Cardiac Surgery Outcomes During the COVID-19 Pandemic Worsened Across All Socioeconomic Statuses.

BACKGROUND: Increasing socioeconomic distress has been associated with worse cardiac surgery outcomes. The extent to which the pandemic affected cardiac surgical access and outcomes remains unknown. We sought to examine the relationship between the COVID-19 pandemic and outcomes after cardiac surgery by socioeconomic status. METHODS: All patients undergoing a Society of Thoracic Surgeons (STS) index operation in a regional collaborative, the Virginia Cardiac Services Quality Initiative (2011-2022), were analyzed. Patients were stratified by timing of surgery before vs during the COVID-19 pandemic (March 13, 2020). Hierarchic logistic regression assessed the relationship between the pandemic and operative mortality, major morbidity, and cost, adjusting for the Distressed Communities Index (DCI), STS predicted risk of mortality, intraoperative characteristics, and hospital random effect. RESULTS: A total of 37,769 patients across 17 centers were included. Of these, 7269 patients (19.7%) underwent surgery during the pandemic. On average, patients during the pandemic were less socioeconomically distressed (DCI 37.4 vs DCI 41.9; P < .001) and had a lower STS predicted risk of mortality (2.16% vs 2.53%, P < .001). After risk adjustment, the pandemic was significantly associated with increased mortality (odds ratio 1.398; 95% CI, 1.179-1.657; P < .001), cost (+$4823, P < .001), and STS failure to rescue (odds ratio 1.37; 95% CI, 1.10-1.70; P = .005). The negative impact of the pandemic on mortality and cost was similar regardless of DCI. CONCLUSIONS: Across all socioeconomic statuses, the pandemic is associated with higher cost and greater risk-adjusted mortality, perhaps related to a resource-constrained health care system. More patients during the pandemic were from less distressed communities, raising concern for access to care in distressed communities.

Autism spectrum disorder among 16- to 30-month-old children in Bangladesh: Observational cross-sectional study.

LAY ABSTRACT: A nationwide survey was done in Bangladesh to assess autism spectrum disorder prevalence in 16- to 30-month-old children at urban-rural distribution and to determine the association with socioeconomic and demographic conditions. A three-stage cluster sampling method was used where districts from all divisions were selected in the first stage, census enumeration areas as blocks of households were selected in the second stage and households (within the blocks) were selected in the third stage. Thereby, it included 38,440 children from 37,982 households (71% rural, 29% urban) aged 16-30 months from 30 districts of eight divisions of Bangladesh. Screening was done with a 'Red Flag' tool and Modified Checklist for Toddlers and a final diagnosis using Diagnostic and Statistical Manual of Mental Disorders, 5th Edition for autism spectrum disorder. Autism spectrum disorder prevalence was 17 per 10,000 young children - in other words, one in 589 young children. Boys were found at higher risk of autism (one in 423 boys; one in 1026 girls). Prevalence of autism spectrum disorder was higher in urban environments than in rural ones - 25/10,000 and 14/10,000, respectively. More autism spectrum disorder children were found in advanced age groups of parents, especially mothers, and in households with a higher wealth quintile. This survey is significant as it covers both urban and rural areas and specifically targets very young children. The involvement of the Bangladesh Bureau of Statistics, as well as support from the entire healthcare system infrastructure, makes this survey more representative on a national level. Its results will form a database to support the development of an effective early intervention programme in Bangladesh. We hope it will prove useful for researchers, clinicians and frontline healthcare workers, and inform the decisions of policymakers and funders in Bangladesh.

Examination of a Proposed 30-day Readmission Risk Score on Discharge Location and Cost.

BACKGROUND: Readmissions cost an estimated $41 billion in the United States each year. To address this, a single institution recently developed a new risk model predictive of 30-day readmission after adult cardiac surgery. The purpose of this study is to validate and refine this new readmission risk model using a statewide database. METHODS: A total of 19,964 patients were analyzed using a statewide Society of Thoracic Surgeons database (2014-2017). The aforementioned multivariate model was replicated (model 1): race, hospital length of stay, chronic lung disease, operation type, and renal failure. Model 2 also included discharge location. Thirty-day readmission risk scores and low-risk (0%-10%), moderate-risk (10%-13%), and high-risk (≥13%) categories were calculated. RESULTS: The overall 30-day readmission rate was 11.1% with both models 1 and 2 predicting readmission (odds ratio, 1.09; 95% confidence interval, 1.08-1.11 vs odds ratio, 1.10; 95% confidence interval, 1.08-1.11). Statistically significant differences were observed across all risk categories in discharge location and total cost. For models 1 and 2, 86% of low-risk patients were discharged to home vs 66.9% and 42.9% of patients in high-risk groups, respectively (P < .001). The largest increases were observed with a hospice discharge location for both model 1 (from $37,930 to $89,285) and model 2 (from $37,930 to $89,230). CONCLUSIONS: Both risk models significantly predicted 30-day readmission in our multiinstitutional dataset, confirming the score is valid and a generalizable quality improvement tool. The addition of discharge location and total cost adds valuable information of the ongoing efforts to identify patients at high risk for readmission.

Assessing Risks from Cyclones for Human Lives and Livelihoods in the Coastal Region of Bangladesh.

As a disaster prone country, Bangladesh is regularly hit by natural hazards, including devastating cyclones, such as in 1970, 1991 and 2007. Although the number of cyclones' fatalities reduced from 0.3 million in 1970 to a few thousand or fewer in recent events, loss of lives and impact on livelihoods remains a concern. It depends on the meteorological characteristics of cyclone and the general vulnerability and capacity of the exposed population. In that perspective, a spatially explicit risk assessment is an essential step towards targeted disaster risk reduction. This study aims at analyzing the spatial variation of the different factors contributing to the risk for coastal communities at regional scale, including the distribution of the hazards, exposure, vulnerability and capacity. An exploratory factor analysis method is used to map vulnerability contrasts between local administrative units. Indexing and ranking using geospatial techniques are used to produce maps of exposure, hazard, vulnerability, capacities and risk. Results show that vulnerable populations and exposed areas are distributed along the land sea boundary, islands and major inland rivers. The hazard, assessed from the density of historical cyclone paths, is highest in the southwestern part of the coast. Whereas cyclones shelters are shown to properly serve the most vulnerable populations as priority evacuation centers, the overall pattern of capacity accounting for building quality and road network shows a more complex pattern. Resultant risk maps also provide a reasonable basis from which to take further structural measures to minimize loss of lives in the upcoming cyclones.

Thromboembolism after pneumonectomy for malignancy: an independent marker of poor outcome.

OBJECTIVE: Because venous thromboembolism results in important postoperative morbidity and mortality after pneumonectomy for malignancy, we sought to determine its prevalence, location, management, timing, and risk factors. We also evaluated short- and long-term outcomes of patients in whom venous thromboembolism developed compared with those of patients in whom it did not. METHODS: Between January 1990 and January 2001, 336 patients underwent pneumonectomy for malignancy. Patients were considered to have venous thromboembolism if they were identified as having deep vein thrombosis or pulmonary embolus through chart review, including pulmonary imaging studies. All patients were managed with anticoagulation or anticoagulation plus thrombolysis. RESULTS: Twenty-five (7.4%) patients had postoperative venous thromboembolism, with peak incidence 7 days after the operation; most had already been discharged from the hospital. Higher pack-years of smoking was associated with increased risk, as well as with earlier occurrence of venous thromboembolism (P < .04). Survival was 55% at 6 months and 13% at 18 months; mode of death was cancer in 14 (61%) of 23, respiratory failure in 4 (17%) of 23, multisystem organ failure in 3 (13%) of 23, myocardial infarction in 1 (4.4%) of 23, and uncertain in 1 (4.4%) of 23. Low preoperative forced vital capacity was predictive of poor long-term survival (P = .02). Patients with venous thromboembolism had substantially lower survival than predicted from competing-risks analysis of survival without venous thromboembolism (13% vs 60% at 18 months), and this difference persisted after censoring for deaths directly attributable to venous thromboembolism. CONCLUSIONS: Venous thromboembolism is surprisingly common after pneumonectomy for malignancy and portends poor survival. Improved screening and better prophylaxis might prevent this complication and enhance outcome.