Abstract 182: Heart Transplantation Patients in the Medicare Population: Outcomes, Costs and Readmission Rates

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Fenton McCarthy ◽  
Desmond Graves ◽  
Danielle Savino ◽  
Amanda Chin ◽  
Danielle Spragan ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Heart Transplant ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Hospital Length Of Stay ◽  
Fee For Service ◽  
Readmission Rates ◽  
Term Survival ◽  
Significant Difference

Objective: The average age of heart transplant recipients in the United States has been increasing over the past decade. The effect of age on outcomes following heart transplantation, including cost and readmission has yet to be thoroughly evaluated. Methods: All Medicare fee-for-service patients undergoing heart transplantation between 2008 and 2013 were included in the study. Denominator files were used to collect patient demographics and mortality. Kaplan-Meier survival estimates and Cox Proportional Hazards models were used for overall survival analysis. Results: A total of 4431 heart transplant patients were included in this study. Patients were broken down into categories of age <60, 60-69, and >70. Patients >70 were more likely to be male, white and have CAD and ischemic cardiomyopathy than patients <60. Multivariable cox survival model showed ECMO (HR 9.5, 95% CI 7.7 - 11.6, p < 0.01) and liver disease (HR 1.6 95% CI 1.2 - 2.2, p < 0.01) were associated with increased long-term mortality (p<0.01 and p=0.02, respectively). There was a significant difference in ECMO usage between patient groups with 6% of patents > 70, 4% of patients 60-69, and 3% of patients < 60 requiring ECMO (p=0.05). There was no significance was seen in 30 day mortality rates among between patients > 70 (5%) and patients < 70 years of age (5% ), p=0.83. Additionally, there was no difference between ICU lengths of stay, 30- and 90-day readmission rates (p=1.0 and p=0.72 respectively), and hospital length of stay (p=0.35) (Table 1). Conclusions: Among Medicare patients undergoing heart transplantation, those over the age of 70 had no difference in terms of survival and cost utilization compared to younger patients. Heart transplantation programs are doing a good job of selecting older patients in order to maintain these outcomes. Age was associated with increased use of ECMO, and ECMO adversely affected long-term survival.

SP6.1.11 The Effect of the Enhanced Recovery Programme for Liver Surgery on Long Term Survival

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Kalaiyarasi Arujunan ◽  
Abdulwarith Shugaba ◽  
Harmony Uwadiae ◽  
Joel Lambert ◽  
Georgios Sgourakis ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Liver Surgery ◽  
Patient Survival ◽  
Enhanced Recovery ◽  
Readmission Rates ◽  
Term Survival ◽  
Significant Difference

Abstract Aims The Enhanced Recovery Programme for Liver Surgery (ERPLS) has been shown to promote functional recovery and reduce hospital stay. However, its effect on long term survival has yet to be established. The aim of this study was to determine the effect of the ERPLS on 5-year patient survival. Methods This was a retrospective study of patients who underwent liver resection for colorectal liver metastasis (CRLM) between January 2011 and December 2016 at a regional hepatobiliary centre. The cohort comprised of 60 pre-ERPLS and 60 post-ERPLS patients. The primary outcome was 5-year patient survival. The secondary outcomes were length of stay (LOS), postoperative complications and 90-day readmission rates. Multivariate analysis was performed to identify independent predictors of overall survival. Results There was no significant difference in the age (p = 0.960), gender (p = 0.332) and type of resection (p = 0.198) between both groups. ERPLS was not an independent predictor for overall survival (Gehan Wilcoxon Test, p = 0.828). There was no significant difference in the LOS (p = 0.874) and 90-day readmission rates (p = 0.349). Major postoperative complications (&gt;3a Clavien-Dindo classification) were significantly less in the ERPLS group (p = 0.02). On multivariate analysis, positive resection margins and major postoperative complications were independent predictors for overall survival. Conclusions ERPLS does not seem to have an effect on long term patient survival. However, it appears to reduce the rate of major postoperative complications. LOS and 90-day readmission rates were not influenced by ERPLS.

scholarly journals Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

2020 ◽  
Vol 9 (8) ◽  
pp. 2455 ◽  
Author(s):  
Tsai-Jung Wang ◽  
Ching-Heng Lin ◽  
Hao-Ji Wei ◽  
Ming-Ju Wu
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Heart Transplantation ◽  
Renal Dysfunction ◽  
Heart Transplant ◽  
Kidney Injury ◽  
Dialysis Patients ◽  
Term Survival

Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.

scholarly journals Long-term survival in patients who had CABG with or without prior coronary artery stenting

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001160
Author(s):  
Pratik Rai ◽  
Rebecca Taylor ◽  
Mohamad Nidal Bittar
Keyword(s):  
Coronary Artery ◽  
Proportional Hazards ◽  
Bypass Graft ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
The Impact

ObjectiveTo conduct a large-scale, single-centre retrospective cohort study to understand the impact of prior percutaneous coronary intervention (PCI) on long-term survival of patients who then undergo coronary artery bypass graft (CABG).MethodsBetween 1999 and 2017, a total of 11 332 patients underwent CABG at a hospital in the UK. The patients were stratified into those who received PCI (n=1090) or no PCI (n=10 242) prior to CABG. A total of 1058 patients from each group were matched using propensity score matching. Kaplan-Meier estimates were used to assess risk-adjusted survival in patients with prior PCI. Cox proportional hazards (CoxPH) model was then used to assess the effect of prior PCI and other variables in patients undergoing CABG.ResultsThe immediate postoperative outcome showed no difference in number of grafts per patients, blood transfusion, hospital stay or 30 days mortality between the groups. There was no significant difference in 5 years (90.8% vs 87.9), 10-year (76.5% vs 74.6%) and 15-year (64.4% vs 64.7%) survival between the non-PCI versus PCI groups. The Cox proportional hazards model further supports the null hypothesis as the PCI variable was found to be non-significant (CoxPH=1.03, p=0.75, CI=0.87–1.22) implying there was no difference in hazard of death for CABG patients with or without previous PCI. However, the model did yield information on the covariates that do affect the hazard of death.ConclusionThere is no difference in 5-year, 10-year and 15-year survival between patients undergoing CABG with or without prior PCI. However, certain patient, preoperative and intraoperative risk factors were identified with high hazard of death which needs to be investigated further.

Abstract 13048: Do Anti-HLA Antibodies Pre-heart Transplant Truly Impact Post-transplant Outcomes?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Timothy Ho ◽  
Jignesh K Patel ◽  
Keith Nishihara ◽  
Michelle M Kittleson ◽  
David H Chang ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Term Survival ◽  
Hla Antibodies ◽  
Major Barrier ◽  
Antibody Mediated Rejection ◽  
Lv Dysfunction ◽  
Significant Difference ◽  
Antibody Levels ◽  
Hla Antibody

Introduction: Antibody-mediated rejection (AMR) continues to be a major barrier to favorable long-term outcomes and long-term survival. Sensitized pre-heart transplant (HTx) patients, those with anti-HLA antibodies, have previously demonstrated increased post-HTx rejection risk as well as increased mortality. In the current era, there is contention as to whether pre-HTx antibodies result in poor outcome after HTx. Methods: Between 2010 and 2015, 580 HTx patients were assessed for pre-HTx panel reactive antibodies (PRA). PRA levels were measured by the Luminex Single Antigen assay. Patients were divided into 5 groups of PRA levels including 0%, n=423 (Control); PRA 1-10%, n= 21; PRA 11-25%, n=24; PRA 26-50%, n=49; PRA 51-75%, n=32; and PRA >75%, n=35. Endpoints included 5-year survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE), freedom from donor specific antibody (DSA) development, and freedom from LV dysfunction (LV ejection fraction ≤40%) and 1-year freedom from rejection (any treated rejection (ATR), acute cellular rejection (ACR), AMR). Results: All groups with PRA >10% had significantly lower 1-year freedom from AMR and 5-year freedom from DSA compared to the control, worsening with higher the PRA group. There was no significant difference in 5-year survival, 5-year freedom from CAV, NF-MACE, or LV dysfunction and 1-year freedom from ATR or ACR. Conclusions: Patients with increased anti-HLA antibody levels pre-HTx do not appear to have lower 5-year survival compared to patients without anti-HLA antibody levels. However, the development of 1-year AMR and 5-year DSA increased progressively with higher the PRA group. Further studies and longer follow-up are needed to better understand the effects of elevated pre-HTx PRA, immune therapies (desensitization) and post-HTx outcomes.

Abstract 13537: Similar Long-term Survival in Patients Bridged With Biventricular Devices or Extracorporeal Membrane Oxygenation in the Contemporary Era of Heart Transplantation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Abhishek Jaiswal ◽  
Naga Vaishnavi Gadela ◽  
Ayesha Azmeen ◽  
Jason A Gluck ◽  
Joseph Radojevic ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Allocation Policy ◽  
Number Of Patients ◽  
Doubly Robust

Introduction: A recent trend favoring donor allocation to sicker patients has led to a rise in the number of patients undergoing heart transplantation (HT) on ECMO or non-dischargeable biventricular mechanical circulatory devices (BiVAD). While suboptimal short-term outcomes of such patients have raised concerns, long-term outcomes are unknown. We examined long-term survival in patients bridged with BiVAD or ECMO in the contemporary era before the donor allocation policy changed. Methods: We identified the adult patients listed for HT and bridged with ECMO or BiVAD between 2000 and 2018 in the Scientific Registry of Transplant Recipients. We compared 3- and 5-year survival with the Kaplan-Meier method. Using overlap propensity score weighting, we constructed doubly-robust Cox proportional hazards regression models to determine the risk-adjusted influence of support type on survival. Results: Of the 1495 listings; 868 (58.1%) were bridged with BiVAD and 627 (41.9%) with ECMO. 730 underwent successful HT; 528 (72.3%) and 202 (27.7%) were bridged with BiVAD and ECMO, respectively. The ECMO group had higher prevalence of pre-transplant ventilator support (30.7% vs 6.3%, p<0.0001), dialysis (15.8% vs 8.0%, p-0.005), inotrope use (36.6% vs 22.4%, p<0.0001) and a higher IMPACT score (11.5 vs 5.5, p<0.0001). Unadjusted 3- and 5-year estimated survival were similar in BiVAD vs. ECMO patients (Figure). After risk-adjustment, BiVAD and ECMO patients had a similar 3-year (HR 1.32, 95% CI 0.80-2.00; p=0.1849) and 5-year survival (HR 1.31, 95% CI 0.88-1.95; p=0.1878). Conclusions: A minority of patients on BiVAD and ECMO underwent HT suggesting high complication and waitlist mortality rates. Besides, the transplantation rate was disproportionately lower in patients on ECMO compared to BiVAD support. Patients with heart failure bridged with BiVAD or ECMO experienced similar long-term outcomes despite worse clinical and hemodynamic profile of patients in the ECMO group.

Insurance and education predict long-term survival after orthotopic heart transplantation in the United States

2012 ◽  
Vol 31 (1) ◽  
pp. 52-60 ◽  
Author(s):  
Jeremiah G. Allen ◽  
Eric S. Weiss ◽  
George J. Arnaoutakis ◽  
Stuart D. Russell ◽  
William A. Baumgartner ◽  
...  
Keyword(s):  
United States ◽  
Heart Transplantation ◽  
The United States ◽  
Orthotopic Heart Transplantation ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3390
Author(s):  
Mats Enlund
Keyword(s):  
Breast Cancer ◽  
Survival Data ◽  
Retrospective Studies ◽  
Breast Cancer Surgery ◽  
Breast Cancer Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
One Year

Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

scholarly journals Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis

2021 ◽  
Vol 10 (1) ◽  
pp. 162
Author(s):  
Christian-Alexander Behrendt ◽  
Thea Kreutzburg ◽  
Jenny Kuchenbecker ◽  
Giuseppe Panuccio ◽  
Mark Dankhoff ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Propensity Score ◽  
Acute Limb Ischemia ◽  
Insurance Claims ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Abdominal Aortic ◽  
Significant Difference

Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data. Methods: Insurance claims from a large German fund were used, covering around 8% of the insured German population. Patients who underwent endovascular aortic repair (EVAR) for intact AAA from 1 January 2011 to 30 April 2017 were included in the cohort. A 1:2 female to male propensity score matching was applied to adjust for confounding variables. Perioperative and long-term outcomes after 5 years were determined using matching and regression methods. Results: Among a total of 3736 patients (19.3% females, mean 75 years) undergoing EVAR for intact AAA, we identified 1863 matched patients. Before matching, females were more likely to be previously diagnosed with hypothyroidism, electrolyte disorders, rheumatoid disorders, and depression, while males were more often diabetics. In the matched sample, 23.4% of the females and 25.8% of the males died during a median follow-up of 776 and 792 days, respectively. Perioperatively, females were more likely to exhibit acute limb ischemia (5.3% vs. 3.2%, p = 0.031) and major bleeding (22.0% vs. 15.9%, p = 0.001) before they were discharged to rehabilitation (5.5% vs. 1.5%, p < 0.001) when compared to males. No statistically significant difference in perioperative (odds ratio 1.12, 95% CI 0.54–2.16) or long-term mortality (hazard ratio 0.91, 95% CI 0.76–1.08) was observed between sexes. This was also true regarding aortic reintervention rates after 1 year (2.0% vs. 2.9%) and 5 years (10.9% vs. 8.1%). Conclusion: The current retrospective matched analysis of insurance claims revealed high early access-related morbidity in females when compared to their male counterparts. Short-term or long-term survival and reintervention outcomes were similar between sexes.

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