REEVALUATION OF THE DIAGNOSIS RELATED GROUPS SYSTEM IN GREECE: THE EXAMPLE OF CORONARY ARTERY BYPASS GRAFT PROCEDURE

2016 ◽  
Vol 10 (3) ◽  
pp. 2163-2167
Author(s):  
Georgios Tagarakis ◽  
Costas Dikeos ◽  
Nikolaos Tsilimingas ◽  
Nikolaos Polyzos
Keyword(s):  
Renal Failure ◽  
Coronary Artery ◽  
Length Of Stay ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Myocardial Infarct ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Perioperative Bleeding

Background. Aim of the current prospective study is to investigate and revise the basic information related to the coronary artery bypass graft (CABG) procedure, in an attempt to reevaluate the current Greek Diagnosis Related Groups (DRGs) system. Methods. In a Greek academic cardiothoracic surgical department, implementing clinical therapeutic protocols, we prospectively recruited 75 patients planned to undergo elective CABG. All basic demographic, medical and perioperative data were gathered in an extensive database, so asto be compared with data predicted by the DRG’s system. Clinical indicators of performance aiming towards quality control were: perioperative mortality, postoperative myocardial infarct, postoperative stroke, postoperative renal failure, total hospital length of stay, rate of reoperation and rate of readmission. Results. None of the study patients deceased. No cases of perioperative myocardial infarct, stroke or renal failure were observed. Two of the patients developed respiratory failure, and one was reoperated for the control of perioperative bleeding. There were no cases of readmission to the hospital. The total length of stay was longer than the DRG’s prediction (mean 11.5 vs 7 days), owed partially to the preoperative stay (mean 3.18days) in the department, due to reasons of medical vigilance and organisatory problems that led to the postponement of the operation. Conclusions. A review of the CABG related DRG’s in Greece seems appropriate, based on the findings of the current study, suggesting a longer than predicted hospital stay.

Increased Risk of Sternal Complications in Patients with Plasma Cell Dyscrasias (PCDs) Undergoing Coronary Artery Bypass Graft (CABG)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5319-5319
Author(s):  
Malini M Patel ◽  
Shams B Bufalino ◽  
Anai N Kothari ◽  
Paul C Kuo ◽  
Sucha Nand
Keyword(s):  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Odds Ratio ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Control Group ◽  
Artery Bypass Graft ◽  
Increased Risk

Abstract Introduction: Skeletal events, including fractures, form an important part of the clinical spectrum of PCDs. Skeletal surveys, even though less sensitive than MRI, remain the usual method of screening for lytic lesions and fractures in these patients but may miss subtle abnormalities. Patients undergoing a CABG normally require a midline sternal incision, which may increase the risk of a skeletal event. Patients with PCDs also have an increased risk of infection, thrombosis, and renal failure. To our knowledge, there is no published data about complications of cardiothoracic surgery in these patients. We hypothesized that patients with PCDs will have a higher risk of complications when compared to those without such history. Methods: Data on patients who underwent non-urgent coronary artery bypass graft (CABG) surgery from 2007 to 2011 was obtained by querying the Healthcare Cost and Utilization State Inpatient Databases for Florida and California. Information was available only for the inpatient stay plus a 30-day follow-up period. Diagnoses of multiple myeloma and monoclonal gammopathy of unknown significance (MGUS) were identified using ICD-9-CM codes. Mixed-effects logistic models were used to measure the association between PCDs and postoperative sternal complications controlling for demographics and comorbidity. Secondary outcomes of study in bivariate analysis included postoperative complications and 30-day readmission rates. Results: A total of 54,422 patients who underwent non-urgent CABG were identified. Of those patients, 500 were known to have a PCD. Ninety two percent of those patients (462 out of 500) had a diagnosis of MGUS. Median age was 66.6 years for the control group and 65.4 years in the PCDs group, and the male to female ratio was equal in both cohorts. In the PCD group, there was a statistically significant higher incidence of anemia, obesity, and renal failure prior to surgical intervention. Sternal infections occurred in 519 (1%) of the patients in the control group versus 18 (3.6%) of the patients in PCDs group (p<0.001). The 30-day all cause readmission rate was similar between the two groups but the 30-day sternal complication rate was significantly higher in the PCDs group (6.8% vs 3.7%; p<0.001). The odds ratio of sternal infection was 3.84 (CI 2.38-6.20) and the odds ratio of sternal dehiscence was 3.87 (CI 1.98-7.57) in the PCDs group when compared to the control group, both of which are statistically significant. Similarly, the odds ratio of sternal complications at 30-days was 1.92 (CI 1.35-2.73) in the PCDs group when compared to the control group. There were no statistically significant differences in the rates of postoperative myocardial infarctions, strokes, urinary tract infections, acute kidney injury, pneumonias, deep venous thrombosis, and gastrointestinal complications between the two cohorts. Conclusions: Our data shows that patients with PCDs have a lower hemoglobin level, renal insufficiency, and are obese at the time of coronary bypass surgery. It is important to note that the majority of the subjects in our study population had MGUS, a condition usually associated with little morbidity. Nonetheless, our cohort of patients with PCDs had a significantly increased risk of sternal wound infection and dehiscence. The treating physicians should be aware of these risks and patients should be informed. Prospective studies will be necessary to confirm and extend these findings. Disclosures No relevant conflicts of interest to declare.

Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery

Open Medicine ◽  
2010 ◽  
Vol 5 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Mahmood Shirzad ◽  
Abbasali Karimi ◽  
Samaneh Dowlatshahi ◽  
Seyed Ahmadi ◽  
Saeed Davoodi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Length Of Stay ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Resource Utilization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Preoperative Anemia ◽  
Mortality And Morbidity

AbstractAnemia is an indisputable finding in patients scheduled for coronary artery bypass graft (CABG) that can occur any time preoperatively. In presence of severe coronary artery disease, anemia can dramatically affect surgical outcomes. Therefore, we conducted this study to determine the effect of low preoperative hemoglobin (Hgb) on postoperative outcome in patients who underwent coronary artery bypass graft (CABG). In all, 4432 patients who had undergone isolated CABG at Tehran Heart Center over the 2-year period from March 2006 to February 2008 were studied. All medical records of the aforementioned patients were derived from our hospital surgery data bank. After adjustment for confounders, the association of different preoperative levels of Hgb with risk of cardiac, pulmonary, infectious, and ischemic complications, and also with prolonged ventilation and resource utilization, were assessed in a multivariable model. After adjustment for confounders that may affect mortality and morbidities, we found that cardiac, infectious, ischemic, and pulmonary complications, as well as postoperative mortality, were significantly higher in anemic patients compared to those with normal Hgb levels. In addition, total ventilation time, total intensive care unit hour stay (ICU), hospital length of stay (HLOS), and postsurgery length of stay (PLOS) were significantly longer in anemic patients. We concluded that isolated CABG patients with preoperative anemia have significantly higher mortality and morbidity, and use more health care resources. Preoperative anemia is an independent variable for increased resource utilization, morbidity, and mortality.

scholarly journals Aprotinin Decreases Postoperative Bleeding and Number of Transfusions in Patients on Clopidogrel Undergoing Coronary Artery Bypass Graft Surgery

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Jan van der Linden ◽  
Gabriella Lindvall ◽  
Ulrik Sartipy
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Unstable Angina ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Postoperative Bleeding ◽  
Artery Bypass Graft ◽  
Perioperative Bleeding ◽  
The Impact

Background— Clopidogrel, an irreversible platelet inhibitor, is used to treat patients with unstable angina. These patients often present for coronary artery bypass graft surgery (CABG) and are at increased risk for perioperative bleeding. The current investigation evaluates the impact of aprotinin on bleeding and transfusion requirements in clopidogrel-treated patients undergoing CABG. Methods and Results— Seventy-five consecutive patients with unstable angina, administered clopidogrel <5 days before CABG, were randomized. Using a double-blind design, patients received full-dose aprotinin (n =37) or saline (n =38). Elapsed times between the last dose of clopidogrel and start of the operation were similar between the 2 groups [aprotinin, 58±28 hour (mean± SD); control, 54±27 hour; P =0.86], as were age (aprotinin, 66.4±10 years; control, 68.3±10 years; P =0.51), number of distal anastomoses (aprotinin, 3.6±1.0; control, 3.7±1.0; P =0.79), operative times (aprotinin, 192±48 minutes; control, 200±53 minutes; P =0.55), and lowest intraoperative hemoglobin level (aprotinin, 87±14 g/L; control, 88±14 g/L; P =0.60). Postoperative bleeding was 760±350 mL in aprotinin-treated patients versus 1200±570 mL ( P <0.001) in control. During the hospital stay, patients in the aprotinin group received 1.2±1.5 and 0.1±0.4 U of erythrocytes and platelets, respectively, versus 2.8±3.2 ( P =0.02) and 0.9±1.4 ( P =0.002) units in the control. In the aprotinin group, 53% of patients received transfusions, whereas 79% of controls were exposed to blood products ( P =0.02). Conclusions— Intraoperative aprotinin decreases postoperative bleeding and the number of transfusions in patients undergoing CABG and treated with clopidogrel <5 days before surgery.

Determinants of Length of Stay After Coronary Artery Bypass Graft Surgery

Circulation ◽  
1995 ◽  
Vol 92 (9) ◽  
pp. 20-24 ◽  
Author(s):  
Harold L. Lazar ◽  
Carmel Fitzgerald ◽  
Stacy Gross ◽  
Tim Heeren ◽  
Gabriel S. Aldea ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Length Of Stay ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft
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