Nonrandom Selection and The Attributable Cost of Surgical-Site Infections

2002 ◽  
Vol 23 (4) ◽  
pp. 177-182 ◽  
Author(s):  
Christopher S. Hollenbeak ◽  
Denise Murphy ◽  
William C. Dunagan ◽  
Victoria J. Fraser
Keyword(s):  
Linear Regression ◽  
Selection Bias ◽  
Medical Center ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cost Of Care ◽  
Two Stage ◽  
Cabg Surgery ◽  
The Cost ◽  
Matched Comparison

Objective:To study the extent to which selection bias poses problems for estimating the attributable cost of deep chest surgical-site infection (SSI) following coronary artery bypass graft (CABG) surgery.Design:Reanalysis of a prospective case–control study.Setting:A large, Midwestern community medical center.Patients:Cases were all patients who had an SSI (N = 41) following CABG and CABG and valve surgery between April 1996 and March 1998. Controls were every tenth uninfected patient (N = 160).Methods:Estimates of the attributable cost of deep chest SSI were computed using unmatched comparison, matched comparison, linear regression, and Heckman's two-stage approach.Results:The attributable cost of deep chest SSI was estimated to be $20,012 by unmatched comparison, $19,579 by matched comparison, $20,103 by linear regression, and $14,211 by Heckman's two-stage method. Controlling for selection bias substantially reduced the cost estimate, but the coefficient capturing selection bias was not statistically significant.Conclusions:Deep chest SSI significantly increases the cost of care for patients who undergo CABG surgery. Unmatched comparison, matched comparison, and linear regression estimated the attributable cost to be approximately $20,000. Although controlling for selection bias with Heckman's two-stage method resulted in a substantially smaller estimate, the coefficient for selection bias was not statistically significant, suggesting that the estimates derived from the other models should be acceptable. However, the magnitude of the difference between the models shows that the effect of selection bias can be substantial. Some exploration for selection bias is recommended when estimating the attributable cost of SSIs.

scholarly journals Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

2017 ◽  
Vol 8 (1) ◽  
pp. 200-207
Author(s):  
Sarah Farukhi Ahmed ◽  
Audrey Xi Tai ◽  
Mason Schmutz ◽  
John Combs ◽  
Sameh Mosaed
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Vision Loss ◽  
Artery Bypass ◽  
Venous Pressure ◽  
Bypass Graft ◽  
Ischemic Optic Neuropathy ◽  
Cabg Surgery ◽  
Ocular Hypotony

Importance: The purpose of this case report is to evaluate risk factors associated with post-coronary artery bypass graft (CABG) ocular hypotony compared to post-CABG ischemic optic neuropathy. Observations: The patient described here is a single case at the University of California, Irvine Medical Center, from July 2016. This case demonstrates the rare incidence of acute post-CABG ocular hypotony and vision loss in a patient with prior history of optic atrophy. Both vision loss and hypotony resolved completely to baseline without intervention within 3 days postoperatively. Conclusions and Relevance: Severe anemia and large fluctuations in central venous pressure and blood pressure can occur in any patient undergoing CABG surgery. These hemodynamic shifts can cause transient ischemia to pressure controlling systems such as the ciliary body and reduce episcleral venous pressure. Other risk factors for acute hypotony in the setting of CABG surgery also include the use of hypertonic agents, cardiopulmonary bypass, and intravenous anesthesia.

IMMUNE FUNCTION IN THE EARLY POSTOPERATIVE PERIOD PREDICTS OUTCOME IN CORONARY ARTERY BYPASS GRAFT (CABG) SURGERY

1990 ◽  
Vol 18 (Supplement) ◽  
pp. S252
Author(s):  
Marcus P. Haw ◽  
Gregory T. Steltzer ◽  
Emma J. Lewis ◽  
Bradley C. Borlase ◽  
Lynda Kabbash ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Immune Function ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Early Postoperative Period ◽  
Artery Bypass Graft ◽  
Cabg Surgery

Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Seyed Tayeb Moradian ◽  
Fatemah Beitollahi ◽  
Mohammad Saeid Ghiasi ◽  
Amir vahedian-azimi
Keyword(s):  
Clinical Trial ◽  
Pulse Oximetry ◽  
Fast Track ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Non Invasive

Abstract Background Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery. Methods In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35); the intervention group and the control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilator setting changes, and alarms were compared between the groups. Results The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, P > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, P < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were lower in the intervention group (P < 0.05). However, the differences in the length of stay in ICU between the two groups were not significant (P = 0.219). Conclusion According to our results, the use of non-invasive monitors, including capnography and pulse oximetry, is emphasized in order to utilize FTE after CABG surgery. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Nevertheless, further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings. Trial registration: IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192

scholarly journals Outcome of off-pump coronary artery bypass graft (OPCAB) surgery: Analysis of 129 cases

2016 ◽  
Vol 31 (1) ◽  
pp. 23-25
Author(s):  
AKM Manzurul Alam ◽  
Istiaq Ahmed ◽  
Manzil Ahmed ◽  
Al Mamun Hossain
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Cabg Surgery ◽  
Off Pump ◽  
Opcab Surgery ◽  
Pump Coronary Artery Bypass

Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, including Bangladesh. Besides medical and interventional treatment, coronary artery bypass graft (CABG) surgery in an effective modality for the management of a subset of CAD patients. Off-pump coronary artery bypass graft (OPCAB) surgery is a recent modification of conventional CABG surgery, which, like other parts of the world, is being increasingly practiced in Bangladesh. But the outcome of this relatively recent surgical approach in our setting is largely unknown. In this study, the outcomes of 129 cases off-pump CABG surgery done in a tertiary cardiovascular centre and a private institute in Dhaka were analyzed. Majority (67, 54.2%) had triple vessel disease (TVD), while 4 (3.2%) patients had left main disease. One, two and three grafts were used in 17 (13.2%),74 (57.4%) and 38 (29.4%) cases respectively. There was no mortality. Post-operative complications occurred in 17 (13.18%) patients; secondary wound infection in 10 (7.75%) and immediate respiratory distress in 7 (5.43%) cases. Ten (7.75%) patients needed secondary stitches.Bangladesh Heart Journal 2016; 31(1) : 23-25

scholarly journals Determining Postoperative Thrombocyte Reduction Cut Off to Predict 30-Day Mortality in Patients Undergo Coronary Artery Bypass Graft Surgery

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4914-4914
Author(s):  
Ikhwan Rinaldi ◽  
Arif Mansjoer
Keyword(s):  
Sensitivity And Specificity ◽  
Roc Analysis ◽  
Conflicts Of Interest ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Area Under The Curve ◽  
Early Mortality ◽  
Receiver Operating Curve ◽  
Thrombocyte Count ◽  
Cabg Surgery

Background There are many factors associated with early mortality after CABG, including postoperative thrombocytopenia (Kertai, 2016). Many factors during CABG surgery, such as administration of heparin or cardio pulmonary bypass during surgery are related to thrombocyte count reduction (Hamid, Akhtar, Naqvi, & Ahsan, 2017; Arepally, 2017). However, it is possible for a post-CABG patient to suffer a significant thrombocyte reduction without reaching the thrombocytopenic state (thrombocyte count <150000/µL). Up to this time, there is still lack of study about association between thrombocyte reduction after surgery and 30-day mortality in patients undergo CABG. This study aim to determine cut off point for postoperative thrombocyte reduction as a predictor of 30-day mortality after CABG surgery. Method This is a retrospective cohort study using medical record of 263 adult patients who underwent CABG surgery in dr. Ciptomangunkusumo National Hospital on 2012-2015. Thrombocyte reduction was determined by substracting preoperative thrombocyte count from postoperative thrombocyte count. Receiver operating curve (ROC) analysis between percentage of thrombocyte reduction and 30-day mortality after surgery was done to obtain the sensitivity and specificity value of a particular degree of thrombocyte reduction. Cut off point was obtained from intersection between sensitivity and specificity value. Result Thirty-day mortality rate after CABG surgery in this study was 11.9%. Cut off point obtained from ROC analysis was 30% with area under the curve (AUC) 0.671. The sensitivity of this cut off point to predict early mortality after CABG surgery was 64.5%, while the specificity was 64.7% Conclusion Thrombocyte reduction more than or equal to 30% can be used as a predictor of 30-day mortality after CABG surgery. Figure Disclosures No relevant conflicts of interest to declare.

Discussion

2010 ◽  
pp. 346-351
Author(s):  
Patricia Cerrito ◽  
John Cerrito
Keyword(s):  
Clinical Trials ◽  
Linear Regression ◽  
Large Datasets ◽  
Cost Of Care ◽  
P Value ◽  
Confounding Factors ◽  
Chi Square ◽  
Sequential Treatments ◽  
The Cost ◽  
Improve Patient

Now that the data are more readily available for outcomes research and the techniques to analyze that data are available, we need to use the tools to investigate the total complexity of patient care. We should no longer rely upon basic tools while ignoring sequential treatments for patients with chronic diseases or the issue of patient compliance, and we can start investigating treatments from birth to death. It is no longer possible, with these large datasets, to rely on t-tests, chi-square statistics and simple linear regression. Without the luxury of clinical trials and randomizing patients into treatment versus control, there will always be confounding factors that should be considered in the data. In addition, large datasets almost guarantee that the p-value in a standard regression is statistically significant, so other methods of model adequacy must be used. If we do not start using outcomes data, we are missing crucial knowledge that can be used to improve patient outcomes while simultaneously reducing the cost of care. If we continue to use inferential statistical methods that were not designed to work with large datasets, we will not extract the information that is readily available in the outcomes datasets.

Beating Heart Coronary Artery Bypass Grafting: A Theatre Nurse's Perspective

2000 ◽  
Vol 10 (3) ◽  
pp. 138-143
Author(s):  
Mark Spence
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Beating Heart ◽  
Artery Bypass Graft ◽  
Time Warp ◽  
Cabg Surgery ◽  
Technological Advances ◽  
High Level

Coronary artery bypass graft (CABG) surgery has been going through a time warp. The development of cardiopulmonary bypass (CPB), together with continuing advances in equipment and refinement of techniques, introduced a high level of safety for CABG operations. Recently, however, with pharmacological and technological advances, surgeons have been able to ‘go back in time’ and undertake complex CABG surgery without CPB.

scholarly journals Perioperative urinary thromboxane metabolites and outcome of coronary artery bypass grafting: a nested case-control study

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021219
Author(s):  
Hanning Liu ◽  
Zhengxi Xu ◽  
Cheng Sun ◽  
Qianlong Chen ◽  
Ning Bao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Case Control Study ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Case Control ◽  
Chinese Patients ◽  
Cabg Surgery ◽  
Nested Case Control ◽  
Control Study

ObjectiveAs a marker of in vivo thromboxane generation, high-level urinary thromboxane metabolites (TXA-M) increase the occurrence of cardiovascular events in high-risk patients. To investigate whether perioperative urinary TXA-M level is associated with major adverse cardiac and cerebrovascular events (MACCE) after coronary artery bypass graft (CABG) surgery, we designed a nested case-control study.DesignObservational, nested case-control study.SettingSingle-centre outcomes research in Fuwai Hospital, Beijing, China.ParticipantsOne thousand six hundred and seventy Chinese patients undergoing CABG surgery from September 2011 to October 2013.MethodsWe obtained urinary samples from 1670 Chinese patients undergoing CABG 1 hour before surgery (pre-CABG), and 6 hours (post-CABG 6 hours) and 24 hours after surgery (post-CABG 24 hours). Patients were followed up for 1 year, and we observed 56 patients had MACCE. For each patient with MACCE, we matched three control subjects. Perioperative urinary TXA-M of the three time spots was detected in these 224 patients.ResultsPost-CABG 24 hours TXA-M is significantly higher than that of patients without MACCE (11 101vs8849 pg/mg creatine, P=0.007). In addition, patients in the intermediate tertile and upper tertile of post-CABG 24 hours urinary TXA-M have a 2.2 times higher (HR 2.22, 95% CI 1.04 to 4.71, P=0.038) and a 2.8 times higher (HR 2.81, 95% CI 1.35 to 5.85, P=0.006) risk of 1 year MACCE than those in the lower tertile, respectively.ConclusionsIn conclusion, post-CABG 24 hours urinary TXA-M elevation is associated with an increase of 1 year adverse events after CABG, indicating that the induction of cyclo-oxygenase-2 by surgery-related inflammatory stimuli or platelet turnover may be responsible for the high levels of post-CABG urinary TXA-M.Trial registration numberNCT01573143.

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