Cardiac surgery in a high-risk group of patients: Is prolonged postoperative antibiotic prophylaxis effective?

Background: Despite steady improvements in cardiac surgery-related outcomes, our understanding of the physiologic mechanisms leading to perioperative mortality remains incomplete. Intraoperative hypotension is an important risk factor for mortality after noncardiac surgery but remains relatively unexplored in the context of cardiac surgery. We examined whether the association between intraoperative hypotension and in-hospital mortality varied by patient and procedure characteristics, as defined by the validated Cardiac Anesthesia Risk Evaluation (CARE) mortality risk score. Methods: We conducted a retrospective cohort study of consecutive adult patients who underwent cardiac surgery requiring cardiopulmonary bypass (CPB) from November 2009–March 2015. Those who underwent off-pump, thoracic aorta, transplant and ventricular assist device procedures were excluded. The primary outcome was in-hospital mortality. Hypotension was categorized by mean arterial pressure (MAP) of <55 and between 55–64 mmHg before, during and after CPB. The relationship between hypotension and death was modeled using multivariable logistic regression in the intermediate and high-risk groups. Results: Among 6627 included patients, 131 (2%) died in-hospital. In-hospital mortality in patients with CARE scores of 1, 2, 3, 4 and 5 was 0 (0%), 7 (0.3%), 35 (1.3%), 41 (4.6%) and 48 (13.6%), respectively. In the intermediate-risk group (CARE = 3–4), MAP < 65 mmHg post-CPB was associated with increased odds of death in a dose-dependent fashion (adjusted OR 1.30, 95% CI 1.13–1.49, per 10 min exposure to MAP < 55 mmHg, p = 0.002; adjusted OR 1.18 [1.07–1.30] per 10 min exposure to MAP 55–64 mmHg, p = 0.001). We did not observe an association between hypotension and mortality in the high-risk group (CARE = 5). Conclusions: Post-CPB hypotension is a potentially modifiable risk factor for mortality in intermediate-risk patients. Our findings provide impetus for clinical trials to determine if hemodynamic goal-directed therapies could improve survival in these patients.

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The operative risk stratification models in cardiac surgery: EuroSCORE II model - risk groups categorization

Vojnosanitetski pregled ◽

10.2298/vsp180516124n ◽

2020 ◽

Vol 77 (6) ◽

pp. 607-613

Author(s):

Dusko Nezic ◽

Miroslav Milicic ◽

Ivana Petrovic ◽

Dragana Kosevic ◽

Slobodan Micovic

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Risk Stratification ◽

Risk Group ◽

Risk Groups ◽

High Risk Group ◽

Operative Risk ◽

Discriminative Power ◽

Mortality Ratio ◽

Good Calibration

Background/Aim. The treshold that defines a low, moderate or high-risk patients is not uniformly determined for the European System for Cardiac Operative Risk Evaluation (EuroSCORE II) by literature at present. The aim of this study was to suggest risk groups categorization within EuroSCORE II risk statification model. Methods. A 7,641 consecutive patients were scored preoperatively using EuroSCORE II. The end point for the study was in-hospital mortality accross the risk group categories. Patients with EuroSCORE II values of ? 2.50, > 2.50?6.50%, and > 6.50% were defined to be at low, moderate, and high perioperative risk, respectively. Discriminative power of the model was tested by calculating the area under the receiver operating characteristic curve (AUC). The calibration of the model was assessed by Hosmer-Lemeshow statistics, and with observed/expected (O/E) mortality ratio. Results. Inhospital mortality observed in our sample was 3.85% (295 out of 7,641 patients). The EuroSCORE II discriminative power was acceptable (AUCs > 0.70) for the low and high risk groups, while it failed to confirm good discrimination in the moderate risk group. Hosmer-Lemeshow statistics confirmed good calibration across risk group categories. The O/E mortality ratio failed to confirm good calibration in the low and high risk group (slight, but significant underprediction ratio of 1.24; 95% confidence interval 1.05?1.43), but confirmed good calibration in all three subcategories of the high risk group. Conclusion. The results of this study showed an acceptable overall performance of the Euro- SCORE II in terms of discrimination and accuracy of model predictions for perioperative mortality across risk group categories. Validation of EuroSCORE II performances across risk group categories needs to be further studied for a continuous improvement of patients' risk stratification before planned cardiac surgery.

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Nutritional assessment and surgical risk makers in children submitted to cardiac surgery

Sao Paulo Medical Journal ◽

10.1590/s1516-31801995000100008 ◽

1995 ◽

Vol 113 (1) ◽

pp. 706-714 ◽

Cited By ~ 12

Author(s):

Heitor Pons Leite ◽

Mauro Fisberg ◽

Neil Ferreira Novo ◽

Eliana Borges Rodrigues Nogueira ◽

lvete Kotomi Ueda

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Postoperative Complications ◽

Risk Group ◽

Heart Diseases ◽

High Risk Group ◽

Individual Identification ◽

Risk Indicator ◽

Surgical Risk ◽

Arm Circumference

In order to assess the nutritional status of children with heart diseases and to evaluate nutritional parameters for predicting postoperative complications, 50 children undergoing to cardiac surgery and classified in high and low surgical risk prospectively evaluated. Assessment parameters included anthropometry and plasma proteins albumin, transferrin and prealbumin. The nutritional classification according to Waterlow's modified criteria showed a high prevalence of malnutrition in the population studied (78%). The measures of arm circumference when located below the 5th percentile showed a significant association with general postoperative complications in the high risk group (arm circumference, p = 0,0019; arm muscle circumference, p = 0,0419). The percentage of weight per height, serum albumin and transferrin has not played a prognostic role concerning postoperative morbidity. The mean value of prealbumin was significantly lower in high risk group patients developing postoperative infections (p < 0,01) compared to those who did not. The sensitivity-specificity analysis of prealbumin as risk indicator for postoperative infection was 87.5% and 59% respectively. The nutritional risk classification seems to be a good way to identify the subgroups of children with additional postoperative surgical risk. However, more specific and sensitive tests are desirable to provide an individual identification of these children.

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Acromegaly and Obstructive Sleep Apnea: Identifying the High-Risk Group

10.1055/s-0039-1679596 ◽

2019 ◽

Author(s):

Xiaojun Zhan ◽

Chandala Chitguppi ◽

Ethan Berman ◽

Gurston Nyquist ◽

Tomas Garzon-Muvdi ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Obstructive Sleep

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Recommendations from male students help shape mental health support for this high-risk group

10.3310/alert_42077 ◽

2020 ◽

Keyword(s):

Mental Health ◽

High Risk ◽

Risk Group ◽

High Risk Group ◽

Male Students ◽

Mental Health Support ◽

Health Support

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Anamnestic factors that shape reproductive health of women with repeated unsuccessful popygamy in vitro fertilization

HEALTH OF WOMAN ◽

10.15574/hw.2016.114.140 ◽

2016 ◽

pp. 140-143

Author(s):

N.V. Cotsabin ◽

◽

O.M. Makarchuk ◽

Keyword(s):

High Risk ◽

Risk Group ◽

Polycystic Ovary ◽

High Risk Group ◽

Stress Factors ◽

Control Group ◽

Fertilization In Vitro ◽

Infertile Women ◽

Group I

The proportion of patients with multiple unsuccessful attempts of assisted reproductive technology (ART) is about 30% of all patients treated with the use of ART. Women with history of unsuccessful ART attempts - a special category of patients who require emergency attention and a thorough examination at the stage of preparation for superovulation stimulation,the selection of embryos and endometrium preparation for embryo transfer. The objective: to distinguish high-risk group of unsuccessful attempts based on a detailed analysis of anamnestic and clinical data of infertile women with repeated unsuccessful ART attempts that requires more in-depth study of hormonal features, ovarian reserve and condition of the endometrium. Materials and methods. For better understanding of the problem of repeated unsuccessful ART attempts and сreation of efficient infertility treatment algorithms for these couples we conducted a thorough analysis of anamnestic data of three groups of infertile women (105 patients), which were distributed by age: group I – younger than 35, the II group – from 35 to 40, the III group - over 40 years. These groups of patients were compared with each other and with the control group of healthy women (30 persons). Results. Leading stress factors in the percentage three times prevailed in the group of infertile women and had a direct connection with the fact of procedure «fertilization in vitro» and chronic stressors caused by prolonged infertility. Primary infertility was observed significantly more frequent in patients younger than 35 years (p <0.05), secondary infertility - mostly in the second and third experimental groups (p <0.05). Noteworthy significant percentage of wellknown causes of infertility and idiopathic factor in all groups, and the prevalence of tubal-peritoneal factor in the second and third experimental groups, and endocrine dysfunction in the I experimental group. The most common disorder among this category of woman was polycystic ovary syndrome. Frequency of usual miscarriage among patients of I ana II groups was two times higher than in the third group (p <0.05). Among the experimental groups the leading place belongs urinary tract infection, respiratory tract diseases, pathologies of the cardiovascular system. Data of the stratified analysis show an increase likelihood of repeated unsuccessful ART attempts under the influence of constant chronic stress (odds ratio OR=2.06; 95% CI: 0.95–3.17; p<0.05). Conclusions. Among infertile patients with repeated unsuccessful ART attempts must be separated a high risk group of failures. The identity depends on the duration of infertility, female age and leading combination of factors. Key words: repeated unsuccessful ART attempts, anamnesis, infertility, high risk.

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