Gastrostomy Tube Placement in Neonates Undergoing Congenital Heart Surgery: A Novel Assessment for Improving Utilization and Timing of Placement.

BACKGROUND: Neonates undergoing congenital heart defect repair require optimized nutritional support in the perioperative period. Utilization of a gastrostomy tube is not infrequent, yet optimal timing for placement is ill-defined. The objective of this study was to identify characteristics of patients whose postoperative course included gastrostomy tube placement to facilitate supplemental tube feeding following neonatal repair of congenital heart defects. METHODS: A single-institution, retrospective chart review identified 64 consecutive neonates who underwent cardiac operations from 2012 to 2016. Perioperative variables were evaluated for significance in relation to gastrostomy tube placement. RESULTS: A total of 27 (42%) underwent gastrostomy tube placement. Diagnosis of a genetic syndrome was associated with the likelihood of placement of gastrostomy tube (P = .032), as were patients with single ventricle physiology (P = .0013) compared to those felt to be amenable to eventual biventricular repair. Aortic arch reconstruction (P = .029), as well as the need for delayed sternal closure (P = .05), was associated with increased frequency of gastrostomy tube placement. Postoperative outcomes including the number of days intubated (P = .0026) and the presence of significant dysphagia (P = .0034) were associated with gastrostomy placement. Additionally, genetic syndrome (P = .003), aortic arch reconstruction (P = .01), and postoperative intubation duration (P = .0024) correlated with increased length of stay, where increased length of stay was associated with gastrostomy tube placement (P = .0004). DISCUSSION: Patient characteristics that were associated with a high likelihood of eventual gastrostomy placement were identified in this study. Early recognition of such characteristics in future patients may allow for reduced time to gastrostomy tube placement, which in turn may improve perioperative growth and outcomes.

Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting.

Objectives: Heart disease is the leading cause of death in American Indians (AIs). For AI patients with severe coronary artery disease requiring coronary artery bypass graft (CABG) surgery, little data exist. The purpose of this study was to evaluate short-term outcomes of Northern Plains AI undergoing CABG and identify variations in patient presentation. Methods: All patients undergoing isolated CABG between June 2012 and June 2017 were studied. Seventy-four AI and 1236 non-American Indian (non-AI) patients were identified. Risk factors, preoperative characteristics, cardiac status, procedural information, and outcomes were collected. Univariate analysis comparing short-term clinical outcomes between AI and non-AI populations was performed. Multivariable logistic regression models were constructed and outcome differences assessed. Unadjusted Kaplan-Meier survival estimates were produced using 5-year survival data. Results: AI patients presented with increased risk factors, including higher rates of diabetes mellitus (AI 63.5% vs. non-AI 38.7% p=< 0.001) and smoking/tobacco use (AI 60.8% vs. non-AI 20.0% p=> 0.001). Seventy-nine percent of AI patients resided on or near federal reservations and presented from rural locations. Internal mammary artery (IMA) graft use in both groups was high (AI 95.9% vs. non-AI 94.9% p=0.904), and multiarterial grafting with left internal mammary artery and radial artery use was common in both groups (AI 67.6% vs. non-AI 69.6% p=0.814). No significant differences in unadjusted 30-day mortality or short-term outcomes were detected. Adjusted Kaplan-Meier survival curves were similar between race groups up through 5 years after CABG (p-value=0.38). Conclusion: AIs presented with significantly more risk factors for cardiovascular disease compared with the general population, with especially high rates of insulin-dependent diabetes and active tobacco use. Despite this, outcomes were similar between groups. In propensity-matched groups, AIs were at decreased risk for prolonged length of stay and combined morbidity/mortality. In contrast to previous reports, AI racial identity did not adversely affect survival up to 5 years after CABG.

A Meta-Analysis of Postoperative Radiotherapy for Thymic Carcinoma.

Postoperative radiotherapy may significantly improve survival of patients undergoing surgery for thymic carcinoma; however, the quality of available evidence is low. We performed a meta-analysis encompassing 973 patients to investigate the effect of postoperative radiotherapy on survival outcomes of thymic carcinoma, and included our analysis of the Surveillance, Epidemiology, and End Results database. The pooled hazard ratio of postoperative radiotherapy was 0.66 (95% confidence interval: 0.54 to 0.80, p < 0.001) for overall survival and 0.54 (95% confidence interval: 0.41 to 0.71, p < 0.001) for progression-free survival. The balance of best available evidence suggests that postoperative radiotherapy after resection of thymic carcinoma is associated with improved overall and progression-free survival.