduced ejection fraction group was 1.75 (95% CI, 1.57 to 1.96). HFpEF was also associated with increased odds of acute respiratory failure (aOR, 1.71; 95% CI, 1.53 to 1.91) and acute renal failure (aOR, 1.52; 95% CI, 1.41 to 1.64). Conclusion: HFpEF confers a significant perioperative risk of MACCE in patients undergoing hip fracture surgery.
BackgroundThere is a lack of evidence for the association between intensive statin therapy and outcomes following vascular surgery. The aim of this study was to evaluate the association between perioperative statin intensity and in‐hospital mortality following open abdominal aortic aneurysm (AAA) repair.MethodsPatients undergoing open AAA repair between 2009 and 2015 were identified from the Premier Healthcare Database. Statin use was classified into low, moderate and high intensity, based on American College of Cardiology/American Heart Association guidelines. Supratherapeutic intensity was defined as doses higher than the recommended guidelines. Multivariable logistic regression analyses were undertaken to assess the association between statin intensity and postoperative major adverse events and in‐hospital mortality.ResultsOf 6497 patients undergoing open AAA repair, 3217 (49·5 per cent) received perioperative statin. Statin users were more likely to present with three or more co‐morbidities than non‐users (26·5 versus 21·8 per cent; P < 0·001). Unadjusted postoperative mortality was significantly lower in statin users (2·6 versus 6·3 per cent; P < 0·001); however, there was no difference in the risk of developing major adverse events. Multivariable analysis showed that statin use was associated with lower odds of death (odds ratio 0·41, 95 per cent c.i. 0·31 to 0·54). Moderate, high and supratherapeutic statin intensities were not associated with lower odds of death or major adverse events compared with low‐intensity statin therapy.ConclusionStatin use is associated with lower odds of death in hospital following open AAA repair. High‐intensity statins were not associated with lower morbidity or mortality.
INTRODUCTION: Management of patients with mycotic aortic aneurysms and prosthetic aortic graft infections is associated with significant morbidity and mortality. We describe a single-center experience with the use of cryopreserved human allografts for in situ reconstruction of infected aortas and aortic grafts. METHODS: We retrospectively reviewed all patients who underwent implantation of cryopreserved aortic allograft at our tertiary care center from June 2010 to December 2016. Demographic data, preoperative work-up, procedural details, and outcomes were collected. RESULTS: Fifteen patients underwent cryopreserved allograft aortic reconstruction. Nine patients had aortic infection associated with a prosthetic graft, and 6 had primary aortic infections. Of these patients, 1 had involvement of the descending thoracic aorta, 6 of the paravisceral aorta, and 8 of the infrarenal abdominal aorta. Mean follow-up was 18.3 months. One (6.7 %) patient died within 30 days (multisystem organ failure). Postoperative complications included graft thrombosis in 1 (6.7%), reoperation for bleeding in 1 (6.7%), MI in 1 (6.7%), acute kidney injury requiring hemodialysis in 3 (20%), paraplegia in 1 (6.7 %), and stroke in 1 (6.7%). During follow-up, 2 patients developed graft stenosis requiring angioplasty, and 1 patient had graft rupture requiring stent placement. At 1 month, 6 months, 1 year, 3 years, and 6 years, estimated survivals were 93%, 78%, 67%, 67%, and 67%, respectively. No patient suffered limb loss. CONCLUSIONS: The management of mycotic aneurysms and infected aortic grafts continues to be challenging. Cryopreserved graft with in situ reconstruction provides a viable alternative for extra-anatomic bypass in the setting of infection.
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