Perioperative Use of Dobutamine in Cardiac Surgery and Adverse Cardiac Outcome

Background Catecholamines, mainly dobutamine, are often administered without institutional guidelines or prespecified algorithms in cardiac surgery. The current study assessed the consequences on clinical outcome of catecholamines simply based on the clinical judgment of the anesthesiologists after cardiopulmonary bypass in adult cardiac surgery. Methods Consecutive patients were enrolled in a nonrandomized cohort study. Factors associated with perioperative use of catecholamines and with outcomes were recorded prospectively to conduct bias adjustment, including propensity scores. Major cardiac morbidity (i.e., ventricular arrhythmia, use of an intraaortic balloon pump and postoperative myocardial infarction) and all-cause intrahospital mortality were the primary and secondary endpoints, respectively. Results are expressed as odds ratio (OR) [95% confidence interval]. Results During the study, 84 of 657 patients (13%) received catecholamines, most often dobutamine (76 of 84, 90%). A higher incidence of both major cardiac morbidity (30 vs. 9%; P < 0.001; OR, 4.2 [2.5-7.3]) and all-cause intrahospital mortality (8 vs. 1%; P < 0.001; OR, 12.9 [3.7-45.2]) was observed in the catecholamine group compared with the control group. After adjusting for channeling bias and confounding factors, catecholamine administration remained significantly associated with major cardiac morbidity after propensity score stratification (OR, 2.1 [1.0-4.4]; P < 0.05), propensity score covariance analysis (OR, 2.3 [1.0-5.0]; P < 0.05), marginal structural models (OR, 1.8 [1.3-2.5]; P < 0.001), and propensity score matching (OR, 3.0 [1.2-7.3]; P < 0.02), but not with all-cause intrahospital mortality. Conclusions These results suggest that dobutamine should only be administered when the benefit is judged to outweigh the risks.

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A propensity-score matched observational study of remdesivir in patients with COVID-19 and severe kidney disease

Kidney360 ◽

10.34067/kid.0006152021 ◽

2021 ◽

pp. 10.34067/KID.0006152021

Author(s):

Rituvanthikaa Seethapathy ◽

Sophia Zhao ◽

Joshua D. Long ◽

Ian A. Strohbehn ◽

Meghan E. Sise

Keyword(s):

Kidney Disease ◽

Propensity Score ◽

Propensity Scores ◽

Altered Mental Status ◽

Control Group ◽

Increased Risk ◽

Kidney Replacement Therapy ◽

Clinically Significant ◽

End Stage ◽

Matched Study

Background: Remdesivir is not currently approved for patients with estimated glomerular filtration rate (eGFR) < 30mL/min/1.73m2. We aimed to determine the safety of remdesivir in patients with kidney failure. Methods: Retrospective cohort study of patients with COVID-19 hospitalized between May 2020 to January 2021 with eGFR <30 mL/min/1.73m2 who received remdesivir and historical controls with COVID-19 hospitalized between March 1, 2020 - April 30, 2020 prior to Emergency Use Authorization of remdesivir within a large healthcare system. Patients were 1:1 matched by propensity scores accounting for factors associated with treatment assignment. Adverse events and hospital outcomes were recorded by manual chart review. Results: The overall cohort included 34 hospitalized patients who initiated remdesivir within 72 hours of hospital admission with eGFR <30 mL/min/1.73m2 and 217 COVID-19 controls with eGFR <30 mL/min/1.73m2. The propensity score-matched cohort included 31 remdesivir treated cases and 31 non-remdesivir-treated controls. The mean age was 74.0 (SD: 13.8), 56.6% female, 67.7% white. A total of 25.5% had end-stage kidney disease. Among patients who were not on dialysis prior to initiating remdesivir, one developed worsening kidney function (defined ≥ 50% increase in creatinine or initiation of kidney replacement therapy) compared to three in the historical control group. There was no increased risk of cardiac arrythmia, cardiac arrest, altered mental status, or clinically significant anemia or liver function test abnormalities. There was a significantly increased risk of hyperglycemia, which may be partly explained by the increased use of dexamethasone in the remdesivir-treated population. Conclusion: In this propensity-score matched study, remdesivir was well tolerated in patients with eGFR < 30 mL/min/1.73m2.

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P1000Do patients with atrial fibrillation being at high-risk for stroke benefit from concomitant left atrial appendix closure during cardiac surgery

European Heart Journal ◽

10.1093/eurheartj/ehz747.0593 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Kozmik ◽

J Pisarenko ◽

N Mainhard ◽

W Weissenberger ◽

F Mourad ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Propensity Score ◽

Heart Surgery ◽

Stroke Rate ◽

Surgical Ablation ◽

Propensity Score Stratification ◽

Laa Closure ◽

Overall Mortality

Abstract Background Left atrial appendix, as an essential source of systemic embolism and stroke in patients with atrial fibrillation, can be excluded during cardiac surgery, however the clinical benefit is as yet uncertain. Methods A total of 376 out of 3741 consecutive patients with atrial fibrillation presenting a high risk for stroke (CHA2DS2-VASc-Score ≥2 for men and ≥3 for women) who underwent heart surgery with cardiopulmonary bypass between 01/2012 and 12/2015 were analysed for mortality and stroke rate at 30 days, 12 and 24 months. Patients with concomitant LAA-closure alone (group1; n=107) were compared to patients with concomitant surgical ablation and LAA-closure (group2; n=85), and patients without surgical ablation and no LAA-closure (group3; n=184) as controls. To further adjust for pre- and intraoperative risk factors, a propensity score stratification analysis based on patients age, gender, EuroSCORE-2, CHA2DS2-VASc-Score and type of procedure was performed. Results Patients age was 72±8 years (mean±SD) and 33% were female. EuroSCORE-2 was 8.7±7.7%, 5.7±3.9%, and 5.4±8.4% and CHA2DS2-VASc-Score was 4.2±1.5, 3.9±1.4, and 4.1±1.4 on average for the respective groups. Mortality did not differ between groups at 30 days, 12 and 24 months. The incidence of stroke was 1.9% at 30 days, 4.8% at 12 and 6.7% at 24 months in group1. There was no stroke at 30 days and 12 months and 1.3% at 24 months in group2, and 1.8% at 30 days, 3.0% at 12 and 24 months in control group3. The overall mortality at 24 months was 27.1%, 20% and 24.6% respectively. After propensity score stratification, stroke rate showed significant benefit in group 2 (P=0.05) at 12 months and a hazard ratio of 0.17, 95% confidents limits 0.02–1.50, (P=0.08) at 24 months, whereas overall mortality did not significantly differ between the groups at 12 and 24 months follow-up. Conclusions In this propensity score stratification analysis, patients undergoing cardiac surgery with surgical ablation and concomitant LAA-closure had significant fewer strokes at 12 months follow-up compared to patients undergoing cardiac surgery with LAA-closure alone. Overall mortality did not significantly differ between the groups. Therefore, a concomitant LAA closure during heart surgery without additional surgical ablation does not show any clinical benefit in terms of reduced stroke rate or survival until 12 and 24 months follow-up.

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Cardiac Surgery Fast-track Treatment in a Postanesthetic Care Unit

Anesthesiology ◽

10.1097/aln.0b013e31817881b3 ◽

2008 ◽

Vol 109 (1) ◽

pp. 61-66 ◽

Cited By ~ 64

Author(s):

Joerg Ender ◽

Michael Andrew Borger ◽

Markus Scholz ◽

Anne-Kathrin Funkat ◽

Nadeem Anwar ◽

...

Keyword(s):

Cardiac Surgery ◽

Fast Track ◽

Propensity Scores ◽

Control Group ◽

Low Cardiac Output Syndrome ◽

Lengths Of Stay ◽

Direct Admission ◽

Postanesthetic Care Unit ◽

Fast Track Concept ◽

Cardiac Operative Risk Evaluation

Background The authors compared the safety and efficacy of a newly developed fast-track concept at their center, including implementation of a direct admission postanesthetic care unit, to standard perioperative management. Methods All fast-track patients treated within the first 6 months of implementation of our direct admission postanesthetic care unit were matched via propensity scores and compared with a historical control group of patients who underwent cardiac surgery prior to fast-track implementation. Results A total of 421 fast-track patients were matched successfully to 421 control patients. The two groups of patients had a similar age (64 +/- 13 vs. 64 +/- 12 yr for fast-track vs. control, P = 0.45) and European System for Cardiac Operative Risk Evaluation-predicted risk of mortality (4.8 +/- 6.1% vs. 4.6 +/- 5.1%, P = 0.97). Fast-track patients had significantly shorter times to extubation (75 min [45-110] vs. 900 min [600-1140]), as well as shorter lengths of stay in the postanesthetic or intensive care unit (4 h [3.0-5] vs. 20 h [16-25]), intermediate care unit (21 h [17-39] vs. 26 h [19-49]), and hospital (10 days [8-12] vs. 11 days [9-14]) (expressed as median and interquartile range, all P < 0.01). Fast-track patients also had a lower risk of postoperative low cardiac output syndrome (0.5% vs. 2.9%, P < 0.05) and mortality (0.5% vs. 3.3%, P < 0.01). Conclusion The Leipzig fast-track protocol is a safe and effective method to manage cardiac surgery patients after a variety of operations.

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Does Payer Status Impact Clinical Outcomes after Cardiac Surgery? A Propensity Analysis

The Heart Surgery Forum ◽

10.1532/hsf98.20111163 ◽

2012 ◽

Vol 15 (5) ◽

pp. 262 ◽

Cited By ~ 9

Author(s):

Antonio Polanco ◽

Andrew M. Breglio ◽

Shinobu Itagaki ◽

Andrew B. Goldstone ◽

Joanna Chikwe

Keyword(s):

Cardiac Surgery ◽

Propensity Score ◽

Clinical Outcomes ◽

Socioeconomic Position ◽

Propensity Scores ◽

Cohort Analysis ◽

Financial Responsibility ◽

Significant Difference ◽

Impact On Survival ◽

The Cost

Background: Medicaid patients bear proportionately greater financial responsibility for the cost of outpatient care and medication than non-Medicaid patients. We hypothesized that this difference in provision of continuing care would be associated with adverse clinical outcomes after cardiac surgery.Materials and Methods: In a retrospective cohort analysis, 5056 consecutive adult patients undergoing cardiac surgery at a single institution between 2005 and 2010 were divided according to payer status. Propensity scores were calculated using 16 preoperative and demographic variables for each patient, and 461 1:1 propensity score-matched pairs were analyzed. Patient socioeconomic position was determined using aggregate data derived from zip codes. The main outcome measures were early mortality, postoperative complications, and patient survival.Results: In multivariate analysis, Medicaid was found to be an independent predictor of worse survival after cardiac surgery (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.2-3.7; P = .01). No significant difference was observed in operative mortality in the 2 groups. After propensity score matching and controlling for socioeconomic position, the only independent predictors of worse midterm survival were an ejection fraction = 30% (HR, 1.7; 95% CI, 1.1-2.7; P = .02) and a higher logistic EuroSCORE (HR, 1.03; 95% CI, 1.0-1.1; P = .02).Conclusions: Comorbidity and lower socioeconomic status appear to be more important predictors of late mortality after cardiac surgery than payer status, which does not have a significant impact on survival.

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The Effects of Administration of Exogenous Albumin Early after Non-cardiac Surgery on Postoperative AKI in Patients with Preoperative Hypoalbuminemia: A Prospective Propensity-score Matching Analysis

10.21203/rs.3.rs-1131516/v1 ◽

2021 ◽

Author(s):

Miao Yan ◽

Wei-Jie Zhou ◽

Min Xie ◽

Sai-Nan Zhu ◽

Nan Li ◽

...

Keyword(s):

Cardiac Surgery ◽

Propensity Score ◽

Propensity Score Matching ◽

Secondary Analysis ◽

Kidney Injury ◽

Final Analysis ◽

Surgical Intensive Care Unit ◽

Control Group ◽

Surgical Intensive Care ◽

Postoperative Aki

Abstract BackgroundEvidence have shown that preoperative hypoalbuminemia is independently associated with acute kidney injury (AKI) after non-cardiac surgery. However, little study has investigated the effects of administration of exogenous albumin early after non-cardiac surgery on postoperative AKI in patients with preoperative hypoalbuminemia.MethodsThis study was a secondary analysis of the database of a previously conducted prospective cohort study. Data of 661 adult patients who underwent non-cardiac surgery and were admitted to Surgical Intensive Care Unit (SICU) after surgery from May 1, 2019 to November 30, 2020 were collected. 267 patients with preoperative hypoalbuminemia were screened, and divided into two groups according to whether they were administrated with exogenous albumin on the day of SICU admission. The demographic and perioperative data of the two groups were propensity-matched. ResultsAfter propensity score matching, 64 pairs of patients were included in the final analysis. The patients of albumin group showed relatively higher serum albumin level on postoperative day 1 than that in patients of control group (31.3±3.4 vs. 29.7±3.8, P=0.008), however, no difference was observed in postoperative AKI incidence in patients of the two groups (59.4% vs. 62.5%, P=0.717). Furthermore, there was no difference in other prognostic factors, such as the use of mechanical ventilation, occurrence of other postoperative complications, in-hospital mortality, length of SICU stay and postoperative hospital stay.ConclusionsFor patients with preoperative hypoalbuminemia following non-cardiac surgery, administration of exogenous albumin early after surgery had no beneficial effect on the incidence of postoperative AKI and other clinical outcomes.

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The Role of Distributional Overlap on the Precision Gain of Bounds for Generalization

American Journal of Evaluation ◽

10.1177/1098214020943302 ◽

2022 ◽

pp. 109821402094330

Author(s):

Wendy Chan

Keyword(s):

Propensity Score ◽

Recent Work ◽

Propensity Scores ◽

Simulation Studies ◽

Propensity Score Methods ◽

The Past ◽

Observable Data ◽

Propensity Score Stratification ◽

The Relationship

Over the past ten years, propensity score methods have made an important contribution to improving generalizations from studies that do not select samples randomly from a population of inference. However, these methods require assumptions and recent work has considered the role of bounding approaches that provide a range of treatment impact estimates that are consistent with the observable data. An important limitation to bound estimates is that they can be uninformatively wide. This has motivated research on the use of propensity score stratification to narrow bounds. This article assesses the role of distributional overlap in propensity scores on the effectiveness of stratification to tighten bounds. Using the results of two simulation studies and two case studies, I evaluate the relationship between distributional overlap and precision gain and discuss the implications when propensity score stratification is used as a method to improve precision in the bounding framework.

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Validating Four Standard Scales in Spiritually Practicing and Nonpracticing Samples Using Propensity Score Matching

European Journal of Psychological Assessment ◽

10.1027/1015-5759.24.3.165 ◽

2008 ◽

Vol 24 (3) ◽

pp. 165-173 ◽

Cited By ~ 8

Author(s):

Niko Kohls ◽

Harald Walach

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Repeated Measures ◽

Propensity Scores ◽

Total Sample ◽

Experimental Manipulation ◽

Brief Symptom Inventory ◽

Time Interaction ◽

Social Support Scale ◽

Lower Test

Validation studies of standard scales in the particular sample that one is studying are essential for accurate conclusions. We investigated the differences in answering patterns of the Brief-Symptom-Inventory (BSI), Transpersonal Trust Scale (TPV), Sense of Coherence Questionnaire (SOC), and a Social Support Scale (F-SoZu) for a matched sample of spiritually practicing (SP) and nonpracticing (NSP) individuals at two measurement points (t1, t2). Applying a sample matching procedure based on propensity scores, we selected two sociodemographically balanced subsamples of N = 120 out of a total sample of N = 431. Employing repeated measures ANOVAs, we found an intersample difference in means only for TPV and an intrasample difference for F-SoZu. Additionally, a group × time interaction effect was found for TPV. While Cronbach’s α was acceptable and comparable for both samples, a significantly lower test-rest-reliability for the BSI was found in the SP sample (rSP = .62; rNSP = .78). Thus, when researching the effects of spiritual practice, one should not only look at differences in means but also consider time stability. We recommend propensity score matching as an alternative for randomization in variables that defy experimental manipulation such as spirituality.

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Efficacy of Near-Infrared Spectrometry for Monitoring the Cerebral Effects of Severe Dilutional Anemia

The Heart Surgery Forum ◽

10.1532/hsf98.2013293 ◽

2014 ◽

Vol 17 (3) ◽

pp. 154 ◽

Cited By ~ 10

Author(s):

Arıtürk Cem ◽

Ustalar Serpil ◽

Toraman Fevzi ◽

Ökten Murat ◽

Güllü Ümit ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Surgery ◽

Blood Lactate ◽

Near Infrared ◽

Bypass Graft ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Infrared Spectrometry ◽

Control Group ◽

Near Infrared Spectrometry

Introduction: Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO2) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG).Methods: The prospective observational study involved patients who underwent cerebral rSO2 monitoring by NIRS during elective isolated first-time CABG: an anemic group (N=15) (minimum Hemoglobin (Hb) N=15) (Hb >8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood lactate level, pCO2, pO2 at five time points and cross-clamp time, extracorporeal circulation time were recorded for each patient. Group results statistically were compared.Results: The anemic group had significantly lower mean preoperative Hb than the control group (10.3 mg/dL versus 14.2 mg/dL; P = .001). The lowest Hb levels were observed in the hypothermic period of CPB in the anemic group. None of the controls exhibited a >20% decrease in cerebral rSO2. Eleven (73.3%) of the anemic patients required an increase in pump blood flow to raise their cerebral rSO2.Conclusions: In this study, the changes in cerebral rSO2 in the patients with low Hb were within acceptable limits, and this was in concordance with the blood lactate levels and blood-gas analysis. It can be suggested that NIRS monitoring of cerebral rSO2 can assist in decision making related to blood transfusion and dilutional anemia during CPB.

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The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20111128 ◽

2012 ◽

Vol 15 (2) ◽

pp. 84 ◽

Cited By ~ 4

Author(s):

Canturk Cakalagaoglu ◽

Cengiz Koksal ◽

Ayse Baysal ◽

Gokhan Alici ◽

Birol Ozkan ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Artery Bypass ◽

Pericardial Tamponade ◽

Anxiety Level ◽

Control Group ◽

Echocardiographic Study ◽

Number Of Patients ◽

Hospital Stays

Aim: The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).Materials and Methods: We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.Results: The 2 groups were not significantly different with respect to demographic and operative data (P > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (P < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (P < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (P = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.Conclusion: Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.

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The Role of Revascularisation in Patients Undergoing Non-cardiac Surgery

Interventional Cardiology Review ◽

10.15420/icr.2010.5.1.104 ◽

2010 ◽

Vol 5 (1) ◽

pp. 104

Author(s):

Daniel S Menees ◽

Eric R Bates ◽

◽

Keyword(s):

Cardiac Surgery ◽

Prediction Models ◽

Cardiovascular Complications ◽

Weight Of Evidence ◽

Beta Blockade ◽

Cardiac Morbidity ◽

Increased Risk ◽

Reduction Strategies ◽

Artery Disease ◽

Risk Reduction Strategies

Coronary artery disease (CAD) affects millions of US citizens. As the population ages, an increasing number of people with CAD are undergoing non-cardiac surgery and face significant peri-operative cardiac morbidity and mortality. Risk-prediction models can be used to help identify those patients at increased risk of peri-operative cardiovascular complications. Risk-reduction strategies utilising pharmacotherapy with beta blockade and statins have shown the most promise. Importantly, the benefit of prophylactic coronary revascularisation has not been demonstrated. The weight of evidence suggests reserving either percutaneous or surgical revascularisation in the pre-operative setting for those patients who would otherwise meet independent revascularisation criteria.

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