scholarly journals 1232 Trust-Wide Assessment of Delirium in Post-Operative Elective Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Sundar ◽  
S Biggs ◽  
M Abraham ◽  
J Cook ◽  
N Watts ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Patient Outcomes ◽  
Assessment Tool ◽  
Elective Surgery ◽  
Outcome Data ◽  
Positive Screen ◽  
Acute Change ◽  
Delirium Management ◽  
The Impact

Abstract Aim Delirium is an acute change in cognition and associated with adverse patient outcomes. The incidence of post-operative delirium after elective non-cardiac surgery is unknown. We aimed to assess the incidence of post-operative delirium in this group and the effect on patient outcomes. Method Patients aged 65 and over who underwent elective non-cardiac surgery were identified on post-operative day three. Delirium screening was performed in real time using the validated 4-AT assessment tool. A retrospective review of the patients’ preoperative and perioperative record was conducted to collect demographics and identify risk factors for delirium. Outcome data was collected at 30 days. Patients with a positive delirium score (>4) underwent a more in-depth assessment and managing teams given a delirium management pack. Results 75 (39 male) consecutive patients were screened over a period of 4 months. Median age 77 years and 18% had frailty assessed as “vulnerable”. The majority of patients (37.3%) underwent thoracic surgery, followed by hepatobiliary (17.3%), gynaecological (17.3%), colorectal (12%), maxillofacial (9.3%) and ENT (4%). 5.3% (4) of patients had a positive 4-AT screen. No patients had a formal delirium screen or diagnosis in the initial 48 hours. The median length of stay for patients with a positive screen was 8.5 days (IQR 7.5-12) compared to 8 days (IQR 5-13) for patients with a negative screen. Conclusions Reassuringly, rate of post-operative delirium following elective operations in our Trust are low (5%). Larger numbers of patients are required to assess the impact this has on patient outcomes and identify correlation with risk factors.

scholarly journals Examination of psychological risk factors for chronic pain following cardiac surgery: protocol for a prospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022995
Author(s):  
Michael H McGillion ◽  
Shaunattonie Henry ◽  
Jason W Busse ◽  
Carley Ouellette ◽  
Joel Katz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Short Form ◽  
Artery Bypass ◽  
Outcome Data ◽  
Life Years ◽  
Chronic Postsurgical Pain ◽  
Gender Based ◽  
And Gender ◽  
The Impact

IntroductionApproximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk factors for poor functional status and patient-level cost of illness from a societal perspective up to 12 months following cardiac surgery; and (B) determine the impact of CPSP on quality-adjusted life years (QALYs) borne by cardiac surgery, in addition to the incremental cost for one additional QALY gained, among those who develop CPSP compared with those who do not.Methods and analysesIn this prospective cohort study, 1250 adults undergoing cardiac surgery, including coronary artery bypass grafting and open-heart procedures, will be recruited over a 3-year period. Putative risk factors for CPSP will be captured prior to surgery, at postoperative day 3 (in hospital) and day 30 (at home). Outcome data will be collected via telephone interview at 6-month and 12-month follow-up. We will employ generalised estimating equations to model the primary (CPSP) and secondary outcomes (function and cost) while adjusting for prespecified model covariates. QALYs will be estimated by converting data from the Short Form-12 (version 2) to a utility score.Ethics and disseminationThis protocol has been approved by the responsible bodies at each of the hospital sites, and study enrolment began May 2015. We will disseminate our results through CardiacPain.Net, a web-based knowledge dissemination platform, presentation at international conferences and publications in scientific journals.Trial registration numberNCT01842568.

scholarly journals 137. Impact of Antimicrobial Stewardship Interventions on Post-Elective Caesarean Antibiotic Prophylaxis and Surgical Site Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S182-S182
Author(s):  
Xue Fen Valerie Seah ◽  
Yue Ling Rina Ong ◽  
Wei Ming Cedric Poh ◽  
Shahul Hameed Mohamed Siraj ◽  
Kai-Qian Kam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Prophylaxis ◽  
Patient Outcomes ◽  
Phase 1 ◽  
Surgical Site Infections ◽  
Phase 2 ◽  
Oral Antibiotics ◽  
Post Intervention ◽  
Phase 3 ◽  
The Impact

Abstract Background Antimicrobial stewardship programs (ASP) aim to improve appropriate antimicrobial use. Post-operative antibiotics are generally not necessary, especially those without surgical site infections risk factors (e.g. obesity). Few studies have described the impact of ASP interventions on patient outcomes especially in unique populations such as obstetrics. This study aims to evaluate the impact of ASP interventions on post-elective caesarean (eLSCS) oral antibiotic prophylaxis use and patient outcomes including SSI rates. Methods This pre-post quasi-experimental study was conducted over 9 months (2 months pre- and 7 months post-intervention) in all women admitted for eLSCS in our institution. Interventions included eLSCS surgical prophylaxis guideline dissemination, where a single antibiotic dose within 60 minutes before skin incision was recommended. Post-eLSCS oral antibiotics was actively discouraged in those without SSI risk factors. This was followed by ASP intervention notes (phase 1) for 3 months, and an additional phone call to the ward team for the next 7 months (phase 2). Phase 3 (next 6 months) constituted speaking to the operating consultant. The primary outcome was post-operative oral antibiotics prescription rates. Secondary outcomes included rates of 30-day post-operative SSI. Results A total of 1751 women was reviewed. Appropriateness of pre-operative antibiotic prophylaxis was 98% in our institution. There were 244 women pre-intervention, 274 in post-intervention phase 1, 658 in phase 2 and 575 in phase 3. Pre-intervention post-eLSCS antibiotic prescribing rates was 82% (200), which reduced significantly post-intervention to 54% (148) in phase 1, 50% (331) in phase 2 and 39% (226) in phase 3 (p< 0.001). There was no significant difference in patients who developed post-operative SSI pre-post intervention (0.8%, 2 of 242 vs. 1.9%, 28 of 1479, p=0.420) and among who received post-operative oral antibiotics compared to those without (1.9%, 17 of 905 vs. 1.5%, 13 of 846, p=0.582). Conclusion ASP interventions can reduce post-eLSCS antibiotic prophylaxis rates without adversely impacting patient safety. Disclosures All Authors: No reported disclosures

P1395The role of hyponatremia in the development of atrial fibrillation after cardiac surgery

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Pavlikova ◽  
A Shevelyok ◽  
N Vatutin
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Serum Sodium ◽  
Sodium Level ◽  
Cox Regression ◽  
Serum Sodium Level ◽  
History Of ◽  
The Impact

Abstract Background. Atrial fibrillation (AF) is one of the most common complication after cardiac surgeries. Age, valvular heart disease, heart failure, chronic obstructive pulmonary disease and a history of AF are well known risk factors for postoperative AF. On the other hand, hyponatremia is also a frequent disorder in patients undergoing cardiac surgery but its relationship with AF has not been studied. Purpose. We evaluated the impact of hyponatremia on the incidence of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods. The retrospective study included case history of 222 patients (174 men and 48 women, median age 64.5 [range 58.0; 69.0] years) who underwent cardiac surgery with cardiopulmonary bypass between January 2015 and December 2018.  In all patients intraoperative sodium level was analyzed. Hyponatremia was defined as serum sodium level < 135 mmol/l. Primary outcome was the episode of AF in postoperative period. Results. The incidence of postoperative AF was 18.9% (95% confidence interval (CI) 14.1-24.3 P = 0.05). Patients with AF more often had obesity, diabetes mellitus and a history of myocardial infarction and were more likely to perform combined surgery compared to non-AF patients (all Ps < 0.05). The prevalence of hyponatremia was significantly higher among AF group compared with non-AF (95.2% versus 77.8%, P = 0.017). Hyponatremia was the independent risk factors of postoperative AF in Cox regression models adjusted for covariates (odds ratio 5.31; 95% CI 1.42-18.7; P = 0.017). Conclusion.  In this analysis serum sodium level was closely associated with the risk of AF. These findings suggest that hyponatremia may cause the development of postoperative AF in patients undergoing cardiac surgery with cardiopulmonary bypass.

Warfarin-Induced Rapid Rise in INR Post–Cardiac Surgery Is Not Associated With Increased Bleeding Risk

2019 ◽  
Vol 53 (12) ◽  
pp. 1184-1191 ◽  
Author(s):  
Logan M. Olson ◽  
Andrea M. Nei ◽  
Ross A. Dierkhising ◽  
David L. Joyce ◽  
Scott D. Nei
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Warfarin Dose ◽  
Retrospective Chart Review ◽  
Female Gender ◽  
Bleeding Risk ◽  
Hospital Length Of Stay ◽  
Rapid Rise ◽  
The Impact ◽  
Post Cardiac Surgery

Background: Post–cardiac surgery bleeding can have devastating consequences, and it is unknown if warfarin-induced rapid international normalized ratio (INR) rise during the immediate postoperative period increases bleed risk. Objective: To determine the impact of warfarin-induced rapid-rise INR on post–cardiac surgery bleeding. Methods: This was a single-center, retrospective chart review of post–cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester. Patients were grouped based on occurrence or absence of rapid-rise INR (increase ≥1.0 within 24 hours). The primary outcome compared bleed events between groups. Secondary outcomes assessed hospital length of stay (LOS) and identified risk factors associated with bleed events and rapid rise in INR. Results: During the study period, 2342 patients were included, and 56 bleed events were evaluated. Bleed events were similar between rapid-rise (n = 752) and non–rapid-rise (n = 1590) groups in both univariate (hazard ratio [HR] = 1.22; P = 0.594) and multivariable models (HR = 1.24; P = 0.561). Those with rapid-rise INR had longer LOS after warfarin administration (discharge HR = 0.84; P = 0.0002). The most common warfarin dose immediately prior to rapid rise was 5 mg. Risk factors for rapid-rise INR were low body mass index, female gender, and cross-clamp time. Conclusion and Relevance: This represents the first report to assess warfarin-related rapid-rise INR in post–cardiac surgery patients and found correlation to hospital LOS but not bleed events. Conservative warfarin dosing may be warranted until further research can be conducted.

Development of health-system inpatient pharmacy clinical metrics

2019 ◽  
Vol 76 (23) ◽  
pp. 1958-1964
Author(s):  
Stacy Cassat ◽  
Lindsay Massey ◽  
Stephanie Buckingham ◽  
Tamara Kemplay ◽  
Jeff Little
Keyword(s):  
Clinical Outcome ◽  
Health System ◽  
Outcome Measures ◽  
Patient Outcomes ◽  
Assessment Tool ◽  
Time Frame ◽  
Pharmacy Services ◽  
Systematic Process ◽  
Institutional Review Board Review ◽  
The Impact

Abstract Purpose To describe a process to identify metrics that represent the impact of inpatient pharmacy services on patient outcomes across a health system. Summary The authors describe a systematic process of identifying inpatient clinical outcome measures that could represent pharmacists’ impact on patient outcomes and eventually be displayed in a dashboard within the electronic medical record (EMR). A list was generated through literature review, assessment of practices at other sites, evaluation of current pharmacy services, and collaboration with the quality department and System Pharmacy Clinical User Group. The project team narrowed the list through assessment against standardized criteria. An assessment tool was designed and distributed to stakeholders to prioritize clinical outcome measures for inclusion on the dashboard. The clinical outcome measures were transformed into metrics by determining measurement criteria, inclusion and exclusion parameters, and review time frame. After validation, the metrics are planned to be displayed on an inpatient pharmacy EMR dashboard. Exemption from institutional review board review was granted for this project. Conclusion A systematic process was developed and used to identify inpatient clinical outcome metrics.

Tissue Factor and Platelet Glycoprotein Ib-α Alleles Are Associated with Age at First Coronary Bypass Operation

2003 ◽  
Vol 99 (6) ◽  
pp. 1287-1294 ◽  
Author(s):  
Brian S. Donahue ◽  
Daniel W. Byrne ◽  
David Gailani ◽  
Alfred L. George
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Tissue Factor ◽  
Multivariate Regression ◽  
Coronary Bypass ◽  
Platelet Glycoprotein ◽  
Glycoprotein Ib ◽  
Younger Age ◽  
Traditional Risk Factors ◽  
The Impact

Background Age is a known risk factor for postoperative complications, but the genetic factors that account for variability in age at presentation for surgery have not been characterized. Because thrombosis is a critical process in the development of coronary syndromes, the authors hypothesized that patients bearing the -1208 insertion allele of tissue factor (TF) and longer glycoprotein Ib-alpha (GpIbalpha) variants may come to surgical attention sooner and undergo coronary artery bypass grafting (CABG) at a younger age. The authors tested this hypothesis in a cardiac surgery population. Methods The impact of the number of TF -1208 insertion alleles and the number of GpIbalpha repeats on age at first CABG were tested in 424 elective coronary bypass patients. Multivariate regression included traditional risk factors of sex, hypertension, diabetes, hyperlipidemia, and smoking. The authors also tested the hypothesis that these alleles are correlated with age at first noncoronary cardiac surgery in a group of 143 patients undergoing noncoronary cardiac operations. Result Both the number of TF -1208 insertion alleles and total number of GpIbalpha repeats were associated with younger age at first CABG in a univariate analysis. In multivariate regression in which traditional risk factors were included, the number of TF -1208 insertion alleles and the total number of GpIbalpha repeats were independent contributors toward age at first CABG. Neither polymorphism had a significant impact on age at first noncoronary cardiac surgery. Conclusions Genetic variants in TF and GpIbalpha are associated with younger age at first CABG, indicating that the younger and older first-time CABG populations are different on the genetic level. How these genetic differences may account for age-associated differences in perioperative risk will be the subject of future investigations.

scholarly journals Impact of surgeon and anaesthesiologist sex on patient outcomes after cardiac surgery: a population-based study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e051192
Author(s):  
Louise Y. Sun ◽  
Sylvain Boet ◽  
Vincent Chan ◽  
Douglas S. Lee ◽  
Thierry G. Mesana ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Patient Outcomes ◽  
Artery Bypass ◽  
Population Based ◽  
Secondary Outcome ◽  
Major Adverse Cardiovascular Events ◽  
Sex And Gender ◽  
Male Physician ◽  
The Impact ◽  
Physician Team

BackgroundEffective teamwork between anaesthesiologists and surgeons is essential for optimising patient safety in the cardiac operating room. While many factors may influence the relationship between these two physicians, the role of sex and gender have yet to be investigated.ObjectivesWe sought to determine the association between cardiac physician team sex discordance and patient outcomes.DesignWe performed a population-based, retrospective cohort study.Participants and settingAdult patients who underwent coronary artery bypass grafting (CABG) and/or aortic, mitral or tricuspid valve surgery between 2008 and 2018 in Ontario, Canada.Primary and secondary outcome measuresThe primary outcome was all-cause 30-day mortality. Secondary outcomes included major adverse cardiovascular events at 30 days and hospital and intensive care unit lengths of stay (LOS). Mixed effects logistic regression was used for categorical outcomes and Poisson regression for continuous outcomes.Results79 862 patients underwent cardiac surgery by 98 surgeons (11.2% female) and 279 anaesthesiologists (23.3% female); 19 893 (24.9%) were treated by sex-discordant physician teams. Physician sex discordance was not associated with overall patient mortality or LOS; however, patients who underwent isolated CABG experienced longer hospital LOS when treated by an all-male physician team as compared with an all-female team (adjusted OR=1.07; p=0.049). When examining the impact of individual physician sex, the length of hospital stay was longer when isolated CABG procedures were attended by a male surgeon (OR=1.10; p=0.004) or anaesthesiologist (OR=1.02; p=0.01).ConclusionsPatient mortality and length of stay after cardiac surgery may vary by sex concordance of the attending surgeon–anaesthesiologist team. Further research is needed to examine the underlying mechanisms of these observed relationships.

scholarly journals EFFECT OF PREOPERATIVE PREPARATION ON PATIENTS OUTCOME AMONG PATIENTS UNDERGOING SURGICAL OPERATIONS AT ALMIK NIMIR HOSPITAL – SUDAN

2020 ◽  
Vol 8 (8) ◽  
pp. 346-355
Author(s):  
Eied Saber Al amine Ali ◽  
Higazi Mohammed Ahmed Abdallah
Keyword(s):  
Assessment Tool ◽  
Elective Surgery ◽  
Computer Software ◽  
University Hospital ◽  
Care Plan ◽  
Postoperative Phase ◽  
Preoperative Preparation ◽  
Quasi Experimental ◽  
Two Phases ◽  
The Impact

Preoperative preparations of the patients physically and psychologically are the cornerstone of the good outcomes. This prospective quasi-experimental hospital-based study was conducted in Sudan, Shendi city at Elmek Nimer university hospital to evaluate the impact of preoperative preparation on patients outcome among patients undergoing general surgery. In the period of June 2016 to May 2019. The study was included a hundred patients undergoing general elective surgery, data were collected by interviewing questionnaire, anxiety scale, pain assessment tool, postoperative parameter, and patients satisfaction tool, data were collected in two phases (pre& postoperative). The data were analyzed by the computer software program (SPPS) version 20. The results showed that more than two third (79.4%) of the patient had poor knowledge about the importance of preoperative preparations, but improve after implemented program and this was reflected on patient behavior and outcome in the postoperative phase. (70%) had reported no anxiety to mild in the postoperative phase. in regard of postoperative pain, majority of patients (70%) experienced moderate to severe level of pain in the first 4 hours, this level of pain reduce to mild to no pain level in (82%) of patients in next 12hours. Most of the patients had full to good satisfaction regarding preparations and outcome. The study support and justifies the effectiveness of the preoperative preparations on patient outcomes. The study recommended surgical nurses have to provide proper explanation and teaching for elective surgical patients to be adherence with the care plan to promote good surgical outcome.

scholarly journals Seizures following cardiac surgery: the impact of tranexamic acid and other risk factors

2011 ◽  
Vol 59 (1) ◽  
pp. 6-13 ◽  
Author(s):  
Rizwan A. Manji ◽  
Hilary P. Grocott ◽  
Jill Leake ◽  
Rob E. Ariano ◽  
Jacqueline S. Manji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Tranexamic Acid ◽  
The Impact

scholarly journals The Impact of Multiple Risk Factors for Venous Thromboembolism and Its Implications for Management

2019 ◽  
Vol 6 ◽  
pp. 2333794X1985916
Author(s):  
Anil P. George ◽  
Paul Kent
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Pediatric Patients ◽  
Assessment Tool ◽  
Factor V Leiden ◽  
Prothrombin G20210a ◽  
Factor V ◽  
Multiple Risk Factors ◽  
Multiple Risk ◽  
The Impact

Venous thromboembolism (VTE) is a rare multifactorial disorder in childhood with an annual incidence of about 0.07 to 0.14 per 10 000 children. A 15-year-old female with a body mass index of 48 kg/m2 who endorsed oral contraceptive use presented with clinical findings consistent with deep venous thrombosis along with the presence of a pulmonary embolism. Further workup revealed that the patient was heterozygous for factor V Leiden and homozygous for prothrombin G20210A mutations. There are no current pediatric guidelines for the antithrombotic management of patients with multiple risk factors for VTE. Two such risk factors, obesity and the use of estrogen-containing hormone contraceptives, have been implicated in adult VTE cases but have not been clearly delineated in pediatric patients. The need for guidance regarding the VTE management of these patients has become more apparent given the increasing incidence of childhood obesity and the number of adolescents using oral contraceptives. Additionally, thrombophilia testing remains controversial though testing may be indicated in asymptomatic first-degree relatives and in families with antithrombin, protein C, or protein S deficiencies. Given the increased incidence of multiple risk factors for VTE, there is also a need to develop a comprehensive risk assessment tool for pediatric patients at high risk of VTE.

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