Identification and quantification of chimeric sequencing reads in a highly multiplexed RAD-seq protocol.

Highly multiplexed approaches have become common in genomic studies. They have improved the cost-effectiveness of genotyping hundreds of individuals using combinatorially barcoded adapters. These strategies, however, can potentially misassigned reads to incorrect samples. Here, we used a modified quaddRAD protocol to analyse the occurrence of index hopping and PCR chimeras in a series of experiments with up to 100 multiplexed samples per sequencing lane (639 samples in total). We created two types of sequencing libraries: four libraries of type A, where PCRs were run on individual samples before multiplexing, and three libraries of type B, where PCRs were run on pooled samples. We used fixed pairs of inner barcodes to identify chimeric reads. Type B libraries show a higher percentage of misassigned reads (1.15%) than type A libraries (0.65%). We also quantify the commonly undetectable chimeric sequences that occur whenever multiplexed groups of samples with different outer barcodes are sequenced together on a single flow cell. Our results suggest that these types of chimeric sequences represent up to 1.56% and 1.29% of reads in type A and B libraries, respectively. We also show that increasing the number of mismatches allowed for barcode rescue to above 2 dramatically increases the number of recovered chimeric reads. We provide recommendations for developing highly multiplexed RAD-seq protocols and analysing the resulting data to minimize the generation of chimeric sequences, allowing their quantification and a finer control on the number of PCR cycles necessary to generate enough input DNA for library preparation.

Respiratory distress and tracheal deviation secondary to sigmoid volvulus / Dificultad respiratoria y desviación traqueal secundaria a vólvulo sigmoideo ­ Un reporte de caso

INTRODUCTION: The trachea is a semiflexible tube of 1.5 to 2 cm in width and 10 to 13 cm in length. Its deviation might be caused by not only diverse thoracic but also abdominal pathologies, which may compromise the airway. We present a case of a severe tracheal deviation due to an abdominal pathology causing displacement of mediastinal structures. CLINICAL CASE: A 78-year-old woman presents with difficulty breathing. History of chronic bedridden and frequently constipated, last stool 5 days prior. On physical examination, cachectic complexion, dry mucous membranes, breathing superficially with scarce wheezing, SatO2 82% on room air. Abdomen distended with an absence of bowel sounds. Chest x-rays show severe tracheal deviation and abdominal x-ray with coffee bean sign. A laparotomy evidences a large sigmoid volvulus. A sigmoidectomy and descending colon colostomy is performed. Room air oxygen saturation improved after extubation to 96%.CONCLUSION: Desaturation and tracheal deviation were caused by a large sigmoid volvulus. Although these pathologies were thoracic, clinicians should suspect different underlying pathologies, in this case, abdominal

INTRODUCCIÓN: La tráquea es un tubo semiflexible de 1-5 a 2 cm de ancho y 10 a 13 cm de longitud. Puede presentar desviaciones en su trayecto, no solo por patologías torácicas, sino también abdominales, las cuales pueden comprometer la vía aérea. Presentamos el caso de una desviación severa de la tráquea por una patología abdominal que ocasionó desplazamiento de las estructuras mediastinales. REPORTE DE CASO: Mujer de 78 años que se presenta por dificultad respiratoria. Antecedente de postramiento crónico en cama y estreñimiento frecuente, con última deposición 5 días previos. En la exploración física presenta complexión caquéctica, mucosas secas, respiración superficial con sibilancias, saturando 82% al aire ambiente. Abdomen distendido con ausencia de ruidos intestinales. Radiografía torácica muestra desviación traqueal severa y la radiografía abdominal muestra signo del grano de café. En el abordaje por laparotomía se evidencia un vólvulo sigmoideo grande. Se realizó sigmoidectomía y colostomía del colon descendiente. La saturación al aire ambiente mejoró después de la extubación a 96%. CONCLUSIÓN: La desaturación y desviación traqueal fueron causadas por un vólvulo sigmoideo grande. Aunque estas patologías eran torácicas, el clínico debe sospechar diferentes patologías de base, como en este caso, abdominales.

Nursing home performance in a trial to reduce hospitalizations: Implications for future trials.

BACKGROUND: Experience in trials of implementing quality improvement (QI) programs in nursing homes (NHs) has been variable. Understanding the characteristics of NHs that demonstrate improvements during these trials is critical to improving NH care. DESIGN: Secondary analysis of a randomized controlled trial of implementation of a QI program to reduce hospital transfers. PARTICIPANTS: Seventy-one NHs that completed the 12-month trial INTERVENTION: Implementation included distance-learning strategies, involvement of a champion, regular submission of data on hospitalizations and root cause analyses of transfers, and training, feedback and support. MEASUREMENTS: Primary outcomes included all-cause and potentially avoidable hospitalizations and emergency department (ED) visits per 1000 NH resident days, and the percentage of residents readmitted in 30-days. We compared multiple other variables that could influence effective program implementation in NHs in the highest versus lowest quartile of changes in the primary outcomes. RESULTS: The 18 high-performing NHs had significant reductions in hospitalization and ED visits, whereas the 18 NHs in the low-performing group had increases. The difference in changes in each outcome varied between a reduction of 0.75 and 2.30 events relative to a NH with a census of 100; the absolute difference in 30-day readmissions was 19%. None of the variables we examined reached significance after adjustment for multiple comparisons between the groups. There was no consistent pattern of differences in nonprofit status, nursing staffing, and quality ratings. CONCLUSION: Our experience and reviews of other NH trials suggest that key factors contributing to successful implementation QI programs in NHs remain unclear. To improve NH care, implementation trials should account for intervention fidelity and factors that have not been examined in detail, such as degree and nature of leadership support, financial and regulatory incentives, quality measures, resident and family perspectives, and the availability of onsite high-quality medical care and support of the medical director.

Adherence to care transitions recommendations among high-risk hospitalized older patients.

BACKGROUND/OBJECTIVES: Evidence on the effectiveness of inpatient hospital geriatric consultation is scant, and it is unknown whether adherence to specific recommendations will improve care and patient outcomes. This study was conducted to provide insights from a quality improvement project that may help guide further improvements in the effectiveness of these consultations made as a component of a care transitions program (CTP). DESIGN: Secondary analysis of the implementation of a multicomponent CTP for high-risk hospitalized patients aged 75 and older. SETTING: A 400-bed community teaching hospital. PARTICIPANTS: Two hundred and two patients admitted to non-ICU beds who met high-risk criteria. INTERVENTION: Inpatient comprehensive geriatric consultation including care transition recommendations, telephone and in-person follow-up weekly for 4 weeks after discharge, and collaboration with post-acute organizations and primary care and specialist physicians to implement recommendations. MEASUREMENTS: Primary outcomes for this analysis was 30-day hospital readmissions and adherence to transition of care recommendations. RESULTS: The 142 patients with at least one post-discharge visit received 936 care transition recommendations. Overall, 663 (71%) of the 936 care transition recommendations were adhered to (71%). The adherence rate was lower in the 22 patients who were readmitted to the hospital within 30 days (63%) compared to 72% adherence in the 120 patients who were not readmitted. This was not a statistically significant difference, and there were no significant differences in the number and percent adherence in any recommendation category between the two groups. CONCLUSION: We found adherence to just over two-thirds of care transition recommendations, similar to a small number of other studies. We did not find a relationship between the number of recommendations and adherence to them with 30-day readmissions to the hospital. Future studies of CTPs should consider several strategies may enhance geriatric consultation care transitions recommendations and adherence to them, and improve patient outcomes.

Postacute Management of Older Adults Suffering an Osteoporotic Hip Fracture: A Consensus Statement From the International Geriatric Fracture Society.

BACKGROUND: The majority of patients require postacute care (PAC) after a hip fracture. Despite its importance, there is no established consensus regarding the standards of care provided to hip fracture patients in PAC facilities. METHODOLOGY: A writing group was created by professionals from the International Geriatric Fracture Society (IGFS) with representation from other organizations. The focus of the statements included in this article is toward PAC providers located in nursing facilities. Contributions were integrated in a single document that underwent several reviews by each author and then underwent a final review by the lead and senior authors. After this process was completed, the document was appraised by reviewers from IGFS. RESULTS/CONCLUSION: A total of 15 statements were crafted. These statements summarize the best available evidence and is intended to help PAC facilities managing older adults with hip fractures more efficiently, aiming toward overall better outcomes in the areas of function, quality of life, and with less complications that could interfere with their optimal recovery.

Thirty-Day Hospital Readmissions in a Care Transitions Program for High-Risk Older Adults.

OBJECTIVES: To describe the causes of 30-day hospital readmissions among high-risk older adults during implementation of a multicomponent care transitions program. DESIGN: Secondary analysis of data from the evaluation of a multicomponent care transitions program for hospitalized high-risk older adults. SETTING: A 400-bed community teaching hospital. PARTICIPANTS: Patients aged 75 and older admitted to non-intensive care unit beds who met specific criteria for high risk of complications and hospital readmissions. The intervention group included 202 patients, of whom 37 were readmitted to the hospital as an inpatient or on observation status within 30 days of discharge. MEASUREMENTS: Root-cause analyses on each readmission were conducted by hospital physicians and post-acute care (PAC) organization staff. Additional data were collected by trained project staff using the medical record and postdischarge telephone or in-person follow-up visits. These data were reviewed and adjudicated among the authors, and each readmission was rated with unanimous agreement as "preventable," "possibly preventable," or "not preventable." RESULTS: No significant differences were found in demographic and clinical characteristics of intervention patients readmitted versus those not readmitted. A higher proportion of the 37 patients who were readmitted did not have a postdischarge visit than the 165 patients who were not readmitted (15 [41%] vs 45 [27%]; P = .11). Among the 37 readmissions, 14 (38%) were rated as not preventable, 14 (38%) as possibly preventable, and 9 (24%) as preventable. Readmissions were rated as preventable or possibly preventable for a variety of reasons that provide insight into how care transitions programs for high-risk older adults might be made more effective. CONCLUSION: Root-cause analyses of hospital readmissions among high-risk older adults by hospital physicians and PAC providers can identify strategies that might enhance the effectiveness of care transitions interventions in this complex population. J Am Geriatr Soc 68:1307-1312, 2020.

Evaluation of a Multicomponent Care Transitions Program for High-Risk Hospitalized Older Adults.

OBJECTIVES: To test the effectiveness of a multicomponent care transition intervention targeted at hospitalized patients, aged 75 years and older, at high risk for hospital readmissions, return emergency department (ED) visits, and related complications. DESIGN: Implementation as a quality improvement program with propensity-matched preintervention and concurrent comparison groups over a 12-month period. SETTING: A 400-bed community teaching hospital. PARTICIPANTS: Patients, aged 75 years and older, admitted to non-intensive care unit beds who met specific high-risk criteria. The intervention group included 202 patients, and the concurrent and preintervention comparison groups included 4142 and 4592 patients, respectively. MEASUREMENTS: Primary outcomes were 30-day hospital readmissions and returns to the ED; 7-day readmissions and ED visits were secondary measures. RESULTS: Among the 202 patients enrolled in the "Safe Transitions for At-Risk Patients" ("STAR") program, 37 (18.3%) were readmitted within 30 days, in contrast to 14.3% and 14.6% in the concurrent and preintervention comparison groups, respectively. Rates for 30-day return ED visits that did not result in hospitalization were 10.9% in the intervention group, and 7.2% and 7.9% in the comparison groups. STAR patients had greater 30-day ED use than patients in the preintervention comparison group (5.0 percentage points; 95% confidence interval = 0.8-9.3 percentage points; P = .020). Implementation challenges included suboptimal involvement of the participating hospital and post-acute care organizations and a relatively high proportion of patients who did not receive the intervention as planned, despite agreeing to participate before leaving the hospital. CONCLUSION: A multicomponent care transitions intervention targeting high-risk patients, aged 75 years and older, admitted to a community teaching hospital was not effective in reducing 30- or 7-day readmissions or return ED visits. Our implementation experience offers many lessons for future programs for similar high-risk geriatric populations. J Am Geriatr Soc 67:2634-2642, 2019.

Sepsis in Older Adults in Long-Term Care Facilities: Challenges in Diagnosis and Management.

Despite the current understanding of the pathophysiology of sepsis and advances in its treatment, the rate of sepsis is increasing globally. Sepsis is a common cause of hospitalization in older adults, and infections are among the most common diagnoses among residents transferred to the hospital from long-term care facilities (LTCFs). LTCFs and hospitals are facing financial and regulatory requirements to reduce potentially preventable emergency department visits, hospitalizations, and hospital readmissions due to infections and other causes. In addition, the human and financial costs of these events are substantial. Current criteria for early identification of sepsis have low sensitivity and specificity among LTCF residents. Early diagnosis must focus on changes in clinical, mental, and functional status, and vital signs including pulse oximetry. Laboratory data can increase the suspicion of sepsis, but the availability of testing and timing of results limits its usefulness in most LTCFs.While new diagnostic criteria for sepsis are being developed and validated in the LTCF setting, clinical practice and decision support tools are available to guide management. Most LTFCs do not have the capabilities to manage sepsis based on current guidelines despite availability of qualified nursing staff and clinicians. Thus excluding circumstances in which a resident's desire is palliative or hospice care without transfer to a hospital, most LTCFs will continue to transfer residents with severe infections at risk for evolving into sepsis to an acute hospital setting. J Am Geriatr Soc 67:2234-2239, 2019.

Geriatrics Screening and Assessment.

Geriatric screening and assessment allows clinicians to care for older patients in an efficient, patient-centered manner. This framework includes standard screening questions that may trigger the use of standard geriatric assessment tools and/or other interventions. Additionally, it serves to complement the history and physical examination, and is critical for maximizing the health, function, safety, and quality of life of older patients.

Biotransformation of 4-nitrophenol by co-immobilized Geobacter sulfurreducens and anthraquinone-2-sulfonate in barium alginate beads.

Geobacter sulfurreducens and anthraquinone-2-sulfonate (AQS) were used suspended and immobilized in barium alginate during the biotransformation of 4-nitrophenol (4-NP). The assays were conducted at different concentrations of 4-NP (50-400 mg/L) and AQS, either in suspended (0-400 µM) or immobilized form (0 or 760 µM), and under different pH values (5-9). G. sulfurreducens showed low capacity to reduce 4-NP in absence of AQS, especially at the highest concentrations of the contaminant. AQS improved the reduction rates from 0.0086 h-1, without AQS, to 0.149 h-1 at 400 µM AQS, which represent an increment of 17.3-fold. The co-immobilization of AQS and G. sulfurreducens in barium alginate beads (AQSi-Gi) increased the reduction rates up to 4.8- and 7.2-fold, compared to incubations with G. sulfurreducens in suspended and immobilized form, but in absence of AQS. AQSi-Gi provides to G. sulfurreducens a barrier against the possibly inhibiting effects of 4-NP.

Care transitions programs for older adults-a worldwide need.

In many countries around the world, including the United States, care for vulnerable older people is fragmented, especially at the time of hospital discharge and in the postacute hospital period. Thus, a major challenge for health care systems is to deliver the right type of post-acute care, in the right setting, by the right health care professionals, and for the right length of time. Care transition programs should avoid unnecessary harm related to poor transfer of care between settings, and address common problems as care transitions occur. In the US, Medicare, the major health insurance for older people, is incentivizing value-based over volume-based care, and financially penalizing hospitals for high 30-day readmission rates. In value-based care programs such as Medicare managed care, accountable care organizations, and bundled payments, effective care transitions programs are financially feasible because they have the potential for substantial cost savings from preventing unnecessary emergency department visits, hospital readmissions, other misuse of resources, and costly complications for patients and their families. In this special article, we provide a brief overview of the challenges of care transitions, and elements of care transitions programs developed and tested in the US that could be adapted to the dynamic, heterogeneous health care system in Europe as well as other countries around the world.

Revisión bibliográfica sobre síndrome de Treacher Collins / Treacher Collins síndrome: A review

INTRODUCTION: Treacher Collins syndrome is a rare disorder of the craniofacial development that constitutes a challenge for anesthesiologists, since it represents a difficult airway in the majority of cases. The main objective of this article is to provide a bibliographic review about how the airway management of patients with Treacher Collins syndrome has been managed. MATERIALS AND METHODS: A literature review was carried out in the following databases: PubMed, EMBASE and ScienceDirect. DISCUSSION: The factors that increase the risk of difficult airway in these patients are presented as well as the strategies to handle it. CONCLUSION: The Treacher Collins syndrome presents a high risk of difficult airway, therefore careful planning of airway management is mandatory and there are different strategies to handle it.

INTRODUCCIÓN: El síndrome de Treacher Collins (STC) es un trastorno inusual del desarrollo craneofacial que constituye un reto para el anestesiólogo, ya que éste condiciona la condición de vía aérea difícil en la mayoría de los casos. El objetivo principal de este artículo es realizar una revisión bibliográfica de cómo se han manejado casos de vía aérea difícil ligados al síndrome de Treacher Collins. MATERIALES Y MÉTODOS: Se realizó una revisión de la literatura disponible en las siguientes bases de datos: PubMed, EMBASE y ScienceDirect. DISCUSIÓN: Se presentan los factores que aumentan el riesgo de vía aérea difícil en estos pacientes, así como las estrategias para manejarla. CONCLUSIÓN: El síndrome de Treacher Collins presenta un alto riesgo de vía aérea difícil, por lo tanto, es obligatoria la planificación cuidadosa de la misma, contando con diferentes estrategias para manejarla.

Management of Acute Changes in Condition in Skilled Nursing Facilities.

OBJECTIVES: To describe the presentation and management of acute changes in condition in skilled nursing facilities (SNFs) during implementation of a program designed to reduce unnecessary emergency department visits and hospitalizations. DESIGN: Secondary analysis of data from a randomized controlled trial involving 264 SNFs. PARTICIPANTS: One hundred thirty-three of the 264 participating SNFs that provided data on acute changes in condition: 55 in the intervention group, 78 in the control group. INTERVENTIONS: During a 12-month period, intervention SNFs received training and support for implementation of the Interventions to Reduce Acute Care Transfers program. Control SNFs were offered training and implementation support after the end of the 12-month trial. MEASURES: Project champions used a structured online tool to describe acute changes in condition that did not result in a hospital transfer within 72 hours of the change. RESULTS: Most of the 7,689 episodes of acute change in condition reported involved multiple changes that were not disease specific. Ten percent resulted in hospital transfer between 72 hours and 7 days after the change. Five acute changes had odds ratios for transfer greater than 2 (mental status change, abnormal vital signs, bleeding, shortness of breath, and unresponsiveness). Most transfers were for reasons other than the initial change in condition. CONCLUSIONS: A wide variety of acute changes in condition can be managed in SNFs without hospital transfer. Most of these changes are nonspecific and multiple, and when they are associated with hospital transfer, the reasons for the transfer are most often different from the initial acute change in condition. These data highlight the multifactorial nature of acute changes in condition in the SNF population and suggest that disease-specific protocols and assessment tools may not be the most appropriate approach to managing acute changes in condition in the SNF setting. J Am Geriatr Soc 66:2259-2266, 2018.

Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations.

OBJECTIVES: To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents. DESIGN: Secondary analysis from a randomized controlled trial. SETTING: SNFs from across the United States (N=264). PARTICIPANTS: Two hundred of the SNFs from the randomized trial that provided baseline and intervention data on INTERACT use. INTERVENTIONS: During a 12-month period, intervention SNFs received remote training and support for INTERACT implementation; control SNFs did not, although most control facilities were using various components of the INTERACT program before and during the trial on their own. MEASUREMENTS: INTERACT use data were based on monthly self-reports for SNFs randomized to the intervention group and pre- and postintervention surveys for control SNFs. Primary outcomes were rates of all-cause hospitalizations, potentially avoidable hospitalizations (PAHs), ED visits without admission, and 30-day hospital readmissions. RESULTS: The 65 SNFs (32 intervention, 33 control) that reported increases in INTERACT use had reductions in all-cause hospitalizations (0.427 per 1,000 resident-days; 11.2% relative reduction from baseline, p<.001) and PAHs (0.221 per 1,000 resident-days; 18.9% relative reduction, p<.001). The 34 SNFs (12 intervention, 22 control) that reported consistently low or moderate INTERACT use had statistically insignificant changes in hospitalizations and ED visit rates. CONCLUSION: Increased reported use of core INTERACT tools was associated with significantly greater reductions in all-cause hospitalizations and PAHs in both intervention and control SNFs, suggesting that motivation and incentives to reduce hospitalizations were more important than the training and support provided in the trial in improving outcomes. Further research is needed to better understand the most effective strategies to motivate SNFs to implement and sustain quality improvement programs such as INTERACT.

Baseline Characteristics and Outcomes of Older Adults Seeking Care in Ambulatory Urgent Care Clinics.

OBJECTIVES: To determine the most common clinical conditions associated with older adults visiting Urgent care centers (UCCs) and the potential need for further resource use. DESIGN: Cross-sectional retrospective study. SETTING: Nonprofit academic medical center with campuses and multiple satellite offices in Ohio and Florida. PARTICIPANTS: Individuals aged 55 and older who visited UCCs between August 2014 and March 2015 (N = 9,445; average age 63.1 ± 10.1, 64% female). Of those, 2,445 had at least one encounter within the same healthcare system within 30 days after the index visit and were included in our final analysis. MEASUREMENTS: 30-day ED visits and hospitalizations. RESULTS: Of the 2,445 patients, 578 (23.6%) visited the emergency department (ED) or were hospitalized, 974 (39.8%) returned to the UCC, and 895 (63.4%) visited their primary care physician's office. A significantly higher proportion (38.4%, n = 68/177) of individuals aged 85 and older visited the ED or were hospitalized within 30 days (P < .010) than of those younger than 65 (20.0%, n = 273/1,367). Diabetes mellitus (odds ratio (OR) = 1.73, 95% confidence interval (CI) = 1.40-2.15, P < .001), coronary artery disease or cerebrovascular disease (OR = 2.45 CI 1.95-3.09, P < .001), chronic obstructive pulmonary disorder or asthma (OR = 1.57, 95% CI = 1.23-2.01, P < .001), polypharmacy (OR = 1.45, 95% CI = 1.18-1.78, P = .004), and cognitive impairment (OR = 2.74, 95% CI = 1.74-4.31, P < .010) were associated with higher rates of ED visits or hospitalizations within 30 days of the UCC visit. CONCLUSION: Older adults (especially those aged ≥85) and those with conditions such as polypharmacy and dementia are at higher risk of being hospitalized or visit the ED after seeking care at UCCs than younger adults and those without these conditions.

Influence of redox mediators and salinity level on the (bio)transformation of Direct Blue 71: kinetics aspects.

The rate-limiting step of azo dye decolorization was elucidated by exploring the microbial reduction of a model quinone and the chemical decolorization by previously reduced quinone at different salinity conditions (2-8%). Microbial experiments were performed in batch with a marine consortium. The decolorization of Direct Blue 71 (DB71) by the marine consortium at 2% salinity, mediated with anthraquinone-2,6-disulfonate (AQDS), showed the highest rate of decolorization as compared with those obtained with riboflavin, and two samples of humic acids. Moreover, the incubations at different salinity conditions (0-8%) performed with AQDS showed that the highest rate of decolorization of DB71 by the marine consortium occurred at 2% and 4% salinity. In addition, the highest microbial reduction rate of AQDS occurred in incubations at 0%, 2%, and 4% of salinity. The chemical reduction of DB71 by reduced AQDS occurred in two stages and proceeded faster at 4% and 6% salinity. The results indicate that the rate-limiting step during azo decolorization was the microbial reduction of AQDS.

Mildly reduced preoperative ejection fraction increases the risk of stroke in older adults undergoing coronary artery bypass grafting.

INTRODUCTION: Current guidelines based on clinical trials may have inadvertently excluded a representative cohort of older adults. As a result, little is known about the predictors of stroke among elderly patients undergoing coronary artery bypass surgery (CABG). The purpose of this study was to determine how a lower than normal ejection fraction (EF) predicted post surgery stroke among elderly patients undergoing CABG when compared with younger populations. METHODS: Retrospective cross-sectional cohort analysis. setting: Charleston Area Medical Center, a tertiary medical center. PARTICIPANTS: 8661 consecutive CABG cases between 2003 and 2009. measurements: PARTICIPANTS were divided into three different age groups: < 65 years old (Group 1), between 65 and 79 years old (Group 2), and > or = 80 years old (Group 3). We calculated the rate of overall neurological complications after CABG for patients with ejection fraction values: < 40%, between 40% and 59%, and > or = 60. RESULT: Group 3 (age > = 80) with EF < = 39 had the highest odds of developing post CABG stroke (Odds Ratio (OR): 5.6) followed by Group 3 (age > = 80) with EF 40-59 (OR: 3.9). In addition, Group 2 (age 65-79) with EF < = 39 had the next highest odds of developing post CABG stroke (OR: 2.3) followed by Group 2 (age 65-79) with EF 40-59 (OR: 1.9). CONCLUSION: Contrary to current guidelines, in our study population, mildly affected EF increased the overall risk of neurological complications among elderly patients undergoing CABG.