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.

Impact of atrial fibrillation on in-hospital outcomes among hospitalizations for cardiac surgery: an analysis of the National Inpatient Sample

2022 ◽  
pp. jim-2021-001864
Author(s):  
Kanishk Agnihotri ◽  
Paris Charilaou ◽  
Dinesh Voruganti ◽  
Kulothungan Gunasekaran ◽  
Jawahar Mehta ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Valve Replacement ◽  
Failure Time ◽  
Artery Bypass ◽  
Bypass Graft ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Hospitalization Costs ◽  
The Impact

The short-term impact of atrial fibrillation (AF) on cardiac surgery hospitalizations has been previously reported in cohorts of various sizes, but results have been variable. Using the 2005–2014 National Inpatient Sample, we identified all adult hospitalizations for cardiac surgery using the International Classification of Diseases, Ninth Revision, Clinical Modification as any procedure code and AF as any diagnosis code. We estimated the impact of AF on inpatient mortality, length of stay (LOS), and cost of hospitalization using survey-weighted, multivariable logistic, accelerated failure-time log-normal, and log-transformed linear regressions, respectively. Additionally, we exact-matched AF to non-AF hospitalizations on various confounders for the same outcomes. A total of 1,269,414 hospitalizations were noted for cardiac surgery during the study period. Coexistent AF was found in 44.9% of these hospitalizations. Overall mean age was 65.6 years, 40.9% were female, mean LOS was 11.6 days, and inpatient mortality was 4.5%. Stroke rate was lower in AF hospitalizations (1.8% vs 2.1%, p<0.001). Mortality was lower in the AF (3.9%) versus the non-AF (5%) group (exact-matched OR or emOR=0.48, 95% CI 0.29 to 0.80, p<0.001; 987 matched pairs, n=2423), with similar results after procedural stratification: isolated valve replacement/repair (emOR=0.38, p<0.001), isolated coronary artery bypass graft (CABG) (emOR=0.33, p<0.001), and CABG with valve replacement/repair (emOR=0.55, p<0.001). A 12% increase was seen in LOS in the AF subgroup (exact-matched time ratio=1.12, 95% CI 1.10 to 1.14, p<0.001) among hospitalizations which underwent valve replacement/repair with or without CABG. Hospitalizations for cardiac surgery which had coexistent AF were found to have lower inpatient mortality risk and stroke prevalence but higher LOS and hospitalization costs compared with hospitalizations without AF.

scholarly journals Mortality and Revascularization among Myocardial Infarction Patients with Schizophrenia: A Population-Based Cohort Study

2020 ◽  
Vol 65 (7) ◽  
pp. 454-462 ◽  
Author(s):  
Tanya S. Hauck ◽  
Ning Liu ◽  
Harindra C. Wijeysundera ◽  
Paul Kurdyak
Keyword(s):  
Myocardial Infarction ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Intervention ◽  
Population Based ◽  
Geographic Region ◽  
Time Varying ◽  
The Impact ◽  
The Relationship

Background: Cardiovascular disease is a major source of mortality in schizophrenia, and access to care after acute myocardial infarction (AMI) is poor for these patients. Aims: To understand the relationship between schizophrenia and access to coronary revascularization and the impact of revascularization on mortality among individuals with schizophrenia and AMI. Method: This study used a retrospective cohort of AMI in Ontario between 2008 and 2015. The exposure was a diagnosis of schizophrenia, and patients were followed 1 year after AMI discharge. The primary outcome was all-cause mortality within 1 year. Secondary outcomes were cardiac catheterization and revascularization (percutaneous coronary intervention or coronary artery bypass graft). Cox proportional hazard regression models were used to study the relationship between schizophrenia and mortality, and the time-varying effect of revascularization. Results: A total of 108,610 cases of incident AMI were identified, among whom 1,145 (1.1%) had schizophrenia. Schizophrenia patients had increased mortality, with a hazard ratio (HR) of 1.55 (95% CI, 1.37 to 1.77) when adjusted for age, sex, income, rurality, geographic region, and comorbidity. After adjusting for time-varying revascularization, the HR reduced to 1.38 (95% CI, 1.20 to 1.58). The impact of revascularization on mortality was similar among those with and without schizophrenia (HR: 0.42; 95% CI, 0.41 to 0.44 vs. HR: 0.40; 95% CI, 0.26 to 0.61). Conclusions: In this sample of AMI, mortality in schizophrenia is increased, and treatment with revascularization reduces the HR of schizophrenia. The higher mortality rate yet similar survival benefit of revascularization among individuals with schizophrenia relative to those without suggests that increasing access to revascularization may reduce the elevated mortality observed in individuals with schizophrenia.

scholarly journals Recurrent acute kidney injury: predictors and impact in a large population-based cohort

2019 ◽  
Vol 35 (8) ◽  
pp. 1361-1369 ◽  
Author(s):  
Jennifer Holmes ◽  
John Geen ◽  
John D Williams ◽  
Aled O Phillips
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Patient Outcomes ◽  
Large Population ◽  
Kidney Injury ◽  
Population Based ◽  
First Episode ◽  
Single Episode ◽  
Subsequent Episode ◽  
The Impact

Abstract Background This study examined the impact of recurrent episodes of acute kidney injury (AKI) on patient outcomes. Methods The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients ≥18 years of age between April 2015 and September 2018. Patients were grouped according to the number of AKI episodes they experienced with each patient’s first episode described as their index episode. We compared the demography and patient outcomes of those patients with a single AKI episode with those patients with multiple AKI episodes. Analysis included 153 776 AKI episodes in 111 528 patients. Results Of those who experienced AKI and survived their index episode, 29.3% experienced a second episode, 9.9% a third episode and 4.0% experienced fourth or more episodes. Thirty-day mortality for those patients with multiple episodes of AKI was significantly higher than for those patients with a single episode (31.3% versus 24.9%, P &lt; 0.001). Following a single episode, recovery to baseline renal function at 30 days was achieved in 83.6% of patients and was significantly higher than for patients who had repeated episodes (77.8%, P &lt; 0.001). For surviving patients, non-recovery of renal function following any AKI episode was significantly associated with a higher probability of a further AKI episode (33.4% versus 41.0%, P &lt; 0.001). Furthermore, with each episode of AKI the likelihood of a subsequent episode also increased (31.0% versus 43.2% versus 51.2% versus 51.7% following a first, second, third and fourth episode, P &lt; 0.001 for all comparisons). Conclusions The results of this study provide an important contribution to the debate regarding the need for risk stratification for recurrent AKI. The data suggest that such a tool would be useful given the poor patient and renal outcomes associated with recurrent AKI episodes as highlighted by this study.

scholarly journals Effects of Extreme Hemodilution during Cardiac Surgery on Cognitive Function in the Elderly

2007 ◽  
Vol 107 (4) ◽  
pp. 577-584 ◽  
Author(s):  
Joseph P. Mathew ◽  
G Burkhard Mackensen ◽  
Barbara Phillips-Bute ◽  
Mark Stafford-Smith ◽  
Mihai V. Podgoreanu ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cognitive Function ◽  
Adverse Events ◽  
Older Patients ◽  
Artery Bypass ◽  
Randomized Study ◽  
Multivariable Analysis ◽  
Neurocognitive Deficits ◽  
The Impact

Background Strategies for neuroprotection including hypothermia and hemodilution have been routinely practiced since the inception of cardiopulmonary bypass. Yet postoperative neurocognitive deficits that diminish the quality of life of cardiac surgery patients are frequent. Because there is uncertainty regarding the impact of hemodilution on perioperative organ function, the authors hypothesized that extreme hemodilution during cardiac surgery would increase the frequency and severity of postoperative neurocognitive deficits. Methods Patients undergoing coronary artery bypass grafting surgery were randomly assigned to either moderate hemodilution (hematocrit on cardiopulmonary bypass &gt;or=27%) or profound hemodilution (hematocrit on cardiopulmonary bypass of 15-18%). Cognitive function was measured preoperatively and 6 weeks postoperatively. The effect of hemodilution on postoperative cognition was tested using multivariable modeling accounting for age, years of education, and baseline levels of cognition. Results After randomization of 108 patients, the trial was terminated by the Data Safety and Monitoring Board due to the significant occurrence of adverse events, which primarily involved pulmonary complications in the moderate hemodilution group. Multivariable analysis revealed an interaction between hemodilution and age wherein older patients in the profound hemodilution group experienced greater neurocognitive decline (P = 0.03). Conclusions In this prospective, randomized study of hemodilution during cardiac surgery with cardiopulmonary bypass in adults, the authors report an early termination of the study because of an increase in adverse events. They also observed greater neurocognitive impairment among older patients receiving extreme hemodilution.

Abstract 16691: The Effect of Socioeconomic Status: Patients in the Lowest Quartile of Income May be Subject to Worse Outcomes After Major Cardiac Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Joshua C Chao ◽  
Xiaoyan Deng ◽  
Alexis K Okoh ◽  
Fady K Soliman ◽  
Jigesh Baxi ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Cardiac Surgery ◽  
Patient Outcomes ◽  
Artery Bypass ◽  
Multivariable Analysis ◽  
Low Ses ◽  
National Inpatient Sample ◽  
Valve Repair ◽  
Surgical Aortic Valve Replacement ◽  
Zip Code

Introduction: Racial disparities in cardiac surgery (CS) are well documented, but socioeconomic status (SES)’s role, independent of race and other factors, requires further study. Our purpose is to investigate effects of low SES on patient outcomes after CS. Methods: National Inpatient Sample 2010-15, was queried. Adult patients undergoing coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), mitral valve repair (MVRR) or replacement (MVRT) were identified. Patient & hospital characteristics, charges, and outcomes of patients in the lowest quartile of income by zip code (low SESP) and highest (high SESP) were compared, per procedure. Multivariable analysis was used to determine effects of SES on outcomes; primary was in-hospital mortality (death). Results: Number of procedures, low v. high SESP: CABG (30,799).

Perioperative Beta-Blocker for Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

2020 ◽  
Author(s):  
Sue Hyun Kim ◽  
Myoung-jin Jang ◽  
Ho Young Hwang
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Beta Blocker ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Randomized Controlled ◽  
Online Databases ◽  
The Impact

Abstract Background This meta-analysis was conducted to evaluate the impact of perioperative use of beta-blocker (BB) on postoperative atrial fibrillation (POAF) after cardiac surgery other than isolated coronary artery bypass grafting (CABG). Methods Five online databases were searched. Studies were included if they (1) enrolled patients who underwent cardiac surgery other than isolated CABG and (2) demonstrated the impact of perioperative use of BB on POAF based on the randomized controlled trial or adjusted analysis. The primary outcome was the occurrence rates of POAF after cardiac surgery. A meta-regression and subgroup analysis were performed according to the proportion of patients with cardiac surgery other than isolated CABG and the timing of BB use, respectively. Results Thirteen articles (5 randomized and 8 nonrandomized studies: n = 25,496) were selected. Proportion of enrolled patients undergoing cardiac surgery other than isolated CABG ranged from 7 to 100%. The BBs were used in preoperative, postoperative, and both periods in 5, 5, and 3 studies, respectively. The pooled analyses showed that the risk of POAF was significantly lower in patients with perioperative BB than those without (odds ratio, 95% confidence interval = 0.56, 0.35–0.91 and 0.70, 0.55–0.91 in randomized and nonrandomized studies, respectively). The risk of POAF was lower in the BB group irrespective of the proportion of nonisolated CABG. Benefit regarding in-hospital mortality was inconclusive. Perioperative stroke and length of stay were not significantly different between BB and non-BB groups. Conclusions Perioperative use of BB is effective in preventing POAF even in patients undergoing cardiac surgery other than isolated CABG, although it did not translate into improved clinical outcomes.

scholarly journals The potential impact of systemic anti-inflammatory therapies in psoriasis on major adverse cardiovascular events: a Korean nationwide cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joo Ran Hong ◽  
Hojin Jeong ◽  
Hyeongsu Kim ◽  
Hyun Suk Yang ◽  
Ji Youn Hong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Events ◽  
Population Based ◽  
University Hospital ◽  
Treatment Modalities ◽  
Major Adverse Cardiovascular Events ◽  
Cardiovascular Comorbidities ◽  
Anti Inflammatory ◽  
The Impact ◽  
Systemic Agents

AbstractThis nationwide population-based cohort study aimed to investigate the impact of systemic anti-inflammatory treatment on the major adverse cardiovascular events (MACE) risk in patients with psoriasis from January 2006 to December 2018, using a database provided by the Korean National Health Insurance Service. Patients were grouped based on the following treatment modalities: biologics, phototherapy, methotrexate, cyclosporine, and mixed conventional systemic agents. Patients who had not received any systemic treatment were assigned to the control cohort. The incidence of MACE per 1000 person-year was 3.5, 9.3, 12.1, 28.4, 39.5, and 14.5 in the biologic, phototherapy, methotrexate, cyclosporine, mixed conventional systemic agents, and control cohorts, respectively. During the 36-month follow-up, the cumulative incidence of MACE in the phototherapy and biologic cohorts remained lower than that of other treatment modalities. Cyclosporine (hazard ratio (HR) = 2.11, 95% confidence interval (CI) = 1.64–2.71) and mixed conventional systemic agents (HR = 2.57, 95% CI = 2.05–3.22) treatments were associated with increased MACE risk. Methotrexate treatment was not associated with MACE. Our finding demonstrates that treatment modalities may affect cardiovascular comorbidities in patients with psoriasis. Thus, an appropriate combination of anti-psoriatic therapies should be considered to manage patients with high cardiovascular risk.IRB approval status: Waiver decision was obtained by the institutional review board, Konkuk University Hospital, Seoul, Republic of Korea (KUH1120107).

Abstract 15492: The Prognostic Role of Education Attainment Level in Individuals With Ischemic Heart Disease: Analysis From the Endocrine Vascular Approach Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Valeria Raparelli ◽  
Claudia Tucci ◽  
Marco Proietti ◽  
Floriana Santonemma ◽  
Andrea Lenzi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Adverse Outcomes ◽  
Ischemic Heart ◽  
Secondary Outcome ◽  
Major Adverse Cardiovascular Events ◽  
Fatal Stroke ◽  
The Impact ◽  
Fatal Myocardial Infarction

Introduction: Although adverse outcomes from cardiovascular disease (CVD) have been on a linear decline, the burden remains high. Addressing the social determinants of health in the care of CVD patients is emerging as a strategy for improving outcomes. Educational attainment level (EAL), a proxy of socioeconomic status, has been associated with both cardiovascular risk and patient’s ability to self-manage the complex cardiovascular treatment. Objective: To assess the impact of EAL on major adverse cardiovascular events (MACE) and all-cause death in patients with ischemic heart disease (IHD). Methods: Endocrine Vascular disease Approach (EVA) is a prospective observational study recruiting hospitalized patients with IHD undergoing coronary angiography and/or percutaneous coronary interventions. Socio-demographics and clinical data, including the level of multimorbidity defined by a Charlson Comorbidity Index≥ 4, were collected. A low-EAL, assessed through a self-reported questionnaire, was defined if at least elementary/middle school education was completed. The primary outcome was the occurrence of MACE (i.e. cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) and a secondary composite endpoint (i.e. all-cause death, non-fatal myocardial infarction, non-fatal stroke) was also analyzed. Results: Among 460 individuals (mean age 67±11, 30% women) with IHD, 252 (55%) had a low-EAL. Individuals with low-EAL were younger and more likely to have heart failure, vascular encephalopathy, and high multimorbidity. A low-EAL was associated with a higher risk of MACE compared with higher EAL (Log-rank=12.29, p<0.001) with similar results for the secondary outcome (Log-rank=9.45, p=0.002). In the adjusted multivariate regression analysis, low EAL was independently associated with MACE [Hazard Ration (HR): 2.31, 95% Confidence Interval (CI): 1.23-4.34, p=0.010] and secondary outcome [HR: 1.73, 95%CI 1.02-2.92, p=0.042] compared to high-EAL. Conclusion: Individuals with IHD and low-EAL had a higher risk of MACE and all-cause death. Interventions that specifically address health literacy and cognition should be tested among these high-risk patients to improve outcomes.

scholarly journals Impact of physician’s sex/gender on processes of care, and clinical outcomes in cardiac operative care: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037139
Author(s):  
Nicole Etherington ◽  
Mimi Deng ◽  
Sylvain Boet ◽  
Amy Johnston ◽  
Fadi Mansour ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
High Risk Patient ◽  
Sex And Gender ◽  
Eligibility Criteria ◽  
Clinical Patient ◽  
Processes Of Care ◽  
Operative Care ◽  
The Impact

ObjectivesThis systematic review aimed to assess the role of physician’s sex and gender in relation to processes of care and/or clinical outcomes within the context of cardiac operative care.DesignA systematic review.Data sourcesSearches were conducted in PsycINFO, Embase and Medline from inception to 6 September 2018. The reference lists of relevant systematic reviews and included studies were also searched.Eligibility criteria for selecting studiesQuantitative studies of any design were included if they were published in English or French, involved patients of any age undergoing a cardiac surgical procedure and specifically assessed differences in processes of care or clinical patient outcomes by physician’s sex or gender. Studies were screened in duplicate by two pairs of independent reviewers.Outcome measuresProcesses of care, patient morbidity and patient mortality.ResultsThe search yielded 2095 publications after duplicate removal, of which two were ultimately included. These studies involved various types of surgery, including cardiac. One study found that patients treated by female surgeons compared with male surgeons had a lower 30-day mortality. The other study, however, found no differences in patient outcomes by surgeon’s sex. There were no studies that investigated anaesthesiologist’s sex/gender. There were also no studies investing physician’s sex or gender exclusively in the cardiac operating room.ConclusionsThe limited data surrounding the impact of physician’s sex/gender on the outcomes of cardiac surgery inhibits drawing a robust conclusion at this time. Results highlight the need for primary research to determine how these factors may influence cardiac operative practice, in order to optimise provider’s performance and improve outcomes in this high-risk patient group.

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