Incidence and risk factors for impaired mobility in older cardiac surgery patients during the early postoperative period

The article provides an overview of recent studies related to epidemiology, diagnosis and treatment of acute symptomatic epileptic seizures (ASES)in the early postoperative period after brain intervention. Themain points distinguishing ASES fromseizures in epilepsy are highlighted. The initial condition of the patient, the reason for which the surgery was performed and the volume of the intervention are the main criteria that must be taken into account when assessing risk factors for epileptic seizures. An algorithm for managing a patient with ASES is presented.

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Early Postoperative Arrhythmias after Paediatric Cardiac Surgery

Delta Medical College Journal ◽

10.3329/dmcj.v6i1.35964 ◽

2018 ◽

Vol 6 (1) ◽

pp. 22-28

Author(s):

Kazi Zahidul Hoque ◽

Akhand Tanzih Sultana ◽

Mamun Mia ◽

Masumul Gani Chowdhury ◽

Makbul Hossein

Keyword(s):

Risk Factors ◽

Body Weight ◽

Cardiac Surgery ◽

Postoperative Period ◽

Significant Risk ◽

Radical Change ◽

Paediatric Cardiac Surgery ◽

Number Of Patients ◽

Paediatric Age ◽

A Prospective Study

Background: The radical change in techniques in paediatric cardiac surgery has dramatically reduced the morbidity and mortality. The different varieties of arrhythmia that are frequently observed in postoperative period in our country are still not well documented.Objectives: To determine the incidence and risk factors of arrhythmia immediately after cardiac surgery in paediatric age group.Materials and method: It was a prospective study. A total of 100 paediatric patients (age <18 years) who underwent cardiac surgery at Dhaka Shishu Hospital between 2013 and 2016 were selected purposivelyResults: Out of 100 patients maximum 41% were from 13-72 months age group. The mean age was 49.73±37.17 months with range of 0.5-231 months, 58% patients were male and rest were female. Postoperatively 31% subjects were arrhythmic and of these the highest number of patients suffered from junctional ectopic tachycardia. Out of these 100 patients, 39% were diagnosed as VSD followed by TOF (35%). Among 31 arrhythmic patients 59.83%, 41.93% and 3.22% manifested onset of arrhythmia at 1st, 1st to 2nd and 2nd to 7th postoperative period respectively. In this study age, body weight, cyanosis, CPB time, postoperative acidosis, ventilation support days, hypertension on arrival in ICU as well as ICU stay days were recognized as significant risk factors (p <0.05).Conclusion: Proper and careful monitoring of younger patient with lower body weight undergoing corrective cardiac surgery with long cardiopulmonary bypass (CPB) time may reduce the episodes of post operative arrhythmia. These patients may require high inotropic support post operatively. So, medical prevention and early diagnosis as well as proper management may improve the operative outcome.Delta Med Col J. Jan 2018 6(1): 22-28

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Cardiopulmonary bypass management and acute renal failure: risk factors and prognosis

Perfusion ◽

10.1177/0267659109105251 ◽

2008 ◽

Vol 23 (6) ◽

pp. 323-327 ◽

Cited By ~ 43

Author(s):

E Sirvinskas ◽

J Andrejaitiene ◽

L Raliene ◽

L Nasvytis ◽

A Karbonskiene ◽

...

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Acute Renal Failure ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Urine Output ◽

Perfusion Pressure ◽

Venous Pressure ◽

Lung Ventilation ◽

Early Postoperative Period

The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who had been subjected to cardiac surgery on CPB were randomized into three groups. The mean perfusion pressure (PP) during CPB in Group 65 (68 patients) was 60–69.9 mmHg, in Group 55 (59 patients) – lower than 60 mmHg and in Group 75 (52 patients) – 70 mmHg and higher. We have analyzed postoperative variables: central venous pressure, the need for diuretics, urine output, fluid balance, acidosis, potassium level in blood serum, the need for hemotransfusions, nephrological, cardiovascular and respiratory complications, duration of artificial lung ventilation, duration of stay in ICU and in hospital, and mortality. In the second study, to identify the risk factors for the development of ARF following CPB, we retrospectively analysed data of all 179 patients, divided into two groups: patients who developed ARF after surgery (group with ARF, n = 19) and patients without ARF (group without ARF, n = 160). We found that urine output during surgery was statistically significantly lower in Group 55 than in Groups 65 and 75. The incidence of ARF in the early postoperative period did not differ among the groups: it developed in 6% of all patients in Group 65, 4% in Group 55 and 6% in Group 75. There were no differences in the rate of other complications (cardiovascular, respiratory, neurological disorders, bleeding, etc) among the groups. There were 19 cases of ARF (10.6%), but none of these patients needed dialysis. We found that age (70.0 ± 7.51 vs. 63.5 ± 10.54 [standard deviation, SD], P = 0.016), valve replacement and/or reconstruction surgery (57.9% vs. 27.2%, P = 0,011), combined valve and CABG surgery (15.8% vs. 1.4%, P = 0.004), duration of CPB (134.74 ± 62.02 vs. 100.59 ± 43.99 min., P = 0.003) and duration of aortic cross-clamp (75.11 ± 35.78 vs. 53.45 ± 24.19 min., P = 0.001) were the most important independent risk factors for ARF. Cardiopulmonary bypass perfusion pressure did not cause postoperative renal failure. The age of patient, valve surgery procedures, duration of cardiopulmonary bypass and duration of aorta cross-clamp are potential causative factors for acute renal failure after cardiac surgery.

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Unexpected deaths and unplanned re-admissions in infants discharged home after cardiac surgery: a systematic review of potential risk factors

Cardiology in the Young ◽

10.1017/s1047951114002492 ◽

2014 ◽

Vol 25 (5) ◽

pp. 839-852 ◽

Cited By ~ 19

Author(s):

Jenifer Tregay ◽

Jo Wray ◽

Catherine Bull ◽

Rodney C. Franklin ◽

Piers Daubeney ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Hospital Discharge ◽

Care Pathway ◽

Early Postoperative Period ◽

Adverse Outcomes ◽

Cochrane Library ◽

Post Discharge ◽

Feeding Difficulties ◽

Wide Range

AbstractBackgroundBabies with CHDs are a particularly vulnerable population with significant mortality in their 1st year. Although most deaths occur in the hospital within the early postoperative period, around one-fifth of postoperative deaths in the 1st year of life may occur after hospital discharge in infants who have undergone apparently successful cardiac surgery.AimTo systematically review the published literature and identify risk factors for adverse outcomes, specifically deaths and unplanned re-admissions, following hospital discharge after infant surgery for life-threatening CHDs.MethodsA systematic search was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Knowledge, and PsycINFO electronic databases, supplemented by manual searching of conference abstracts.ResultsA total of 15 studies were eligible for inclusion. Almost exclusively, studies were conducted in single US centres and focussed on children with complex single ventricle diagnoses. A wide range of risk factors were evaluated, and those more frequently identified as having a significant association with higher mortality or unplanned re-admission risk were non-Caucasian ethnicity, lower socio-economic status, co-morbid conditions, age at surgery, operative complexity and procedure type, and post-operative feeding difficulties.ConclusionsStudies investigating risk factors for adverse outcomes post-discharge following diverse congenital heart operations in infants are lacking. Further research is needed to systematically identify higher risk groups, and to develop interventions targeted at supporting the most vulnerable infants within an integrated primary and secondary care pathway.

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Risk Factors for Acute Kidney Injury In Cardiac Surgical Patients with Infectious Complications In The Early Postoperative Period

Clinical Therapeutics ◽

10.1016/j.clinthera.2017.05.093 ◽

2017 ◽

Vol 39 (8) ◽

pp. e30

Author(s):

M.V. Lukina ◽

M.A. Chukina ◽

T.B. Andruchichina ◽

T.E. Morozova

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Postoperative Period ◽

Kidney Injury ◽

Infectious Complications ◽

Early Postoperative Period ◽

Surgical Patients

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Cognitive disorders in patients after cardiac surgery

Biomedical and Biosocial Anthropology ◽

10.31393/bba40-2020-04 ◽

2021 ◽

pp. 26-32

Author(s):

A. V. Belinskyi ◽

L. V. Rasputina ◽

Y. M. Mostovoy ◽

O. P. Mostova ◽

T. D. Danilevych

Keyword(s):

Cardiac Surgery ◽

Postoperative Period ◽

Cognitive Functions ◽

Heart Defects ◽

Cognitive Disorders ◽

Statistical Processing ◽

Early Postoperative Period ◽

Cognitive Test ◽

Before And After ◽

Prolonged Recovery

The occurrence of cognitive disorders is a common problem after surgery. The degree of worsening of cognitive functions after surgery and anesthesia has a significant impact on the patient's health and is significantly associated with prolonged recovery in the hospital, increased morbidity and delayed functional recovery. The aim of the study was to increase the effectiveness of the diagnosis of moderate cognitive impairment and to determine its gender and age characteristics in patients before and after cardiac surgery in the early postoperative period (3 and 7 days). We examined 56 patients who underwent cardiac surgery for coronary heart disease in 37 (66.1 %) and valvular heart defects in 19 (33.9 %) patients. Assessment of cognitive functions was performed before surgery, on the 3rd and 7th day of the postoperative period. Testing was performed using the Montreal Cognitive Test. Statistical processing of the obtained data was performed on a personal computer using the statistical software package SPSS 12.0 for Windows using parametric and non-parametric methods. It was found that presence of cognitive disorders before surgery was registered in 37 (66.1 %) patients, mostly among the age of group of 60-74 years and had no gender difference. It was found that in the early postoperative period there is a significant worsening of cognitive functions in patients after cardiac surgery on 3rd day – in 45 (80.4 %), on 7th day – in 44 (78.6 %) patients, respectively.

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Frequency and structure of cardiac arrhythmias in the early postoperative period following cardiac surgery

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.461 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

TD Danilevych ◽

LV Rasputina ◽

YM Mostovoy ◽

AV Belinskyi

Keyword(s):

Cardiac Surgery ◽

Postoperative Period ◽

Cardiac Arrhythmias ◽

Heart Defects ◽

Statistical Processing ◽

Early Postoperative Period ◽

Av Block ◽

Paroxysmal Tachycardia ◽

Anterior Branch ◽

St Segment

Abstract Funding Acknowledgements Type of funding sources: None. Background. Cardiac arrhythmias occupy one of the key places in the structure of complications of the early postoperative period following cardiac surgery. According to various literature sources, they range from 10% to 40% and often determine the course of the postoperative period. Purpose. To determine the frequency and structure of cardiac arrhythmias in the early postoperative period in the patients following cardiac surgery (up to 7 days). Methods. 56 patients were examined, among them 19 (33.9%) men and 37 (66,1%) women (p = 0.02). The age of patients ranged from 31 to 79 years, averaging 60.86 ± 8.87 years. Cardiac surgery was performed for coronary heart disease in 37 (66.1%) and valvular heart defects in 19 (33.9%) patients (p = 0.02). The duration of the operation ranged from 240 to 600 minutes, averaging 371.94 ± 102.04 minutes. In 25 (44.6%) cases, the operations were performed in conditions of bypass, the average duration of which did not differ from operations without bypass (389.44 ± 116.88 vs. 355.47 ± 86.16, p = 0.34). Assessment of cardiac arrhythmias was performed during the first 7 days after cardiac surgery. Statistical processing was performed by SPSS 12.0 for Windows. Results. 27 (48.2%) patients have developed arrhythmias within first 7 days of the postoperative period, among them in 12 (63.2%) women and 15 (40.5%) men (p = 0.24). Analysis of age structure showed that the patients <45 years didn’t have arrhythmias, 45-59 years - 8 (14.2%), 60-74 - 17 (30.4%), 75-90 - 2 (3,6%) of the patients have rhythm disorders, respectively. Atrial fibrilation (AF) dominates in the structure of arrhythmias - 17 (30.4%) patients, among them – in 11 (64.7%) patients was paroxysmal, in 6 (35.3%) – persistent form. The mean score of CHA2DS2VASc scale - 2.56 ± 0.89. Also registered atrial flutter – in 3 (5.4%), atrial tachycardia – in 2 (3.6%), supraventricular paroxysmal tachycardia – in 1 (1.8%), frequent supraventricular premarute beats (PB) – in 11 (19.6%) ), ventricular PB – in 12 (21.4%), among them ventricular PB 1st Laun class - 8 (66.7%), 2nd class - 2 (16.7%), 3rd class - 1 (8.3%), class 4A - 1 (8.3%) patients, respectively. Among the heart blocks were registered left bundle branch (LBB) block – in 4 (7.1%), anterior branch block of LBB – in 10 (17.9%), right bundle branch block – in 6 (10.7%), atrio-ventricular (AV) block 1 degree – in 4 (7.1%), complete AV block – in 8 (14.3%) patients, respectively. The implantation of the pacemaker was performed in 9 (16.1%) patients. Disorders of repolarization flattening / inversion of the T wave – in 31 (55.4%), elevation of the ST segment – in 5 (8.9%), depression of the ST segment – in 16 (28.6%), pathological Q wave – in 5 (8.9%) patients, respectively. Conclusions The prevalence of arrhythmias in the early postoperative period (7 days) following cardiac surgery is 48.2%, equally common in men and women. AF dominated in the structure of cardiac arrhythmias (30,4%).

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Knee Extension Deficit in the Early Postoperative Period Predisposes to Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk Factor Analysis in 3633 Patients From the SANTI Study Group Database

The American Journal of Sports Medicine ◽

10.1177/0363546519897064 ◽

2020 ◽

Vol 48 (3) ◽

pp. 565-572

Author(s):

Jean-Romain Delaloye ◽

Jozef Murar ◽

Thais D. Vieira ◽

Florent Franck ◽

Charles Pioger ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Risk Factor ◽

Postoperative Period ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Early Postoperative Period ◽

Extension Deficit ◽

Potential Risk Factors ◽

Anterior Cruciate

Background: Cyclops syndrome is characterized by a symptomatic extension deficit attributed to impingement of a cyclops lesion within the intercondylar notch. The syndrome is an important cause of reoperation after anterior cruciate ligament reconstruction (ACLR). It has been suggested that remnant-preserving ACLR techniques may predispose to cyclops syndrome, but there is very limited evidence to support this. In general terms, risk factors for cyclops syndrome are not well-understood. Purpose: To determine the frequency of and risk factors for reoperation for cyclops syndrome in a large series of patients after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who underwent primary ACLR between January 2011 to December 2017. Patients undergoing major concomitant procedures were excluded. Demographic data, intraoperative findings (including the size of preserved remnants), and postoperative outcomes were recorded. Those patients who underwent reoperation for cyclops syndrome were identified, and potential risk factors were evaluated in multivariate analysis. Results: A total of 3633 patients were included in the study, among whom 65 (1.8%) underwent reoperation for cyclops syndrome. Multivariate analysis demonstrated that preservation of large remnants did not predispose to cyclops lesions (odds ratio [OR], 1.11; 95% CI, 0.63-1.93). The most important risk factor was extension deficit in the early postoperative period. If present at 3 weeks postoperatively, it was associated with a >2-fold increased risk of cyclops syndrome (OR, 2.302; 95% CI, 1.268-4.239; P < .01), which was increased to 8-fold if present 6 weeks after ACLR (OR, 7.959; 95% CI, 4.442-14.405; P < .0001). None of the other potential risk factors evaluated were found to be significantly associated with an increased frequency of cyclops syndrome. Conclusion: Failure to regain full extension in the early postoperative period was the only significant risk factor for cyclops syndrome after ACLR in a large cohort of patients. Other previously hypothesized risk factors, such as preservation of a large anterior cruciate ligament remnant, did not predispose to the development of this debilitating postoperative complication.

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