scholarly journals Survival curve identifies critical period for postoperative mortality in cardiac patients undergoing emergency general surgery

2020 ◽  
Author(s):  
Diego Martines ◽  
Fernanda Nii ◽  
Kayo Medeiros ◽  
Barbara Carvalho ◽  
Leonardo Pipek ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Survival Curve ◽  
Postoperative Mortality ◽  
Acute Mesenteric Ischemia ◽  
Cardiac Surgical Procedures ◽  
Clinical Severity ◽  
High Rate ◽  
Postoperative Phase ◽  
Emergency General Surgery ◽  
Cardiovascular Comorbidity

Abstract Introduction: The number of non-cardiac major surgeries carried out has significantly increased in recent years to around 200 million procedures carried out annually. Approximately 30% of patients submitted to non-cardiac surgery present some form of cardiovascular comorbidity. In emergency situations, with less surgery planning time and greater clinical severity, the risks become even more significant. The aim of this study is to determine the incidence and clinical outcomes in patients with cardiovascular disease submitted to non-cardiac surgical procedures in a single cardiovascular referral center. Methods: This is a prospective cohort study of patients with cardiovascular disease submitted to non-cardiovascular surgery. All procedures were carried out by the same surgeon, between January 2006 and January 2018. Results: 240 patients included were elderly, 154 were male (64%), 8 patients presented two diagnoses. Of the resulting 248 procedures carried out, 230 were emergency (92.8%). From the data obtained it was possible to estimate the day from which the occurrence of mortality is less probable in the postoperative phase. Conclusion: Our research evaluated the epidemiological profile of the surgeries and we were able to estimate the survival and delimit the period of greatest risk of mortality in these patients. The high rate of acute mesenteric ischemia was notable, a serious and frequently fatal condition.

scholarly journals Survival curve identifies critical period for postoperative mortality in cardiac patients undergoing emergency general surgery

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Diego Ramos Martines ◽  
Fernanda Nii ◽  
Kayo Augusto de Almeida Medeiros ◽  
Bárbara Justo Carvalho ◽  
Leonardo Zumerkorn Pipek ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Survival Curve ◽  
Postoperative Mortality ◽  
Acute Mesenteric Ischemia ◽  
Cardiac Surgical Procedures ◽  
Clinical Severity ◽  
High Rate ◽  
Postoperative Phase ◽  
Emergency General Surgery ◽  
Cardiovascular Comorbidity

Abstract The number of non-cardiac major surgeries carried out has significantly increased in recent years to around 200 million procedures carried out annually. Approximately 30% of patients submitted to non-cardiac surgery present some form of cardiovascular comorbidity. In emergency situations, with less surgery planning time and greater clinical severity, the risks become even more significant. The aim of this study is to determine the incidence and clinical outcomes in patients with cardiovascular disease submitted to non-cardiac surgical procedures in a single cardiovascular referral center. This is a prospective cohort study of patients with cardiovascular disease submitted to non-cardiovascular surgery. All procedures were carried out by the same surgeon, between January 2006 and January 2018. 240 patients included were elderly, 154 were male (64%), 8 patients presented two diagnoses. Of the resulting 248 procedures carried out, 230 were emergency (92.8%). From the data obtained it was possible to estimate the day from which the occurrence of mortality is less probable in the postoperative phase. Our research evaluated the epidemiological profile of the surgeries and we were able to estimate the survival and delimit the period of greatest risk of mortality in these patients. The high rate of acute mesenteric ischemia was notable, a serious and frequently fatal condition.

scholarly journals Abnormal upregulation of cardiovascular disease biomarker PLA2G7 induced by proinflammatory macrophages in COVID-19 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yang Li ◽  
Yongzhong Jiang ◽  
Yi Zhang ◽  
Naizhe Li ◽  
Qiangling Yin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Normal Limit ◽  
Genomic Analysis ◽  
High Rate ◽  
Hub Gene ◽  
Viral Loads ◽  
Protein Levels ◽  
Nasal Swabs ◽  
Positive Rate ◽  
Validation Stage

AbstractHigh rate of cardiovascular disease (CVD) has been reported among patients with coronavirus disease 2019 (COVID-19). Importantly, CVD, as one of the comorbidities, could also increase the risks of the severity of COVID-19. Here we identified phospholipase A2 group VII (PLA2G7), a well-studied CVD biomarker, as a hub gene in COVID-19 though an integrated hypothesis-free genomic analysis on nasal swabs (n = 486) from patients with COVID-19. PLA2G7 was further found to be predominantly expressed by proinflammatory macrophages in lungs emerging with progression of COVID-19. In the validation stage, RNA level of PLA2G7 was identified in nasal swabs from both COVID-19 and pneumonia patients, other than health individuals. The positive rate of PLA2G7 were correlated with not only viral loads but also severity of pneumonia in non-COVID-19 patients. Serum protein levels of PLA2G7 were found to be elevated and beyond the normal limit in COVID-19 patients, especially among those re-positive patients. We identified and validated PLA2G7, a biomarker for CVD, was abnormally enhanced in COVID-19 at both nucleotide and protein aspects. These findings provided indications into the prevalence of cardiovascular involvements seen in patients with COVID-19. PLA2G7 could be a potential prognostic and therapeutic target in COVID-19.

The impact of gender on outcomes in patients with chronic total coronary occlusions undergoing percutaneous coronary intervention: results from a Dutch nationwide registry including 7560 patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Van Veelen ◽  
J Elias ◽  
I.M Van Dongen ◽  
J.P.S Henriques ◽  
P Knaapen
Keyword(s):  
Cardiovascular Disease ◽  
Percutaneous Coronary Intervention ◽  
Survival Curve ◽  
Coronary Intervention ◽  
Chronic Total Occlusions ◽  
Nationwide Registry ◽  
Percutaneous Coronary ◽  
Baseline Characteristics ◽  
Gender Based ◽  
The Impact

Abstract Background Females comprise a minority of patients with chronic total occlusions (CTO). It is known that men have a greater benefit from CTO percutaneous coronary intervention (PCI) than women. We aimed to determine gender-based differences in baseline characteristics and outcomes after PCI in patients with CTO. Methods The Netherlands Heart Registration (NHR) is a nationwide registry that registers outcomes of cardiac interventions. For the purpose of this analysis, the data of all patients undergoing PCI from inception of the NHR to December 2018 were selected, that included PCI with at least one CTO in one of the treated coronary arteries. We compared baseline characteristics and the outcomes 1 year mortality, 30 day myocardial infarction (MI) and target vessel revascularization (TVR) <1 year between men and women. Results A total of 7560 patients were identified that underwent PCI between January 1, 2015 and December 31, 2018 with at least 1 CTO in the treated vessel. A total of 5850 was male (77.4%) and 1710 was female (22.6%). Women were older (68.5±10.6 versus 64.7±10.6 years old, p<0.001), and more frequently had diabetes (29.4% [n=529] versus 25.0% [n=1602], p<0.001) and kidney disease (4.5% [n=529] versus 2.2% [n=142], p<0.001). However, men had more extensive cardiovascular disease, i.e. multi-vessel disease (56.0% [n=3584] versus 50.4% [n=912], p<0.001), previous MI (39.7% [n=2527] versus 31.0% [n=555], p<0.001), previous PCI (48.2% [n=1967] versus 40.2% [n=455], p<0.001) and previous coronary artery bypass grafting (16.8% [n=1085] versus 10.5% [n=191], p<0.001) and more frequently presented with an out-of-hospital cardiac arrest, compared to women (2.1% [n=136] versus 1.1% [n=20], p=0.004). The 1-year mortality was higher in women (10.3% versus 7.5%, p<0.001), as well as the 30-day MI (0.9% versus 0.4%, p=0.043), but men had higher risk for TVR<1 year (11.7% versus 9.5%, p=0.044). Corrected for age and comorbidities, female gender was an independent predictor for mortality (Figure 1; odds ratio 1.83, 95% confidence interval 1.08–3.11, p=0.025). Conclusion In this nationwide registry comprising 7560 CTO patients undergoing PCI, significant gender-based differences were found. Males were found to have more extensive cardiovascular disease. However, females were at higher risk of mortality, possibly due to higher age and higher prevalence of concomitant comorbidities. Figure 1. Survival curve Funding Acknowledgement Type of funding source: None

Surgical Management of Mitral Regurgitation After Repair of Endocardial Cushion Defects

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Adrian M. Moran ◽  
Sabine Daebritz ◽  
John F. Keane ◽  
John E. Mayer
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Clinical Status ◽  
Postoperative Mortality ◽  
Heart Association ◽  
Morphological Type ◽  
Early Postoperative Period ◽  
High Rate ◽  
Mitral Valve Operation

Background —Mitral regurgitation (MR) represents the principal indication for reoperation in patients after repair of atrioventricular septal defects (AVSD). Reports of mitral valvuloplasty (MVP) in such patients are few; the alternative, mitral valve replacement (MVR), necessitates commitment to future valve replacement and long-term anticoagulation. We sought to determine the outcome of those patients who underwent either MVP or MVR between January 1, 1988, and December 31, 1998, for significant MR after repair of AVSD. Furthermore, we sought to identify (a) morphological predictors necessitating MVR, and (b) predictors of future reoperation within the MVP group. Methods and Results —Retrospective review of clinical, operative, and echocardiographic data were performed. There were 46 patients identified (37 MVP and 9 MVR). The median age at initial AVSD repair was 0.6 years, and the age at subsequent mitral valve operation was 2.8 years. The early postoperative mortality rate was 2.2%, and survival at 1 and 10 years was 89.9% and 86.6%, respectively. A high rate of complete heart block was noted within the MVR group (37.5%). Freedom from later mitral valve reoperation for both groups was similar. No significant morphological predictors necessitating MVR were found. Predictors of reoperation within the MVP group included the presence of moderate or worse MR in the early postoperative period. In both groups New York Heart Association class, degree of MR, growth, and ventricular volumes improved. Conclusions —Mitral valve surgery significantly improves clinical status, with a sustained improvement in ventricular chamber size. MR can be successfully managed in patients after repair of AVSD independent of morphological type. Overall survival is acceptable, and further reoperation within the MVP group is influenced by early outcome of repair.

scholarly journals Recurrent Sigmoid Volvulus – Early Resection may Obviate Later Emergency Surgery and Reduce Morbidity and Mortality

2009 ◽  
Vol 91 (3) ◽  
pp. 205-209 ◽  
Author(s):  
JO Larkin ◽  
TB Thekiso ◽  
R Waldron ◽  
K Barry ◽  
PW Eustace
Keyword(s):  
Emergency Surgery ◽  
Hospital Admissions ◽  
Elective Surgery ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Sigmoid Volvulus ◽  
High Rate ◽  
Colonoscopic Decompression ◽  
Non Operative Management ◽  
Overall Mortality

INTRODUCTION Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS We reviewed our unit's experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.

scholarly journals Perioperative complications of esophagectomy - prevention, diagnosis and management

2017 ◽  
Vol 64 (1) ◽  
pp. 27-38
Author(s):  
Dejan Stojakov ◽  
Predrag Sabljak ◽  
Bratislav Spica ◽  
Dejan Velickovic ◽  
Vladimir Sljukic ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Perioperative Complications ◽  
Rapid Development ◽  
Postoperative Mortality ◽  
High Volume ◽  
Esophageal Resection ◽  
Vocal Cord Palsy ◽  
Pulmonary Complications ◽  
High Rate ◽  
Septic Complications

Esophageal resection with reconstruction is complex surgical procedure with high rate of postoperative morbidity, with decreasing mortality rate during last decades, particularly in high-volume hospitals. Numerous preoperative, intraoperative and postoperative factors have contribute to incidence and type of complications. Intraoperative haemorrhage and tracheobronchial lesions could be avoid by good surgical judgement and operative technique. Pulmonary complications are often, with multifactorial etiology, and they are the main cause of postoperative mortality after esophagectomy. Dehiscence of esophageal anastomosis could be fatal, and only high index of suspicion and early diagnosis lead to successful treatment. In majority of such cases conservative measures are successful, however, conduit necrosis is indication for surgical reoperation. Vocal cord palsy due to intraoperative injury of recurrent laryngeal nerves is not rare and increases pulmonary complications rate. New onset of arrhythmia could be associate with other surgical complications. Postesophagectomy chylothorax is life-threatening complication due to rapid development of immunosuppression and septic complications, and early ligation of thoracic duct is often mandatory. Intrathoracic herniation of intrabdominal viscera is rare, and ischemic spinal cord lesions are very rare after esophagectomy. Majority of perioperative complications could be prevented or solved, decreasing mortality rate of esophagectomy.

Abstract 05: Race and Hospitalization for Cardiovascular Disease in Patients With Systemic Lupus Erythematosus

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Meghan Angley ◽  
Tene T Lewis ◽  
Penelope P Howards ◽  
Sung Lim
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiovascular Disease ◽  
African Americans ◽  
Lupus Erythematosus ◽  
Survival Curve ◽  
Population Based ◽  
Systemic Lupus ◽  
Time To Event Data ◽  
Artery Disease ◽  
Stratified Analysis

Background: Patients diagnosed with systemic lupus erythematosus (SLE) are at greater risk of cardiovascular disease (CVD) and death at earlier ages than the general population, with African Americans (AA) at risk at earlier ages than non-AAs. However, the association between race and recurrent hospitalizations for CVD, which are associated with mortality, has not been explored. Methods: The Georgia Lupus Registry (GLR) is a population-based registry of individuals with SLE in 2002-2004 in Atlanta, Georgia. Both incident and prevalent cases were enrolled, and we included all cases diagnosed beginning in 2000. The GLR was matched to Georgia inpatient hospital discharge records from 2000-2013. Using ICD-9-CM codes, we identified hospitalizations classified as having coronary heart disease, peripheral artery disease, cerebrovascular disease or heart failure. The Prentice-Williams-Peterson Model with a total time scale measured from diagnosis was used to examine recurrent time to event data. We truncated the number of hospitalizations at 3 to maintain stable modeling estimates. Patients were censored at the time of death or at the end of 2013. Models were adjusted for sex and age at diagnosis. Results: A total of 556 participants in the GLR (87% female, 73% AA) had a median age at SLE diagnosis of 38 years and 27% experienced at least 1 CVD hospitalization, while 17% experienced ≥ 2. Overall, AA race was associated with recurrent hospitalizations (adjusted hazard ratio [aHR]: 1.7, 95% confidence interval [CI]: 1.2, 2.3). In an event-specific stratified analysis, the association between AA race and the hazard of recurrence became even more pronounced in later events (Event 1 aHR: 1.2, 95% CI: 1.0, 1.5; Event 2 aHR: 1.5, 95% CI: 1.2, 2.2; Event 3 aHR: 1.9, 95% CI: 1.1, 3.2). Conclusions: African-Americans with SLE were more likely to experience recurrent hospitalizations for CVD than their non-AA counterparts, suggesting that AA individuals with SLE may be more vulnerable to CV complications of SLE. Figure 1. Survival curve for 1st event

scholarly journals Characteristics and Clinical Outcomes of Open Surgery for Trigger Digits in Diabetes

2018 ◽  
Vol 11 (02) ◽  
pp. 080-083
Author(s):  
Sean Wei Loong Ho ◽  
Ching Yee Chia ◽  
Vaikunthan Rajaratnam
Keyword(s):  
Clinical Outcomes ◽  
Open Surgery ◽  
Clinical Presentation ◽  
Clinical Severity ◽  
High Rate ◽  
Dominant Hand ◽  
Diabetes Group ◽  
Initial Surgery ◽  
Patient Reported ◽  
Surgical Release

Abstract Introduction Trigger digit is a common condition of the hand. Diabetes has a known association with the development of trigger digit. It is thought to influence the clinical presentation and efficacy of open surgical release. This study aimed to assess the differential characteristics of trigger digits and the clinical outcomes of open surgery for trigger digits in diabetics. Materials and Methods This was a retrospective study of all patients who underwent open surgical release of trigger digits in a single institution from 2012 to 2013. Patients were divided into two groups with group 1 consisting of all patients with a history of diabetes. Group 2 consisted of all patients without diabetes. Demographics and clinical presentation were reviewed. All patients were reviewed via a telephone questionnaire at least 2 years after the initial surgery and were assessed for patient-reported outcomes. Results There were 201 patients who met the inclusion criteria, of which 191 patients were recruited. This included 87 (45.5%) males and 104 (54.5%) females. A total of 260 open releases were performed. Sixty-one (31.9%) patients were diabetic, and 130 (68.1%) patients were nondiabetic. The diabetic group was significantly older than the nondiabetic group (p = 0.002). The dominant hand was not significantly more affected than the nondominant hand (p = 0.51). The middle finger was most commonly involved (43.5%), and the little finger was the least commonly involved (1.2%). There was no significant increase in multiple-digit presentation in the diabetic population when compared with the nondiabetic population (p = 0.52). There was a low complication rate and a high rate of postoperative satisfaction after open surgery in both groups. Conclusion Diabetes does not predispose patients to increased rates of multiple trigger digit presentation or increased clinical severity on presentation. Open surgery for trigger digit is an effective and safe treatment modality for diabetics.

Preoperative skeletal muscle density is associated with postoperative mortality in patients with cardiovascular disease

2019 ◽  
Vol 30 (4) ◽  
pp. 515-522 ◽  
Author(s):  
Masashi Yamashita ◽  
Kentaro Kamiya ◽  
Atsuhiko Matsunaga ◽  
Tadashi Kitamura ◽  
Nobuaki Hamazaki ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Skeletal Muscle ◽  
Receiver Operating Characteristic Curve ◽  
Prognostic Model ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Postoperative Mortality ◽  
Youden Index ◽  
Muscle Density ◽  
Operating Characteristic Curve

Abstract OBJECTIVES Although skeletal muscle density (SMD) is useful for predicting mortality, the cut-off in an acute clinical setting is unclear, especially in patients with cardiovascular disease (CVD). This study was performed to determine the preoperative SMD cut-off using the psoas muscle and to investigate the effect on postoperative outcomes, including sarcopaenia, in CVD patients. METHODS Preoperative psoas SMD was measured by abdominal computed tomography in CVD patients. Postoperative sarcopaenia was defined according to the criteria of the Asia Working Group for Sarcopaenia. The Youden index was used to test the predictive accuracy of survival models. The prognostic capability was evaluated using multivariable survival and receiver operating characteristic curve analyses. RESULTS Continuous data were available for 1068 patients (mean age 65.5 years; 63.6% male). A total of 105 (9.8%) deaths occurred during the 1.99-year median follow-up period (interquartile range 0.71–4.15). The psoas SMD cut-off estimated by the Youden index was 45 Hounsfield units with high sensitivity and moderate specificity for all-cause mortality and was consistent in various stratified analyses. After adjusting for the existing prognostic model, EuroSCORE II, preoperative and postoperative physical status, psoas SMD cut-off was predicted for mortality (hazard ratio 2.42, 95% confidence interval 1.32–4.45). The psoas SMD cut-off was also significantly associated with postoperative sarcopaenia and provided additional prognostic information to EuroSCORE II on receiver operating characteristic curve analysis (area under the curve 0.627 vs 0.678, P = 0.011). CONCLUSIONS Reduced psoas SMD was associated with postoperative mortality and added information prognostic for mortality to the existing prognostic model in CVD patients.

scholarly journals Genetic defects of CHM and visual acuity outcome in 24 choroideremia patients from 16 Japanese families

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takaaki Hayashi ◽  
Shuhei Kameya ◽  
Kei Mizobuchi ◽  
Daiki Kubota ◽  
Sachiko Kikuchi ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Survival Curve ◽  
Japanese Patients ◽  
Outcome Data ◽  
High Rate ◽  
Exon 2 ◽  
Pathogenic Variants ◽  
Kaplan Meier ◽  
Whole Exome

Abstract Choroideremia (CHM) is an incurable progressive chorioretinal dystrophy. Little is known about the natural disease course of visual acuity in the Japanese population. We aimed to investigate the genetic spectrum of the CHM gene and visual acuity outcomes in 24 CHM patients from 16 Japanese families. We measured decimal best-corrected visual acuity (BCVA) at presentation and follow-up, converted to logMAR units for statistical analysis. Sanger and/or whole-exome sequencing were performed to identify pathogenic CHM variants/deletions. The median age at presentation was 37.0 years (range, 5–76 years). The mean follow-up interval was 8.2 years. BCVA of the better-seeing eye at presentation was significantly worsened with increasing age (r = 0.515, p < 0.01), with a high rate of BCVA decline in patients > 40 years old. A Kaplan–Meier survival curve suggested that a BCVA of Snellen equivalent 20/40 at follow-up remains until the fifties. Fourteen pathogenic variants, 6 of which were novel [c.49 + 5G > A, c.116 + 5G > A, p.(Gly176Glu, Glu177Ter), p.Tyr531Ter, an exon 2 deletion, and a 5.0-Mb deletion], were identified in 15 families. No variant was found in one family only. Our BCVA outcome data are useful for predicting visual prognosis and determining the timing of intervention in Japanese patients with CHM variants.

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