Visual recovery after immediate sequential bilateral cataract surgery at a veterans' hospital.

PURPOSE: To answer patient questions about the expected timeline for recovery, the objective postoperative visual acuities were reviewed for patients undergoing immediate sequential bilateral cataract surgery (ISBCS). SETTING: Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri. DESIGN: Retrospective chart review. METHODS: All patients who underwent ISBCS in 2019 were evaluated. A total of 116 patients (232 eyes) were studied. Uncorrected distance visual acuity (UDVA) for postoperative day 0 or 1 (POD0/1), postoperative week 1 (POW1), and postoperative month 1 (POM1) were required for study inclusion. Patients with ocular comorbidities were not excluded, although all patients passed an initial screening to qualify for ISBCS. The outcome measures included POD0/1, POW1, and POM1 UDVA. RESULTS: Postoperative UDVA was stable or improved compared with preoperative corrected distance visual acuity (CDVA) for 48% (66/138) of eyes on POD0, 79% (74/94) of eyes on POD1, and 90% (209/232) of eyes on POW1. 83% of patients at POD1 and 90% of patients at POW1 had stable or improved visual acuity in at least 1 eye. 92% (214/232) of eyes had a POW1 UDVA of 20/40 or better. Of the 18 eyes with a postoperative POW1 UDVA of 20/50 or worse, 5 (28%) were known preoperatively to have limited visual potential. 99% (115/116) of patients had at least 1 eye 20/40 or better. CONCLUSIONS: Most of the patients who underwent ISBCS demonstrated meaningful improvement in UDVA compared with preoperative CDVA as early as POD1. These results serve to guide discussion of postoperative expectations with patients interested in ISBCS.

Outcomes of Early Mitral Valve Reoperation in the Medicare Population.

BACKGROUND: Surgical series on mitral valve reoperation are limited by small numbers and lack of national representation. Large-scale outcomes of reoperation for mitral valve surgery remain uncertain. METHODS: This is a descriptive analysis of 1,627 Medicare beneficiaries who underwent mitral valve reoperation within a 3-year follow-up period after an initial mitral operation (repair or replacement) that took place between 2000 and 2006. The primary outcomes were hospital mortality and long-term survival. RESULTS: The 1,627 patients included in the study comprise 1.6% of patients who underwent operation between 2000 and 2006. The initial surgery was repair in 49.9%, bioprosthetic replacement in 22.0%, and mechanical replacement in 28.1%. Re-repair was performed in 15.4%. Hospital mortality was 12.0% and was similar for repair and bioprosthetic or mechanical replacement. Reoperative mortality was similar for men and women and for patients aged 75 years or less versus more than 75 years; and was significantly higher for nonelective than for elective operations (15.6% versus 5.5%, p = 0.0001), for patients with endocarditis than without endocarditis (21.4% versus 11.0%, p = 0.0001), and for patients with heart failure than without heart failure (14.2% versus 9.9%, p = 0.0080). Cumulative long-term survival rates were 58.6% at 5 years. CONCLUSIONS: The incidence of mitral valve reoperation within 3 years after initial repair or replacement is low but carries high surgical risk, which is significantly increased by certain preoperative characteristics, such as urgent status, endocarditis, and heart failure.

Improving coronary artery bypass grafting readmission outcomes from 2000 to 2012 in the Medicare population.

OBJECTIVE: The study objective was to examine trends in 30-day readmission after coronary artery bypass grafting in the Medicare population over 13 years. METHODS: The study included isolated coronary artery bypass grafting procedures in the Medicare population from January 2000 to November 2012. Comorbidities and causes of readmission were determined using Internal Classification of Diseases, 9th Revision, Clinical Modification diagnostic codes. RESULTS: The cohort included 1,116,991 patients. Readmission rates decreased from 19.5% in 2000 to 16.6% in 2012 (P = .0001). There was significant improvement across all categories of admission status, age, race, gender, and hospital annual coronary artery bypass grafting volume that were analyzed. Adjusted odds of readmission in 2000 compared with 2012 was 1.28 (95% confidence interval, 1.24-1.32). Median length of stay for the readmission episode was 5 days, which improved to 4 days by 2012. Hospital mortality during the readmission episode was 2.8% overall and declined to 2.4% in 2012 (P = .0001). The most common primary readmission diagnoses were heart failure (12.6%), postoperative wound infection/nonhealing wound (8.9%), arrhythmias (6.4%), and pleural effusions (3.7%). Readmission for wound infections/nonhealing wounds decreased significantly over time, from 9.8% to 6.5% (P = .0001). CONCLUSIONS: In a large cohort of Medicare patients undergoing coronary artery bypass grafting over 13 years, there was a significant decrease in 30-day readmission rates, a reduction in readmission for wound infections, and reduced mortality during the readmission episode, despite an increase in patient comorbidities. The improvement in readmission rates was seen regardless of patient variables examined.

Combined closures in reconstructive surgery.

It is common for dermatology surgery patients to present on the day of surgery with more than one skin cancer needing Mohs micrographic surgery. When these carcinomas are located near one another, it may be more practical to treat both at the same time as the reconstruction for one defect may involve or otherwise affect the treatment or reconstruction for the other carcinoma. Treating both cancers on the same day creates an opportunity for efficient repairs where a creative single reconstruction may minimize the amount of tissue wasted during reconstruction,and minimize morbidity for the patient. Further,combining multiple defects into one closure may reduce cost as it has been shown that reconstructive choice affects the cost-effectiveness of Mohs surgery relative to a traditional excision and Mohs surgeons more commonly select less costly options for wound management. We present a case series of two-in-one closures - repairing two defects with one closure.

Mitral valve procedure selection and outcomes in patients with rheumatoid arthritis.

BACKGROUND AND AIM OF THE STUDY: Cardiovascular disease is a frequent cause of death in patients with rheumatoid arthritis (RA). Valvular involvement is common, most frequently affecting the mitral valve. Whether RA is an additional risk factor for patients undergoing mitral surgery has not been studied. The study aim was to examine procedure selection and outcome in patients with RA compared to that in patients without RA. METHODS: The 2005-2008 NIS database was searched to identify patients aged > or = 18 years undergoing isolated mitral valve repair or replacement. Patients with and without RA were compared on their baseline characteristics and hospital outcomes. Within the subset of patients with RA, patients undergoing repair and replacement were compared. RESULTS: RA patients comprised 1.0% (710/70,969) of the population, and were older, more likely to be female, and had a higher Charlson comorbidity index. The repair rate for RA patients was lower (37.6% versus 45.5%, p = 0.0401). The hospital length of stay (OR = 1.27, 95% CI 0.88-1.82, p = 0.1946) and hospital mortality (OR = 0.57, 95% CI 0.19-1.72, p = 0.3081) were similar for patients with and without RA. Baseline characteristics were similar between mitral valve repair and replacement subsets. The median LOS was higher for replacement (10 days versus 7 days, p = 0.0242). Hospital mortality was similar for repair versus replacement (OR = 1.17, 95% CI 0.10-13.46, p = 0.8983). CONCLUSION: RA does not appear to be an additional risk factor for adverse outcome following isolated mitral valve surgery. Although repair rates were lower for patients with RA, hospital mortality was similar to that in patients without RA. Within the RA subset, hospital mortality rates between mitral valve repair and replacement were similar.