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).

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.

Abstract 15935: Socioeconomic Disparities in Urgent versus Elective Transcatheter Mitral Valve Repair: Insights From the National Inpatient Sample

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexander M Spring ◽  
Michael A Catalano ◽  
Bruce J Rutkin ◽  
Alan R Hartman ◽  
Pey-Jen Yu
Keyword(s):  
Mitral Valve ◽  
Length Of Stay ◽  
Mitral Valve Repair ◽  
Low Income ◽  
Multivariable Analysis ◽  
Socioeconomic Disparities ◽  
National Database ◽  
National Inpatient Sample ◽  
Valve Repair ◽  
Prolonged Length

Objective: Cardiac interventions performed urgently are known to be associated with poor outcomes compared to electively performed procedures. Transcatheter edge-to-edge mitral valve repair (TMVr) has developed as a reasonable alternative to mitral valve surgery in certain patient populations. We aimed to leverage a national database to identify predictors of urgent versus elective TMVr, as well as the association between urgency and outcomes. Methods: The National Inpatient Sample (NIS) was queried to identify weighted hospital discharge records of patients who underwent TMVr from 2016 - 2017. Hospitalizations are identified within the database as elective versus non-elective. Univariate and multivariable analyses were performed to identify patient characteristics associated with urgent procedures. In-hospital outcomes were assessed. Results: There were 10,195 cases of TMVr in this cohort, 24.2% of which were performed urgently. In multivariable analysis, Hispanic race, Medicaid insurance, and low income were associated with increased likelihood of urgent hospital admission and TMVr. Additionally, small hospital size and Northeast region were associated with increased likelihood of urgent admission and procedure. Older patients were more likely to undergo elective procedures (Table 1). Urgent TMVr was associated with increased mortality (4.5% vs. 1.6%, p < .001), prolonged length of stay (6.0 vs. 2.0, p < .001), and increased cost ($267,292 vs. $167,889, p < .001). Conclusion: Socioeconomic disparities exist in the utilization of TMVr as an urgent versus elective procedure, suggesting differences in access to surveillance and preventive care. Urgent TMVr is associated with increased morbidity and mortality, prolonged length of stay, and increased hospital costs. Priority should be placed on mitigating such disparities to improve outcomes.

Abstract 266: Incidence, Predictors and Outcomes of Permanent Pacemaker Implantation Among Patients With Bradyarrhythmias Following Cardiac Surgery: Insights From the National Inpatient Sample Database

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Karol Quelal ◽  
Olakanmi Olagoke ◽  
Jose Baez
Keyword(s):  
Cardiac Surgery ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Hospital Death ◽  
National Inpatient Sample ◽  
Permanent Pacemaker Implantation

Introduction: Significant atrioventricular blocks and bradyarrhythmias are known complications of open-heart surgery. These are frequently transient, however, some patients go on to need a permanent pacemaker (PP). We sought to describe the incidence, predictors, and outcomes of PP implantation among patients admitted for cardiac surgery who develop bradyarrhythmias. Methods: We queried the National Inpatient Sample (NIS) database from 2010 to 2014 for adults admitted for surgical valve replacement, valvuloplasty or coronary artery bypass grafting (CABG) who had bradyarrhythmias during the admission using the appropriate ICD codes. We identified patients who had permanent pacemaker implantation documented during the admission. Categorical and continuous variables were compared using the chi-square and student's t-test. Predictors of PP implantation and in-hospital mortality were evaluated by logistic regression. Results: Of the 1402930 patients who underwent cardiac surgery, 94748 patients had bradyarrhythmias defined as sinoatrial node dysfunction (SND) and/or atrioventricular block (AVB) during hospitalization. The primary procedure was identified as valve replacement in 50.3% (47615 of 94748), CABG in 29.9% (27622 of 94748) and valvuloplasty in 8.7% (8248 of 94748). SND was found in 29.9% (28372 of 94748) and AVB in 76% (72017 of 94748). Permanent pacemaker implantation was done in 39.3% (37246 of 94748). Valve replacement was the most common surgery associated with PP implantation [58% (21682 of 37246) compared to 21.5% in CABG (8007 of 37246) and 7.7% in valvuloplasty (2882 of 37246), p < 0.001). Female sex aOR 1.36 (95% CI 1.31 - 1.40), young age 18 - 44 years aOR 1.36 (95% CI 1.24 - 1.49), Asiatic and Hispanic origin aOR 1.36 (95% CI 1.23 - 1.51), aOR 1.25 (95% CI 1.17 - 1.34) respectively, diabetes mellitus with chronic complications aOR 1.16 (95% CI 1.09 - 1.24), drug abuse aOR 1.38 (95% CI 1.21 - 1.55) were associated with higher odds of pacemaker implantation. African American origin aOR 0.79 (95CI 0.74 - 0.85), AIDS aOR 0.33 (95% CI 0.17 - 0.67), south hospital region aOR 0.89 (95% CI 0.85 - 0.93), no-charge admissions aOR 0.66 (95% CI 0.49 - 0.89) were associated with a lower odds of PPM implantation. Death during hospitalization was found in 3% of the patients. After multivariable regression, PP implantation was associated with a lower likelihood of in-hospital death aOR 0.45 (95% CI 0.41 - 0.50). Conclusion: Approximately one-third of the patients hospitalized for cardiac surgery related to AVB and/or SND were implanted a permanent pacemaker. Factors like age, sex, race and comorbidities determine the likelihood of this procedure that has a significant impact on mortality. Having a better insight into these predictors would allow a better triage of patients who would benefit from its implantation.

scholarly journals Impact of Socioeconomic Status on Return to Work after Acute Ankle Fracture

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0020
Author(s):  
Alessandra L. Falk ◽  
Regina Hanstein ◽  
Chaiyaporn Kulsakdinun
Keyword(s):  
Socioeconomic Status ◽  
Return To Work ◽  
Low Socioeconomic Status ◽  
Ankle Fracture ◽  
Low Ses ◽  
Insurance Status ◽  
Low Socioeconomic ◽  
The Impact ◽  
Zip Code

Category: Ankle; Trauma Introduction/Purpose: Socioeconomic status has been recognized throughout the medical literature, both within orthopedics and beyond, as a factor that influences outcomes after surgery, and can result in substandard care. Within the foot and ankle subspecialty, there is limited data regarding socioeconomic status and post-operative outcomes, with the current literature focusing on outcomes for diabetic feet. However, ankle fractures are among the most common fractures encountered by orthopedic surgeons. While a few studies have explored the impact of ankle fractures on employment and disability status, the effect of socioeconomic status on return to work post operatively has not yet been investigated. The purpose of this study was to determine the impact of low socioeconomic status on return to work. Methods: We retrospectively reviewed 592 medical charts of patients with CPT code 27766, 27792, 27814, 27822, 27823, 27827, 27829, 27826, 27828 from 2015-2018. Included were patients >18 yrs of age who sustained an acute ankle fracture, were employed prior to the injury, and with information on return to work after ankle surgery, zip code, race, ethnicity and insurance status. Excluded were patients who were not employed prior to their injury. Socioeconomic status was either defined by insurance status - Medicaid/Medicare, commercial, or workman’s compensation -, or by assessing socioeconomic status (SES) using medial household per capita income by zip code as generated and reported by the US National Census Bureau’s 2013-2017 American Community Survey 5-Year Estimates. The national dataset was divided into quartiles with the lowest quartile defined as low SES. Patients who had income that fell within this income category were classified as low SES. Results: 174 patients were included with an average follow-up of 10.2months. 22/174 (12.6%) patients didn’t return to work post-operatively. Univariate analysis identified non-sedentary work to decrease the likelihood of return to work (HR:0.637; p=0.03). Patients with a low SES were more prevalent in the no return group compared to the return to work group (86% vs 60%; p=0.028). 95% of patients with low SES were a minority compared to 56% with average/high SES (p<0.005). Patients with low SES had a higher BMI (p=0.026), a longer hospitalization (p=0.04) and more wound complications (p=0.032). Insurance type didn’t affect return to work (p=0.158). Patients with workman’s compensation had a longer follow-up time and a longer time to return to work compared to other insurances (p<0.005 for each comparison). Conclusion: Low socioeconomic status based on income, not insurance type, affected return to work after an ankle fracture ORIF. Patients with workman’s compensation took a longer time to return to work compared to other insurance types. These findings warrants the need to consider socioeconomic status when allocating resources to treat these patients.

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.

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 Operative consideration in patient with cryoglobulinaemia undergoing cardiac surgery with use of cardiopulmonary bypass

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Saifullah Mohamed ◽  
Akshay J Patel ◽  
Yassir Iqbal ◽  
Khurum Mazhar ◽  
Timothy R Graham
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Management ◽  
Extracorporeal Circuit ◽  
Artery Bypass Graft ◽  
Valve Repair ◽  
Systemic Complications ◽  
Circulating Levels

Abstract Cryoglobulinaemia can be defined as the presence of single or mixed immunoglobulins in the serum, which precipitate at sub-homeostatic temperatures and redissolve at higher temperatures. This condition in the context of cardiac surgery can precipitate systemic complications secondary to cold agglutination and lead to significant perioperative problems with the cardiopulmonary bypass machine and the extracorporeal circuit. We present a case of a 74-year-old gentleman with cryoglobulinaemia who underwent mitral valve repair and coronary artery bypass graft surgery. The patient was to undergo preoperative plasmapheresis to reduce circulating levels of cryoglobulin and thereby decrease the risk of potential protein agglutination during cardiopulmonary bypass. Operative considerations included the level of systemic temperature required, the temperature of the cardioplegia solution, level of anticoagulation and the speed and timing of rewarming of the patient to normal homeostatic temperatures. The postoperative management also consisted of early plasmapheresis to further reduce the number of cryoglobulins.

scholarly journals Cardiac Surgery 2019 Reviewed

2020 ◽  
Vol 68 (05) ◽  
pp. 363-376
Author(s):  
Torsten Doenst ◽  
Steffen Bargenda ◽  
Hristo Kirov ◽  
Alexandros Moschovas ◽  
Sophie Tkebuchava ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Search Term ◽  
Surgical Aortic Valve Replacement ◽  
Joint Decision

AbstractFor the year 2019, almost 25,000 published references can be found in PubMed when entering the search term “cardiac surgery.” We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for article selection and reviewed the main fields of adult cardiac surgery (i.e., coronary, valve, aortic, and heart failure surgery). The past decade has experienced an enormous development of interventional techniques that compete more and more with classic surgery. This contest was broadly visible in 2019. It peaked over the interpretation of the EXCEL trial data, where percutaneous coronary intervention and coronary artery bypass grafting (CABG) for left main disease were compared. A novel pathomechanism for CABG was proposed, potentially answering open questions in the field. In aortic valve surgery, two low-risk trials comparing transcatheter aortic valve implantation (TAVI) to classic aortic valve replacement (surgical aortic valve replacement) received attention for showing equal or superior short-term outcomes for TAVI. Longer follow-up information from recent trials became available presenting results emphasizing the need for joint decision making. While publications addressing surgery on the aorta and the mitral and tricuspid valves were less abundant, there was substantial activity regarding left ventricular assist device support and heart transplantation. This article attempts to summarize the most pertinent publications. It does not expect to be complete and cannot be free of individual interpretation. We aimed to provide a condensed summary of 2019s publications with a stimulus for in-depth reading and a basis supporting patient information.

Key Articles and Guidelines in the Management of Patients Undergoing Cardiac Surgery

2015 ◽  
Vol 28 (1) ◽  
pp. 67-85
Author(s):  
Ian B. Hollis ◽  
Douglas L. Jennings ◽  
Carrie S. Oliphant ◽  
William L. Baker ◽  
Estella M. Davis ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Patient Outcomes ◽  
Mechanical Circulatory Support ◽  
Antimicrobial Prophylaxis ◽  
Artery Bypass ◽  
Pharmacy Practice ◽  
Evidence Base ◽  
Circulatory Support ◽  
Short And Long Term

Significant numbers of patients undergo cardiac surgery worldwide each year. A large evidence base exists regarding the optimal pre-, intra-, and postoperative mediation management for patients undergoing coronary artery bypass grafting (CABG) surgery, valve replacements or repairs, and mechanical circulatory support (MCS). Prevention and treatment of perioperative arrhythmias, perioperative antimicrobial prophylaxis, prevention of thrombosis, and bleeding through proper management of perioperative antiplatelet and anticoagulant therapies, and the use of pharmacotherapy to optimize both short- and long-term patient outcomes after cardiac surgery are the focus of this first compilation of guidelines and key articles in this patient population to be published in the Journal of Pharmacy Practice.

Pregnancy-Related Cardiovascular Complications: Case Presentation and Review of Literature

2016 ◽  
Vol 19 (5) ◽  
pp. E248-E254 ◽  
Author(s):  
Hasan Baki Altinsoy ◽  
Ozkan Alatas ◽  
Salih Colak ◽  
Hakan Atalay ◽  
Omer Faruk Dogan
Keyword(s):  
Cardiac Surgery ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Median Time ◽  
Artery Bypass ◽  
Prosthetic Heart Valve ◽  
Cardiovascular Complications ◽  
Time To Diagnosis ◽  
Valve Thrombosis ◽  
Placental Blood

Background: Cardiovascular complications that can cause severe catastrophic outcomes for both the mother and the fetus are rarely seen during pregnancy. Time to diagnosis is often delayed by a low degree of suspicion and atypical presentation. We report surgical strategies in three pregnant women with cardiovascular complications. Methods: A retrospective search from 2009 to 2016 identified three pregnant women who underwent urgent cardiac surgery. We used extracorporeal circulation (ECC) without cesarean section with careful follow-up of the fetuses during the perioperative and postoperative period. We used levosimendan as a potent inodilator in all patients to increase feto-placental blood flow and fetal heart rhythm.Results: Median time to diagnosis was 23.8 h (range 11.7-120 h) and median time from diagnosis to arrival in the operating theater was 9.8 h (range 7.4-19.8 h). One patient with prosthetic heart valve thrombosis underwent concomitant cesarean section prior to cardiac surgery. In a young pregnant woman who had spontaneous dissection of the left anterior descending artery, on-pump beating heart coronary artery bypass grafting was performed without cross clamping. Two and three months after surgery, cesarean sections were performed without any complication in two pregnant women.Conclusion: Because unusual cardiovascular complications are the main cause of maternal and/or fetus death during pregnancy, prompt and exact diagnosis is very important. Life-saving surgical strategy with the help of appropriate teams are necessary to optimize outcome for both mother and baby.

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