Lower preoperative hematocrit, longer hospital stay, and neurocognitive decline after cardiac surgery

Objectives: This study aims to analyze the nosocomial infection factors in post–cardiac surgery extracorporeal membrane oxygenation (ECMO) supportive treatment (pCS-ECMO). Methods: The clinical data of the pCS-ECMO patients who obtained nosocomial infections (NI) were collected and analyzed retrospectively. Among the 74 pCS-ECMO patients, 30 occurred with NI, accounting for 40.5%; a total of 38 pathogens were isolated, including 22 strains of Gram-negative bacteria (57.9%), 15 strains of Gram-positive bacteria (39.5%), and 1 fungus (2.6%). Results: Multidrug-resistant strains were highly concentrated, among which Acinetobacter baumannii and various coagulase-negative staphylococci were the main types; NI was related to mechanical ventilation time, intensive care unit (ICU) residence, ECMO duration, and total hospital stay, and the differences were statistically significant (P < .05). The binary logistic regression analysis indicated that ECMO duration was a potential independent risk factor (OR = 0.992, P = .045, 95.0% CI = 0.984-1.000). Conclusions: There existed significant correlations between the secondary infections of pCS-ECMO and mechanical ventilation time, ICU residence, ECMO duration, and total hospital stay; therefore, hospitals should prepare appropriate preventive measures to reduce the incidence of ECMO secondary infections.

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Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

Journal of Cardiac Critical Care TSS ◽

10.1055/s-0041-1723749 ◽

2021 ◽

Author(s):

Chalattil Bipin ◽

Manoj K. Sahu ◽

Sarvesh P. Singh ◽

Velayoudam Devagourou ◽

Palleti Rajashekar ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cardiac Surgery ◽

Hospital Stay ◽

Pediatric Patients ◽

Tertiary Care ◽

Surgical Patients ◽

Surgical Intensive Care Unit ◽

Care Hospital ◽

Surgical Intensive Care ◽

Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

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Objective Quantification of In-Hospital Patient Mobilization after Cardiac Surgery Using Accelerometers: Selection, Use, and Analysis

Sensors ◽

10.3390/s21061979 ◽

2021 ◽

Vol 21 (6) ◽

pp. 1979

Author(s):

Frank R. Halfwerk ◽

Jeroen H. L. van Haaren ◽

Randy Klaassen ◽

Robby W. van Delden ◽

Peter H. Veltink ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Hospital Stay ◽

Intensive Care Unit Stay ◽

Heart Surgery ◽

Mixed Model ◽

Postoperative Recovery ◽

Time In Bed ◽

Surgical Ward

Cardiac surgery patients infrequently mobilize during their hospital stay. It is unclear for patients why mobilization is important, and exact progress of mobilization activities is not available. The aim of this study was to select and evaluate accelerometers for objective qualification of in-hospital mobilization after cardiac surgery. Six static and dynamic patient activities were defined to measure patient mobilization during the postoperative hospital stay. Device requirements were formulated, and the available devices reviewed. A triaxial accelerometer (AX3, Axivity) was selected for a clinical pilot in a heart surgery ward and placed on both the upper arm and upper leg. An artificial neural network algorithm was applied to classify lying in bed, sitting in a chair, standing, walking, cycling on an exercise bike, and walking the stairs. The primary endpoint was the daily amount of each activity performed between 7 a.m. and 11 p.m. The secondary endpoints were length of intensive care unit stay and surgical ward stay. A subgroup analysis for male and female patients was planned. In total, 29 patients were classified after cardiac surgery with an intensive care unit stay of 1 (1 to 2) night and surgical ward stay of 5 (3 to 6) nights. Patients spent 41 (20 to 62) min less time in bed for each consecutive hospital day, as determined by a mixed-model analysis (p < 0.001). Standing, walking, and walking the stairs increased during the hospital stay. No differences between men (n = 22) and women (n = 7) were observed for all endpoints in this study. The approach presented in this study is applicable for measuring all six activities and for monitoring postoperative recovery of cardiac surgery patients. A next step is to provide feedback to patients and healthcare professionals, to speed up recovery.

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Subacute postoperative atrial fibrillation after heart surgery: incidence and predictive factors in cardiac rehabilitation

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.326 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

V Rizza ◽

F Maranta ◽

L Cianfanelli ◽

R Grippo ◽

C Meloni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Hospital Stay ◽

Heart Surgery ◽

Troponin T ◽

Management Strategies ◽

Inpatient Rehabilitation ◽

Postoperative Atrial Fibrillation ◽

Funding Sources ◽

Valvular Surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery. It may occur between the second and fourth postoperative days as acute POAF, or within 30 days as subacute POAF (sPOAF). The incidence varies from 15% to 60%, with the highest rates observed in patients undergoing valvular surgery. POAF is associated with longer hospital stay and higher thromboembolic risk, which consistently increase patients’ morbidity and mortality. Identification of high-risk categories may allow optimization of in-hospital prevention and treatment, possibly improving clinical outcomes. Aim of the study. The aim of this study was to assess the incidence of sPOAF and to identify possible predictors in patients performing Cardiovascular Rehabilitation (CR) after Cardiac Surgery (CS). Methods. A single-centre retrospective study was performed on 383 post-cardiac surgery patients hospitalised in our CR Unit for inpatient rehabilitation. The entire population was on sinus rhythm at the admission in CR and continuous monitoring with 12-lead ECG telemetry was performed during the hospital stay. We calculated the incidence of sPOAF and then evaluated the predictive value of the following variables: anamnestic data, type of cardiac intervention, clinical course in both CS and CR Unit, laboratory parameters including baseline neutrophil-to-lymphocyte ratio (NLR). Results. Median age was 65 years (63% male). sPOAF was documented in 122 cases (31.9%). Patients developing sPOAF were older [median age 69 (63-76) vs. 61 (51-70); p < 0.001)], more frequently underwent complex surgical procedures (50% vs. 36%; p = 0.009) and were known for previous episodes of atrial fibrillation (27.9% vs. 11.2%; p < 0.001). On the first day after surgery (T1), sPOAF group showed higher values of glycemia [median 155 (126.5–186.8) vs. 129 (106.5–164); p < 0.001] and troponin T [median 721.5 (470.1–1084.3) vs. 488 (301.6-776.2); p < 0.001]. The multivariate analysis identified advanced age (OR 1.04, 95% CI 1.01-1.08; p = 0.023), acute POAF in the Cardiac Surgery Unit (OR 3.51, 95% CI 1.62-7.59; p = 0.001), baseline NLR (OR 1.46, 95% CI 1.10-1.93; p = 0.008) and T1-troponin > 552 ng/L (OR 4.16 95% CI 1.50-11.53; p = 0.006) as independent risk predictors of sPOAF during the CR period. Conclusions. sPOAF is common after cardiac surgery occurring in 31.9% of patients during CR. Age, acute POAF, baseline NLR and elevated troponin T on the first postoperative day were shown predictors of increased sPOAF risk. Recognition of new predictors of POAF could be helpful to better stratify patients, improving management strategies and outcomes.

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Lack of Association between Preoperative Statin Use and Respiratory and Neurologic Complications after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000001569 ◽

2017 ◽

Vol 126 (5) ◽

pp. 799-809 ◽

Cited By ~ 4

Author(s):

Ryu Komatsu ◽

Huseyin Oguz Yilmaz ◽

Jing You ◽

C. Allen Bashour ◽

Shobana Rajan ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Hospital Mortality ◽

Hospital Stay ◽

Odds Ratio ◽

Hospital Length Of Stay ◽

Neurologic Complications ◽

Prolonged Ventilation ◽

Statin Use

Abstract Background Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. Methods The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions. Second, the authors analyzed the collapsed composite of neurologic complications using logistic regression. Intensive care unit and hospital length of stay were evaluated with Cox proportional hazard models. Results Among 14,129 eligible patients, 6,642 patients were successfully matched. There was no significant association between preoperative statin use and prolonged ventilation (statin: 408/3,321 [12.3%] vs. nonstatin: 389/3,321 [11.7%]), pneumonia (44/3,321 [1.3%] vs. 54/3,321 [1.6%]), and in-hospital mortality (52/3,321 [1.6%] vs. 43/3,321 [1.3%]). The estimated odds ratio was 1.06 (98.3% CI, 0.88 to 1.27) for prolonged ventilation, 0.81 (0.50 to 1.32) for pneumonia, and 1.21 (0.74 to 1.99) for in-hospital mortality. Neurologic outcomes were not associated with preoperative statin use (53/3,321 [1.6%] vs. 56/3,321 [1.7%]), with an odds ratio of 0.95 (0.60 to 1.50). The length of intensive care unit and hospital stay was also not associated with preoperative statin use, with a hazard ratio of 1.04 (0.98 to 1.10) for length of hospital stay and 1.00 (0.94 to 1.06) for length of intensive care unit stay. Conclusions Preoperative statin use did not reduce pulmonary or neurologic complications after cardiac surgery.

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The association between neutrophil–lymphocyte ratio and poor outcomes following infant cardiac surgery

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02345-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Peng Gao ◽

Jinping Liu ◽

Xu Wang ◽

Peiyao Zhang ◽

Yu Jin ◽

...

Keyword(s):

Mechanical Ventilation ◽

Logistic Regression ◽

Cardiac Surgery ◽

Hospital Stay ◽

Clinical Outcomes ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Time Length ◽

Mechanical Ventilation Time ◽

Poor Outcomes

Abstract Background Neutrophil–lymphocyte ratio (NLR) is a valuable indicator for evaluating inflammation and adverse outcomes after cardiac surgery. The objective of this study was to evaluate the association of perioperative NLR with clinical outcomes in infants undergoing congenital heart surgery with cardiopulmonary bypass. Methods We performed a retrospective review of 424 consecutive infants (≤ 1 year) undergoing cardiac surgery between January 2019 and September 2019. Neonates (≤ 28 days) and patients with incomplete NLR data were excluded. The study endpoint was a composite of poor outcomes after surgery. We assess the correlation between perioperative NLR and clinical outcomes. A receiver operating characteristic curve and multivariable logistic regression were applied to identify the prognosis performance of postoperative NLR for poor outcomes. Results A total of 68 (16%) infants experienced at least one of the poor outcomes. Postoperative NLR on the third day after the surgery showed the best prognostic significance (AUC = 0.763, 95%CI 0.700–0.826) among perioperative period, with a cut-off value of 2.05. Postoperative NLR was also strongly correlated with mechanical ventilation time, length of ICU and hospital stay (p < 0.001). Multivariable logistic regression revealed that elevated postoperative NLR (OR 3.722, 95%CI 1.895–7.309, p < 0.001) was an independent risk factor for poor outcomes in infants after cardiac surgery. Conclusions Postoperative NLR was correlated with increased mechanical ventilation time, length of ICU and hospital stay. Elevated postoperative NLR was an independent predictor for poor outcomes after cardiac surgery in infants.

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Low whole blood selenium level is associated with higher mortality and longer ICU and hospital stay in patients undergoing elective cardiac surgery

Critical Care ◽

10.1186/cc9793 ◽

2011 ◽

Vol 15 (S1) ◽

Author(s):

G Koszta ◽

Z Kacska ◽

K Szatmári ◽

T Szerafin ◽

C Mitre ◽

...

Keyword(s):

Cardiac Surgery ◽

Hospital Stay ◽

Whole Blood ◽

Selenium Level ◽

Elective Cardiac Surgery

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Esmolol before cardioplegia and as cardioplegia adjuvant reduces cardiac troponin release after cardiac surgery. A randomized trial

Perfusion ◽

10.1177/0267659116681437 ◽

2016 ◽

Vol 32 (4) ◽

pp. 313-320 ◽

Cited By ~ 9

Author(s):

Elena Bignami ◽

Marcello Guarnieri ◽

Annalisa Franco ◽

Chiara Gerli ◽

Monica De Luca ◽

...

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Placebo Group ◽

Cardiopulmonary Bypass ◽

Hospital Stay ◽

Troponin T ◽

Mechanical Activity ◽

Double Blind ◽

Elective Cardiac Surgery

Background: Cardioplegic solutions are the standard in myocardial protection during cardiac surgery, since they interrupt the electro-mechanical activity of the heart and protect it from ischemia during aortic cross-clamping. Nevertheless, myocardial damage has a strong clinical impact. We tested the hypothesis that the short-acting beta-blocker esmolol, given immediately before cardiopulmonary bypass and as a cardioplegia additive, would provide an extra protection to myocardial tissue during cardiopulmonary bypass by virtually reducing myocardial activity and, therefore, oxygen consumption to zero. Materials and methods: This was a single-centre, double-blind, placebo-controlled, parallel-group phase IV trial. Adult patients undergoing elective valvular and non-valvular cardiac surgery with end diastolic diameter >60 mm and ejection fraction <50% were enrolled. Patients were randomly assigned to receive either esmolol, 1 mg/kg before aortic cross-clamping and 2 mg/kg with Custodiol® crystalloid cardioplegia or equivolume placebo. The primary end-point was peak postoperative troponin T concentration. Troponin was measured at Intensive Care Unit arrival and at 4, 24 and 48 hours. Secondary endpoints included ventricular fibrillation after cardioplegic arrest, need for inotropic support and intensive care unit and hospital stay. Results: We found a reduction in peak postoperative troponin T, from 1195 ng/l (690–2730) in the placebo group to 640 ng/l (544–1174) in the esmolol group (p=0.029) with no differences in Intensive Care Unit stay [3 days (1-6) in the placebo group and 3 days (2-5) in the esmolol group] and hospital stay [7 days (6–10) in the placebo group and 7 days (6–12) in the esmolol group]. Troponin peak occurred at 24 hours for 12 patients (26%) and at 4 hours for the others (74%). There were no differences in other secondary end-points. Conclusions: Adding esmolol to the cardioplegia in high-risk patients undergoing elective cardiac surgery reduces peak postoperative troponin levels. Further investigation is necessary to assess esmolol effects on major clinical outcomes.

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Abstract 11053: The Association Between the Systemic Immune-Inflammation Index with the Duration of Cardiopulmonary Bypass in Cardiac Surgery: A Retrospective, Single-Center Study

Circulation ◽

10.1161/circ.144.suppl_2.11053 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Yanan Hu ◽

Yi Liu ◽

Yongzhe Liu ◽

Hui Chen ◽

Wei Jiang ◽

...

Keyword(s):

Cardiac Surgery ◽

Inflammatory Response ◽

Hospital Stay ◽

Time Course ◽

Ischemia Reperfusion ◽

Systemic Inflammatory Response ◽

Surgical Trauma ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Immune Inflammation

Introduction: Systemic inflammatory response evoked by cardiac surgery involving a cardio-pulmonary bypass (CPB) in combination of surgical trauma, ischemia/reperfusion injury, hypothermia, and endotoxin release contributed to the postoperative morbidity and mortality. This study aimed to explore the potential of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) as novel markers to evaluate and predict the adverse clinical outcomes after longer CPB time in cardiac surgery. Methods: Patients who underwent cardiac surgery with or without CPB were allocated into two groups, CPB group (n=11) and N-CPB group (n=21). The time course of NLR, PLR, SII, and C-reactive protein (CPR) were analyzed at preoperative day 1 and postoperative day 1, 3, and 7. The baseline and postoperative parameters, the ICU and hospital stay were recorded. Results: There were no differences of baseline parameters between groups. The level of NLR, PLR, SII, and CPR at postoperative day 1 was higher than that in the preoperative day 1 in both groups (p < 0.01). The level of NLR, SII and CPR at postoperative day 3 was higher than that in the preoperative day 1 in both groups (p < 0.05). The NLR and SII at postoperative day 3 were higher in CPB group than that in N-CPB group (p < 0.05). The ICU and hospital stay was longer in CPB group than N-CPB group (p < 0.05). Conclusions: The longer duration of CPB time induced higher systemic inflammatory response characterized by higher level of NLR, PLR and SII. The SII predicted the poor outcome after longer CPB. The peak of systemic inflammatory response occurred on the third day after cardiac surgery.

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Abstract 2270: Preoperative Metabolic Therapy Improves Cardiac Surgical Outcomes: A Prospective Randomized Clinical Trial

Circulation ◽

10.1161/circ.116.suppl_16.ii_495-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Franklin L Rosenfeldt ◽

Jee Y Leong ◽

Salvatore Pepe ◽

Juliana Van der Merwe ◽

Donald S Esmore ◽

...

Keyword(s):

Atrial Fibrillation ◽

Multivariate Analysis ◽

Cardiac Surgery ◽

Hospital Stay ◽

Lipoic Acid ◽

Troponin I ◽

Myocardial Damage ◽

Postoperative Hospital Stay ◽

Postoperative Atrial Fibrillation ◽

Metabolic Therapy

In the current era the typical patient presenting for cardiac surgery is elderly with multiple co-morbidities. These high-risk patients contribute disproportionately to postoperative morbidity and mortality. We have shown that metabolic therapy with antioxidants such as coenzyme Q 10 (Co Q 10 ) and lipoic acid as well as energy substrate precursors such as orotate have protective effects on the stressed myocardium. We postulated that such therapy would reduce myocardial damage and improve post-operative recovery. Aim: To assess the effects of perioperative metabolic therapy on clinical and biochemical outcomes of cardiac surgery. Methods: Patients ( n =117), mean age 65 years, 74% male, undergoing elective coronary artery bypass graft (CABG) or valve surgery were randomised to receive daily for a minimum of 2 weeks before, and 4 weeks after surgery, metabolic therapy consisting of CoQ 10 300mg, magnesium orotate 1.2g, alpha lipoic acid 300mg, fish oil 999 mg and selenium 200 μg or placebo. Results: In the whole group, metabolic therapy vs placebo was associated (multivariate analysis) with lower 24-hour postoperative plasma troponin I (1.44 ± 0.25 vs 2.65 ± 0.61 ug/L, p =0.003) and reduced postoperative hospital stay (6.9± 0.04 vs 8.1 ± 0.04 days, p =0.002). In CABG alone group (n=70), metabolic therapy reduced the incidence of postoperative atrial fibrillation (23% vs 46%, p =0.04, multivariate analysis). Conclusions: Metabolic therapy before cardiac surgery is associated with: Reduced myocardial damage (troponin I release); Shortened postoperative hospital stay; Reduced incidence of postoperative atrial fibrillation in CABG patients. Clinical and economic benefits may be expected from general application of this therapy.

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