Predictors of Discharge Home Without Opioids After Cardiac Surgery: A Multicenter Analysis

Cardiac surgery (CSX) can be lifesaving in elderly patients (age ≥ 80 years) but may still be associated with complications and functional decline. Frailty represents a determinant to outcomes in critically ill patients, but little is known about its influence on elderly CSX-patients. This is a secondary exploratory analysis of a multi-center, prospective observational cohort study of 610 elderly patients admitted to the ICU and followed for one year to document long-term outcomes. CSX-ICU-patients (n = 49) were compared to surgical ICU patients (n = 184) with regard to demographics, frailty, and outcomes. Of all surgical patients, 102 (43%) were considered vulnerable or frail. The subdistribution hazard ratio (SHR) of time to discharge home (TTDH) for vulnerable/frail vs. fit/well patients was 0.54 (95% confidence interval (CI), 0.34, 0.86, p = 0.007). The p-value for effect modification between surgery group (CSX vs. surgical ICU patients) and Clinical Frailty Scale (CFS) group was not significant (p = 0.37) suggesting that the observed difference in the CFS effect between the CSX and surgical ICU patients is consistent with random error. A further subgroup analysis shows that among surgical ICU patients, the SHR of time to discharge home (TTDH) for vulnerable/frail vs. fit/well patients was 0.49 (95% CI, 0.29, 0.83) while the corresponding SHR for CSX patients was 0.77 (0.32–1.88). In conclusion, preoperative frailty reduced the rate of discharge to home in both surgical and CSX patients, but a larger sample of CSX patients is needed to adequately address this question in this patient group.

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Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis

The Journal of Pediatrics ◽

10.1016/j.jpeds.2016.12.028 ◽

2017 ◽

Vol 182 ◽

pp. 190-196.e4 ◽

Cited By ~ 18

Author(s):

Christopher W. Mastropietro ◽

Katherine Cashen ◽

Lisa M. Grimaldi ◽

Keshava Murty Narayana Gowda ◽

Kurt D. Piggott ◽

...

Keyword(s):

Cardiac Surgery ◽

Extubation Failure ◽

Neonatal Cardiac Surgery ◽

Multicenter Analysis

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Impact of Remote Heart Rhythm Monitoring by Photoplethysmography-based Smartphone Technology in the Rehabilitation after Cardiac Surgery: Prospective Observational Study (Preprint)

10.2196/preprints.26519 ◽

2020 ◽

Author(s):

Marie Lamberigts ◽

Lucas Van Hoof ◽

Tine Proesmans ◽

Pieter Vandervoort ◽

Lars Grieten ◽

...

Keyword(s):

Cardiac Surgery ◽

Primary Care Physicians ◽

Clinical Care ◽

Heart Rhythm ◽

Smartphone Application ◽

Pericardial Tamponade ◽

Permanent Pacemaker ◽

Postoperative Rehabilitation ◽

Discharge Home

BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery yet the precise incidence and significance of arrhythmias after discharge home needs to be better defined. Photoplethysmography (PPG) based smartphone applications are promising tools to enable early detection and follow-up of arrhythmias. OBJECTIVE By using a PPG based smartphone application, we aimed to gain more insight into the prevalence of AF and other rhythm-related complications upon discharge home after cardiac surgery and evaluate the implementation of this app into routine clinical care. METHODS In this prospective single center trial, patients recovering from cardiac surgery were asked to register their heart rhythm three times daily, using an FDA-approved PPG-based app, for either 30 or 60 days after discharge home. Patients with permanent AF or a permanent pacemaker were excluded. RESULTS 24 patients (age 60.2 ± 12y, 65.2% male) who underwent CABG and/or valve surgery were included. During hospitalization, 39% experienced postoperative AF. After discharge, the PPG-app reported AF or atrial flutter in 5 patients. While the app notified flutter in 1 patient, this was a false positive as ECG revealed a 2nd degree 2:1 AV block necessitating a permanent pacemaker. AF was confirmed in 4 patients (4/24, 16.7%) and interestingly, was associated with an underlying postoperative complication in 2 participants (pneumonia n=1, pericardial tamponade n= 1). A significant increase in the proportion of measurements indicating sinus rhythm was observed when comparing the first to the second month of follow-up (p < 0.001). In the second month of follow-up, compliance was significantly lower with 2.2 ± 0.7 measurements per day versus 3.0 ± 0.8 in the first month (p=0.002). The majority of participants (73.9%), as well as the surveyed primary care physicians, experienced a positive value by using the app as they felt more involved in the postoperative rehabilitation. CONCLUSIONS Implementation of smartphone-based PPG-technology enables detection of AF and other rhythm- related complications after cardiac surgery. Our observations indicate that smartphone-based PPG-technology supplements the rehabilitation after cardiac surgery by acting as a sentinel for underlying complications, rhythm-related or otherwise. CLINICALTRIAL “Ethics Committee Research of UZ/KU Leuven trial number S63159”

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