Short- and long-term mortality after deep sternal wound infection following cardiac surgery: experiences from SWEDEHEART

2021 ◽  
Author(s):  
Alexander Emil Kaspersen ◽  
Susanne J Nielsen ◽  
Andri Wilberg Orrason ◽  
Astridur Petursdottir ◽  
Martin Ingi Sigurdsson ◽  
...  
Keyword(s):  
Wound Infection ◽  
Valve Surgery ◽  
Absolute Difference ◽  
Deep Sternal Wound Infection ◽  
Adjusted Relative Risk ◽  
Sternal Wound Infection ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
Long Term Mortality

Abstract Graphical Abstract OBJECTIVES Deep sternal wound infection (DSWI) is a serious complication after open-heart surgery. We investigated the association between DSWI and short- and long-term all-cause mortality in a large well-defined nationwide population. METHODS A retrospective, nationwide cohort study, which included 114 676 consecutive patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery from 1997 to 2015 in Sweden. Short- and long-term mortality was compared between DSWI patients and non-DSWI patients using propensity score inverse probability weighting adjustment based on patient characteristics and comorbidities. Median follow-up was 8.0 years (range 0–18.9). RESULTS Altogether, 1516 patients (1.3%) developed DSWI, most commonly in patients undergoing combined CABG and valve surgery (2.1%). DSWI patients were older and had more disease burden than non-DSWI patients. The unadjusted cumulative mortality was higher in the DSWI group compared with the non-DSWI group at 90 days (7.9% vs 3.0%, P < 0.001) and at 1 year (12.8% vs 4.5%, P < 0.001). The adjusted absolute difference in risk of death was 2.3% [95% confidence interval (CI): 0.8–3.9] at 90 days and 4.7% (95% CI: 2.6–6.7) at 1 year. DSWI was independently associated with 90-day [adjusted relative risk (aRR) 1.89 (95% CI: 1.38–2.59)], 1-year [aRR 2.13 (95% CI: 1.68–2.71)] and long-term all-cause mortality [adjusted hazard ratio 1.56 (95% CI: 1.30–1.88)]. CONCLUSIONS Both short- and long-term mortality risks are higher in DSWI patients compared to non-DSWI patients. These results stress the importance of preventing these infections and careful postoperative monitoring of DSWI patients.

scholarly journals Long term mortality of deep sternal wound infection after coronary artery bypass surgery

2012 ◽  
Vol 27 (3) ◽  
pp. 377-382 ◽  
Author(s):  
Aline Alexandra Iannoni de Moraes ◽  
Cely Saad Abboud ◽  
André Zeraik Limma Chammas ◽  
Yara Santos Aguiar ◽  
Lucas Cronemberger Mendes ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Wound Infection ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Long Term Mortality

scholarly journals QT prolongation predicts short-term mortality independent of comorbidity

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1254-1260 ◽  
Author(s):  
Charlotte Gibbs ◽  
Jacob Thalamus ◽  
Doris Tove Kristoffersen ◽  
Martin Veel Svendsen ◽  
Øystein L Holla ◽  
...  
Keyword(s):  
Main Diagnosis ◽  
Short Term ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Short Term Mortality ◽  
Comorbidity Index ◽  
Short And Long Term ◽  
Mortality Hazard Ratio ◽  
Long Term Mortality

Abstract Aims A prolonged corrected QT interval (QTc) ≥500 ms is associated with high all-cause mortality in hospitalized patients. We aimed to explore any difference in short- and long-term mortality in patients with QTc ≥500 ms compared with patients with QTc <500 ms after adjustment for comorbidity and main diagnosis. Methods and results Patients with QTc ≥500 ms who were hospitalized at Telemark Hospital Trust, Norway between January 2007 and April 2014 were identified. Thirty-day and 3-year all-cause mortality in 980 patients with QTc ≥500 ms were compared with 980 patients with QTc <500 ms, matched for age and sex and adjusting for Charlson comorbidity index (CCI), previous admissions, and main diagnoses. QTc ≥500 ms was associated with increased 30-day all-cause mortality [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.38–2.62; P < 0.001]. There was no significant difference in mortality between patients with QTc ≥500 ms and patients with QTc <500 ms who died between 30 days and 3 years; 32% vs. 29%, P = 0.20. Graded CCI was associated with increased 3-year all-cause mortality (CCI 1–2: HR 1.62, 95% CI 1.34–1.96; P < 0.001; CCI 3–4: HR 2.50, 95% CI 1.95–3.21; P < 0.001; CCI ≥5: HR 3.76, 95% CI 2.85–4.96; P < 0.001) but was not associated with 30-day all-cause mortality. Conclusion QTc ≥500 ms is a powerful predictor of short-term mortality overruling comorbidities. QTc ≥500 ms also predicted long-term mortality, but this effect was mainly caused by the increased short-term mortality. For long-term mortality, comorbidity was more important.

scholarly journals Short- and long-term mortality after pulmonary embolism in patients with and without cancer

2018 ◽  
Vol 23 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Ghazi Alotaibi ◽  
Cynthia Wu ◽  
Ambikaipakan Senthilselvan ◽  
Michael Sean McMurtry
Keyword(s):  
Pulmonary Embolism ◽  
Short Term ◽  
Term Survival ◽  
Patients With Cancer ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
Incident Cases ◽  
Long Term Mortality

Pulmonary embolism (PE) is a major cause of mortality and morbidity. It is known that the risk of death varies by provoking factors; however, it is unknown if the risk of death persists beyond the initial diagnosis among patients with cancer-associated and non-cancer provoked patients. In this study, we aimed to investigate the effect of cancer on overall, short- and long-term mortality in a cohort of consecutive incident PE patients. Using administrative databases, we identified all incident cases of PE between 2004 and 2012 in Alberta, Canada. Cases were stratified by provoking factors (i.e. unprovoked, provoked, and cancer-associated). A multivariate Cox survival model was used to estimate the hazard ratios of short- and long-term death. We identified 8641 patients with PE, among which 42.2% were unprovoked, 37.9% were provoked and 19.9% were cancer-associated. The 1-year and 5-year survival probabilities were 60% (95% CI: 57–64%) and 39% (95% CI: 36–43%) in patients with cancer-associated PE, 93% (95% CI: 92–94%) and 80% (95% CI: 78–81%) in provoked PE, and 94% (95% CI: 93–95%) and 85% (95% CI: 83–87%) in unprovoked PE, respectively. Compared to patients with unprovoked events, both short-term and long-term survival in patients with cancer-associated PE have a higher observed risk of all-cause mortality in all age groups ( p<0.001). In contrast, patients with provoked events had a similar short- and long-term all-cause mortality. While PE has a significant mortality in all risk groups, patients with cancer have a higher risk of short-term mortality compared to patients with unprovoked PE.

scholarly journals Short- and Long-Term Mortality Trends in STEMI-Cardiogenic Shock over Three Decades (1989–2018): The Ruti-STEMI-Shock Registry

2020 ◽  
Vol 9 (8) ◽  
pp. 2398
Author(s):  
Cosme García-García ◽  
Teresa Oliveras ◽  
Nabil El Ouaddi ◽  
Ferran Rueda ◽  
Jordi Serra ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Mortality Trends ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
St Elevation ◽  
Multivariable Adjustment ◽  
Long Term Mortality

Aims: Cardiogenic shock (CS) is an ominous complication of ST-elevation myocardial infarction (STEMI), despite the recent widespread use of reperfusion and invasive management. The Ruti-STEMI-Shock registry analysed the prevalence of and 30-day and 1-year mortality rates in ST-elevation myocardial infarction (STEMI) complicated by CS (STEMI-CS) over the last three decades. Methods and Results: From February 1989 to December 2018, 493 STEMI-CS patients were consecutively admitted in a well-defined geographical area of ~850,000 inhabitants. Patients were classified into six five-year periods based on their year of admission. STEMI-CS mortality trends were analysed at 30 days and 1 year across the six strata. Cox regression analyses were performed for comparisons. Mean age was 67.5 ± 11.7 years; 69.4% were men. STEMI-CS prevalence did not decline from period 1 to 6 (7.1 vs. 6.2%, p = 0.218). Reperfusion therapy increased from 22.5% in 1989–1993 to 85.4% in 2014–2018. Thirty-day all-cause mortality declined from period 1 to 6 (65% vs. 50.5%, p < 0.001), with a 9% reduction after multivariable adjustment (HR: 0.91; 95% CI: 0.84–0.99; p = 0.024). One-year all-cause mortality declined from period 1 to 6 (67.5% vs. 57.3%, p = 0.001), with an 8% reduction after multivariable adjustment (HR: 0.92; 95% CI: 0.85–0.99; p = 0.030). Short- and long-term mortality trends in patients aged ≥ 75 years remained ~75%. Conclusions: Short- and long-term STEMI-CS-related mortality declined over the last 30 years, to ~50% of all patients. We have failed to achieve any mortality benefit in STEMI-CS patients over 75 years of age.

scholarly journals Single versus bilateral mammary artery grafts in the setting of off-pump coronary revascularization: Survival benefit with bilateral mammary

2021 ◽  
Author(s):  
Ana Lopez-Marco ◽  
Aidil Syed ◽  
Mabel Phillips Bn ◽  
Jennifer Williams ◽  
John Hogan Phd ◽  
...  
Keyword(s):  
Wound Infection ◽  
Survival Benefit ◽  
Long Term Results ◽  
Deep Sternal Wound Infection ◽  
Sternal Wound Infection ◽  
Term Survival ◽  
Off Pump ◽  
Mammary Arteries ◽  
Single Versus

OBJECTIVE To compare postoperative and long-term results (angina, myocardial and cerebrovascular events and coronary re-intervention) using single versus bilateral internal mammary arteries (SIMA vs. BIMA) in the setting of off-pump revascularisation (OPCAB) within a single-surgeon practice. METHODS Retrospective analysis of all isolated OPCAB performed in our institution by a single surgeon in the last 12 years.Two groups were analysed: SIMA (n = 681) and BIMA (n = 342). A propensity score matching was performed to compare the groups, reducing the sample to 684 patients.Follow-up (mean 6.5 ± 3.5 years) was done by telephone interviews or clinical visits, registering also late mortality and coronary re-intervention. Outcomes were compared to literature. RESULTS Demographic characteristics differed between groups, with BIMA offered predominantly to non-diabetic younger males (mean 59.4 years) with less comorbidity. In-hospital mortality was 2% for the SIMA group and 1% for BIMA (p = 0.18). Long-term mortality was also higher for the SIMA group (2% vs. 1% at 1 year, p = 0.22 and 16% vs. 5% at 5 years, p < 0.001). Sternal wound infection was similar in both groups (2-3%). Long-term follow-up revealed good freedom from angina (94%) with low rates of neurological and myocardial events (3%) or need for repeated revascularisation (3%) in both groups. CONCLUSION BIMA offers long-term survival benefit with similar postoperative complications. Rates of deep sternal wound infection were comparable between the two groups.Excellent outcomes can be achieved with OPCAB BIMA in real world practice with adequate patient selection.

scholarly journals Survival Comparison of Patients Undergoing Secondary Aortic Repair

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Dean J. Yamaguchi ◽  
Thomas C. Matthews ◽  
Marjan Mujib ◽  
Marc A. Passman ◽  
Mark A. Patterson ◽  
...  
Keyword(s):  
Open Repair ◽  
Aortic Aneurysms ◽  
Aortic Repair ◽  
Kaplan Meier ◽  
Abdominal Aortic ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
Aortic Interventions ◽  
Long Term Mortality

Introduction. Infrarenal abdominal aortic aneurysm (AAA) repair warrants lifelong surveillance. Secondary aortic intervention (SAI) outcomes may be affected by the therapeutic approach. We compared short- and long-term mortality in patients who underwent SAIs after initial aortic repair, either endovascular (EVAR) or open. Methods. Patients who underwent AAA repair between 1986 and 2010 were retrospectively identified in a vascular surgery database as well as those who underwent SAIs. All-cause mortality and Kaplan-Meier survival curves were calculated. Results. We identified 149 patients who underwent either open AAA repair or EVAR followed by open or endovascular SAI. Seventy-seven patients (51.7%) underwent initial EVAR while 72 patients (48.3%) underwent open repair. Sixty (78%) initial EVAR patients underwent secondary EVAR while 17 (22%) patients had an open SAI. Initial open repair patients were evenly distributed between EVAR and open SAIs. Compared to EVAR, patients who underwent initial open repair had longer intervals between primary aortic interventions (PAIs) and SAIs. Multivariable-adjusted all-cause mortality was significantly higher for patients who underwent initial open AAA repair followed by EVAR when compared to patients who underwent endovascular PAI and SAI. Conclusion. Long-term mortality in patients with infrarenal aortic aneurysms who require SAI may be improved by an EVAR-first algorithm.

Impact of Sustained Cardiac Tachyarrhythmias Recorded in Coronary Intensive Care Unit on Short- and Long-Term Mortality and Duration of Hospitalization

2020 ◽  
pp. 088506662091879
Author(s):  
Panteleimon E. Papakonstantinou ◽  
Angelliki Malliou ◽  
Gregory Chlouverakis ◽  
Eleftherios Kallergis ◽  
Hercules Mavrakis ◽  
...  
Keyword(s):  
Intensive Care ◽  
Ventricular Arrhythmias ◽  
Cardiovascular Disorders ◽  
All Cause Mortality ◽  
Duration Of Hospitalization ◽  
Coronary Syndromes ◽  
Short And Long Term ◽  
Supraventricular Tachycardias ◽  
Long Term Mortality

Background: Studies conducted in coronary intensive care units (CICUs) have demonstrated that tachyarrhythmias are associated with increased mortality after acute coronary syndromes (ACSs). However, the data for tachyarrhythmias occurred in CICUs due to a variety of cardiovascular disorders are limited. Methods: We conducted a single-center prospective observational study, which included consecutive CICU patients (January 1, 2014 to May 31, 2018). We recorded the ventricular arrhythmias (VAs), supraventricular tachycardias (SVTs), and days of CICU hospitalization. The patients were followed up for 6 months after CICU discharge. Results: A total of 943 patients (age: 66.37 ±15.4 years; 673 males [71.4%]) were included. Patients with tachyarrhythmias had higher in-CICU mortality (8.0% vs 4.1%, P = .029, odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.08-3.86) and higher 6-month all-cause mortality (12.8% vs 6.1%, P = .002, OR: 2.27, 95% CI: 1.35-3.83) than those who did not develop tachyarrhythmias. Ventricular arrhythmias was significantly associated with higher all-cause mortality than no tachyarrhythmia (15.4% vs 6.1%; P = .001) or SVTs (15.4% vs 7.0%; P = .001). The mean duration of hospitalization for the patients with tachyarrhythmias was 3.89 ± 4.90 days, while for the patients without was 2.79 ± 3.31 days ( P < .001). Patients without ACS had higher short- and long-term mortality compared to patients with ACS (9.2% vs 2.9%, P < .001 and 12.9% vs 4.9%, P < .001). Conclusions: Tachyarrhythmias were associated with prolonged CICU hospitalization, while non-ACS cardiovascular disorders and the occurrence of VAs were associated with increased short- and long-term mortality.

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