Reintervention and mortality risk after total anomalous pulmonary venous connection repair.

BACKGROUND: Management of total anomalous pulmonary venous connections has been extensively studied to further improve outcomes. Our institution previously reported factors associated with mortality, recurrent obstruction, and reintervention. The study purpose was to revisit the cohort of patients and evaluate factors associated with reintervention, and mortality in early and late follow-up. METHODS: A retrospective review at our institution identified 81 patients undergoing total anomalous pulmonary venous connection repair from January 2002 to January 2018. Demographic and operative variables were evaluated. Anastomotic reintervention (interventional or surgical) and/or mortality were primary endpoints. RESULTS: Eighty-one patients met the study criteria. Follow-up ranged from 0 to 6,291 days (17.2 years), a mean of 1263 days (3.5 years). Surgical mortality was 16.1% and reintervention rates were 19.8%. In re-interventions performed, 80% occurred within 1.2 years, while 94% of mortalities were within 4.1 months. Increasing cardiopulmonary bypass times (p = 0.0001) and the presence of obstruction at the time of surgery (p = 0.025) were predictors of mortality, while intracardiac total anomalous pulmonary venous connection type (p = 0.033) was protective. Risk of reintervention was higher with increasing cardiopulmonary bypass times (p = 0.015), single ventricle anatomy (p = 0.02), and a post-repair gradient >2 mmHg on transesophageal echocardiogram (p = 0.009). CONCLUSIONS: Evaluation of a larger cohort with longer follow-up demonstrated the relationship of anatomic complexity and symptoms at presentation to increased mortality risk after total anomalous pulmonary venous connection repair. The presence of a single ventricle or a post-operative confluence gradient >2 mmHg were risk factors for reintervention. These findings support those found in our initial study.

Using a quality improvement initiative to reduce acute kidney injury during on-pump coronary artery bypass grafting.

INTRODUCTION: In response to a perceived high incidence of acute kidney injury following cardiopulmonary bypass at our institution, a quality improvement initiative consisting of a systematic change to a delivered oxygen (DO2) goal-directed perfusion practice was implemented. We sought to maintain DO2 > 270 mL/min/m2 to reduce the incidence of acute kidney injury. METHODS: 'The study population included all patients receiving isolated, non-emergent, on-pump coronary artery bypass grafting from January 2015 through December 2018, excluding patients requiring preoperative hemodialysis. DO2 goal-directed perfusion was instituted in February 2017. Acute kidney injury was defined using Acute Kidney Injury Network criteria. RESULTS: The pre-goal-directed perfusion cohort included 257 patients, and the post-goal-directed perfusion cohort included 226 patients. The DO2 was significantly higher in the post-goal-directed perfusion group (p < 0.001). Postoperative change in serum creatinine and incidence of acute kidney injury were significantly lower in the post-goal-directed perfusion group (p < 0.001, p = 0.001, respectively). Estimation with probit and ordered probit models support these findings. CONCLUSION: This initiative confirms previous assertions that DO2 is a critical intraoperative parameter and should direct perfusion intervention accordingly.

The event study in international business research: Opportunities, challenges, and practical solutions.

The event study or event study method (ESM) is an empirical technique for capturing investors' reaction to an event affecting one or more publicly traded firms. The ESM has been little employed in international business (IB) research despite its frequency in accounting, economics, and finance; for example, only two percent of the empirical articles in JIBS over 1970-2019 include an event study. While this scarcity could indicate a lack of demand, we argue that the field of IB studies offers many interesting and important research opportunities for an event study. We believe that the challenges arise primarily from the supply side, because conducting an event study involves overcoming a variety of data and analytical hurdles. We examine these methodological challenges and offer practical solutions designed to encourage adoption of the ESM. An online appendix with coding and examples provides additional resources. Supplementary Information: The online version contains supplementary material available at 10.1057/s41267-022-00509-7.

L'étude d'événement ou la méthode d'étude d'événement (Event Study Method - ESM) est une technique empirique qui vise à refléter la réaction des investisseurs à un événement influençant une ou plusieurs entreprises cotées en bourse. Malgré sa fréquence dans la comptabilité, l'économie et la finance, l'ESM a été peu utilisée dans la recherche portée sur les affaires internationales (International Business - IB) ; A titre d'exemple, seuls deux pour cent des articles empiriques publiés dans la JIBS sur la période 1970­2019 incluent une étude d'événement. Bien que cette rareté puisse indiquer un manque de demande, nous argumentons que le domaine des IB offre de nombreuses opportunités de recherche intéressantes et importantes à une étude d'événement. Nous croyons que les défis proviennent principalement du côté de l'offre, car la réalisation d'une étude d'événement implique de surmonter une variété d'obstacles analytiques et de données. Nous examinons ces défis méthodologiques, et proposons des solutions pratiques conçues pour encourager l'adoption de l'ESM. Une annexe en ligne avec codage et exemples fournit des ressources supplémentaires.

El estudio de eventos o método de estudio de eventos (ESM por sus iniciales en inglés) es una técnica empírica para capturarar la reacción de los inversionistas a un evento que afecta a una o más empresas que cotizan en bolsa. El método de estudio de eventos ha sido poco empleado en la investigación de negocios internacionales (IB por las siglas en inglés) a pesar de su frecuencia en contabilidad, economía y finanzas; por ejemplo, sólo el dos por ciento de los artículos empíricos en JIBS durante 1970­2019 incluyen un estudio de eventos. Si bien esta escasez podría indicar una falta de demanda, sostenemos que el campo de los estudios de negocios internacionales ofrece muchas interesantes e importantes oportunidades de investigación para un estudio de eventos. Creemos que los retos surgen principalmente del lado de la oferta, debido a que llevar a cabo un estudio de eventos supone superar una variedad de datos y obstáculos analíticos. Examinamos estos retos metodológicos y ofrecemos soluciones prácticas diseñadas para fomentar la adopción del estudio de eventos. Un apéndice en línea con codificación y ejemplos ofrece recursos adicionales.

O estudo de eventos ou método de estudo de eventos (ESM) é uma técnica empírica para capturar a reação de investidores a um evento que afeta uma ou mais empresas de capital aberto. O ESM tem sido pouco empregado na pesquisa de negócios internacionais (IB), apesar da sua frequência em contabilidade, economia e finanças; por exemplo, apenas dois por cento dos artigos empíricos no JIBS entre 1970­2019 incluem um estudo de evento. Embora essa escassez possa indicar falta de demanda, argumentamos que o campo de estudos em IB oferece muitas oportunidades de pesquisa interessantes e importantes para um estudo de evento. Acreditamos que os desafios surjam principalmente do lado da oferta, já que a condução de um estudo de evento envolve superar uma variedade de dados e obstáculos analíticos. Examinamos esses desafios metodológicos e oferecemos soluções práticas destinadas a incentivar a adoção do ESM. Um apêndice online com códigos e exemplos fornece recursos adicionais.

Lung lobectomy surgical approach and resource utilization differ by anatomic lobe in a statewide discharge registry.

Background: Anatomic lobe-specific differences with respect to pulmonary lobectomy have been suggested in the thoracic surgery literature but hard data has been lacking in larger population studies in part due to coding systems that do not distinguish pulmonary lobectomy by anatomic lobe. International Classification of Diseases, Tenth Revision (ICD-10) procedure codes, adopted in the United States in 2015, may provide novel methodologic accessibility for pulmonary lobectomy studies as they classify lobectomy operations by specific anatomic lobe. We queried the Texas Inpatient Public Use Data File (TPUDF) ICD-10 codes for both open and endoscopic approach lobectomy with a specific view to differences based on anatomic lobes. Methods: Between fourth fiscal quarter (Q4) 2015 and Q4 2017, all pulmonary lobectomy operations performed in Texas state-licensed hospitals were identified by querying the TPUDF for ICD-10 procedure codes for pulmonary lobectomy as classified by anatomic lobe. Surgical approach, additional procedures and diagnosis codes, length of hospital stay (LOS), and discharge status were recorded with aggregate values undergoing statistical analysis. Results: Right and left upper versus lower lobe resections were more prevalent however minimally invasive surgery was less commonly performed for upper than right lower lobectomy. LOS, irrespective of surgical approach, was longer for upper versus lower lobe resection as was need for transfer to additional inpatient facilities. LOS was longer and need for additional surgical or procedural interventions days after the primary procedure of lobectomy was greater for right versus left upper lobe resection, suggesting some differential properties of the right versus left pleural space. Conclusions: The marked clinical differences between anatomic lobes in the setting of pulmonary lobectomy observed in this study have the potential to translate to differences in expected hospital and health system costs and surgeon time-expenditure and experience premium that currently have no mechanism for their accounting. These findings highlight the value of ICD-10 coding for analysis of pulmonary lobectomy in administrative databases and suggest a possible path to more informed patient counseling and equitable hospital and surgeon reimbursement based on payment adjustment by anatomic lobe in pulmonary lobectomy operations.