The Epidemiology and Economics of Cardiothoracic Surgery in the Elderly

Etzioni, David A.; Starnes, Vaughn A.

doi:10.1007/978-1-4419-0892-6_2

Cited by 29 publications

(20 citation statements)

References 36 publications

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“…Cardiac surgery is commonly performed in the elderly population, which is particularly susceptible to post-operative neurologic dysfunction [ 11 , 12 ]. Since neurological dysfunction is thought to be in part caused by cerebral air microemboli [ 4 ], efforts are taken by operative teams to reduce microembolism associated with heart surgery [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

A novel software program for detection of potential air emboli during cardiac surgery

Secretain

Pollard

Uddin

et al. 2015

Cardiovasc Ultrasound

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BackgroundRisks associated with air emboli introduced during cardiac surgery have been highlighted by reports of postoperative neuropsychological dysfunction, myocardial dysfunction, and mortality. Presently, there are no standard effective methods for quantifying potential emboli in the bloodstream during cardiac surgery. Our objective was to develop software that can automatically detect and quantify air bubbles within the ascending aorta and/or cardiac chambers during cardiac surgery in real time.FindingsWe created a software algorithm (“Detection of Emboli using Transesophageal Echocardiography for Counting, Total volume, and Size estimation”, or DETECTS™) to identify and measure potential emboli present during cardiac surgery using two-dimensional ultrasound. An in vitro experiment was used to validate the accuracy of DETECTS™ at identifying and measuring air emboli. An experimental rig was built to correlate the ultrasound images to high definition camera images of air bubbles created in water by an automatic bubbler system. There was a correlation between true bubble size and the size reported by DETECTS™ in our in vitro experiment (r = 0.76). We also tested DETECTS™ using TEE images obtained during cardiac surgery, and provide visualization of the software interface.ConclusionsWhile monitoring the heart during cardiac surgery using existing ultrasound technology and DETECTS™, the operative team can obtain real-time data on the number and volume of potential air emboli. This system will potentially allow de-airing techniques to be evaluated and improved upon. This could lead to reduced air in the cardiac chambers after cardiopulmonary bypass, possibly reducing the risk of neurological dysfunction following cardiac surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-7120-13-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A novel software program for detection of potential air emboli during cardiac surgery

Secretain

Pollard

Uddin

et al. 2015

Cardiovasc Ultrasound

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“…Moreover, CPB time (148 [100] vs. 95 [14]; p < 0.001), cross-clamp time (91 [75] vs. 70 [35]; p < 0.001), and the number of transfused blood units (6.5 [6] vs. 2 [2]; p < 0.001) were all significantly higher in the RRT group compared to the non-RRT group. Apart from deep sternal wound infection, all other postoperative complications presented more frequently among patients who received RRT, while the length of ICU hospitalization (5 [8] vs. 1 [1] days; p < 0.001) was also longer in the RRT group. Table 3 presents all demographic characteristics, baseline parameters, and intraoperative parameters that were univariately and multivariately associated with RRT use.…”

Section: Intraoperative and Postoperative Parametersmentioning

confidence: 94%

“…Cardiac surgery, including coronary artery bypass grafting (CABG) and valve surgery, are currently among the most common surgical procedures conducted worldwide and their numbers are expected to rise further within the next decades [1,2]. Although surgical outcomes have substantially improved over time, acute kidney injury (AKI) is a relatively common complication following cardiac surgery with incidence ranging from 3 to 30% [3,4].…”

Section: Introductionmentioning

confidence: 99%

Serum Creatinine and Chronic Kidney Disease-Epidemiology Estimated Glomerular Filtration Rate: Independent Predictors of Renal Replacement Therapy following Cardiac Surgery

et al. 2018

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Background: Most studies evaluating predictors of renal replacement therapy (RRT) following cardiac surgery use arbitrary defined limits of preoperative serum creatinine. The aim of this study was to evaluate the effect of preoperative renal function using either estimated-glomerular filtration rate (eGFR) derived using Chronic Kidney Disease-Epidemiology (CKD-EPI) or serum creatinine alone as a predictor for RRT after cardiac surgery. Methods: In this prospective cohort study, baseline, intraoperative, and postoperative data of all patients who underwent an elective, urgent, or emergency cardiac surgery between 2012 and 2016 in a single center were analyzed in order to identify multivariate parameters determining the need for RRT after surgery. For preoperative renal function, we used serum creatinine levels and eGFR-derived CKD-EPI equation. We also divided our cohort into eGFR groups following the thresholds of the currently proposed CKD classification. Results: From the 1,614 patients (mean age: 65.4 ± 10.6 years; male: 77.6%) that constituted the study population, 42 (2.6%) underwent RRT postoperatively. EUROSCORE II, cardiopulmonary bypass time, cross clamp time, red blood cell (RBC) units transfused, type and urgency of surgery, combined/non combined operation, peripheral vascular disease, heart failure, chronic obstructive pulmonary disease, dyslipidemia, and preoperative renal function were all univariately associated with RRT use. Multivariate regression with bootstrap utilization indicated that CKD-EPI eGFR (OR 0.979; 95% CI 0.956–0.998), heart failure with the New York Heart Association class ≥2 (OR 4.695; 95% CI 1.756–14.061) and RBC units transfused (OR 1.287; 95% CI 1.081–1.850) were independently associated with RRT need. When serum creatinine (OR 2.920, 95% CI1.056–8.074) was used in the model, the associations with RRT were also significant. Conclusion: Preoperative renal function, defined by serum creatinine or eGFR by CKD-EPI, NYHA class II–IV, and the number of blood units transfused were all independent predictors of RRT postoperatively.

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“…As the population ages, the number of cardiac surgeries performed annually is predicted to grow. 1 As such, practitioners will find themselves faced more frequently with complications, including postoperative atrial fibrillation (POAF), which is among the most prevalent. Estimates indicate that nearly one third of all coronary artery bypass graft (CABG) patients will experience POAF, with that number climbing to 40% for valvular procedures and ≤50% when these procedures are combined.…”

Section: Goals and Vision Of The Programmentioning

confidence: 99%

Design, Challenges, and Implications of Quality Improvement Projects Using the Electronic Medical Record

Ebinger

Porten

Strauss

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Postoperative atrial fibrillation (POAF) is a frequent complication of cardiac surgery, which results in increased morbidity, mortality, length of stay, and hospital costs. We developed and followed a process map to implement a protocol to decrease POAF: (1) identify stakeholders and form a working committee, (2) formal literature and guideline review, (3) retrospective analysis of current institutional data, (4) data modeling to determine expected effects of change, (4) protocol development and implementation into the electronic medical record, and (5) ongoing review of data and protocol adjustment. Retrospective analysis demonstrated that POAF occurred in 29.8% of all cardiovascular surgery cases. Median length of stay was 2 days longer (P<0.001), and median total variable costs $2495 higher (P<0.001) in POAF patients. Modeling predicted that up to 60 cases of POAF and >$200 000 annually could be saved. A clinically based electronic medical record tool was implemented into the electronic medical record to aid preoperative clinic providers in identifying patients eligible for prophylactic amiodarone. Initial results during the 9-month period after implementation demonstrated a reduction in POAF in patients using the protocol, compared with those who qualified but did not receive amiodarone and those not evaluated (11.1% versus 38.7% and 38.8%; P=0.022); however, only 17.3% of patients used the protocol. A standardized methodological approach to quality improvement and electronic medical record integration has potential to significantly decrease the incidence of POAF, length of stay, and total variable cost in patients undergoing elective coronary artery bypass graft and valve surgeries. This framework for quality improvement interventions may be adapted to similar clinical problems beyond POAF.

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The Epidemiology and Economics of Cardiothoracic Surgery in the Elderly

Cited by 29 publications

References 36 publications

A novel software program for detection of potential air emboli during cardiac surgery

A novel software program for detection of potential air emboli during cardiac surgery

Serum Creatinine and Chronic Kidney Disease-Epidemiology Estimated Glomerular Filtration Rate: Independent Predictors of Renal Replacement Therapy following Cardiac Surgery

Design, Challenges, and Implications of Quality Improvement Projects Using the Electronic Medical Record

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