Supplementing prediction by EuroSCORE with social and patient-reported measures among patients undergoing cardiac surgery.

OBJECTIVES: The risk of poor outcomes is traditionally attributed to biological and physiological processes in cardiac surgery. However, evidence exists that other factors, such as emotional, behavioral, social, and functional, are predictive of poor outcomes. Objectives were to evaluate the predictive value of several emotional, social, functional, and behavioral factors on four outcomes: death within 90 days, prolonged stay in intensive care, prolonged hospital admission, and readmission within 90 days following cardiac surgery. METHODS: This prospective study included adults undergoing cardiac surgery 2013-2014, including information on register-based socioeconomic factors and self-reported health in a nested subsample. Logistic regression analyses to determine the association and incremental value of each candidate predictor variable were conducted. Multiple regression analyses were used to determine the incremental value of each candidate predictor variable, as well as discrimination and calibration based on the area under the curve (AUC) and Brier score. RESULTS: Of 3217 patients, 3% died, 9% had prolonged intensive care stay, 51% had prolonged hospital admission, and 39% were readmitted to hospital. Patients living alone (odds ratio, 1.19; 95% confidence interval, 1.02-1.38), with lower educational levels (1.27; 1.04-1.54) and low health-related quality of life (1.43; 1.02-2.01) had prolonged hospital admission. Analyses revealed living alone as predictive of prolonged intensive care unit (ICU) stay (Brier, 0.08; AUC, 0.68), death (0.03; 0.71), and prolonged hospital admission (0.24; 0.62). CONCLUSION: Living alone was found to supplement EuroSCORE in predicting death, prolonged hospital admission, and prolonged ICU stay following cardiac surgery. Low educational level and impaired health-related quality of life were, furthermore, predictive of prolonged hospital admission.

Evaluation of time to intubation and rate of success for different healthcare professionals using a double-lumen left-sided endotracheal video tube: A prospective observational study.

Intubation with a double-lumen left-sided endotracheal video tube has been the standard procedure for nearly five years in the Department of Cardiothoracic Surgery, Copenhagen University Hospital, but no systematic evaluations have been done. For a 12-month period ending November 2017, data were collected from 579 consecutive patients, scheduled for thoracic surgery with a requirement for one-lung ventilation; 35 anaesthetist trainees (nurses or doctors) (287 cases), 27 nurse anaesthetists (239 cases) and 8 anaesthesiologists (53 cases) managed intubation with a double-lumen tube. Time to intubation was relatively equal across healthcare professionals with a mean time of 53 (anaesthetist trainees), 40 (nurse anaesthetists) and 63 (anaesthesiologists) seconds. The shorter time for nurse anaesthetists and prolonged time for anaesthesiologists might be due to the small number of cases and the fact that anaesthesiologists carried out 60% of the cases, where a third attempt was needed, and 25% of cases for the anaesthesiologists were assessed to a Cormack-Lehane grade of 3 or 4 compared to 6% for anaesthetist trainees and 5% for nurse anaesthetists. The rate of successful placement in the first attempt of placing the double-lumen left-sided endotracheal video tube was high, which emphasises that intubation with a double-lumen left-sided endotracheal video tube is suitable for use by different healthcare professionals.

Time to expand risk evaluation systems for cardiac surgery? Looking beyond physiological parameters.

Risk assessment in cardiac surgery traditionally consists of medical and physiological parameters. However, non-physiological factors have also been found to be predictive of poor outcomes following cardiac surgery. Therefore, the isolated focus on physiological parameters is questionable. This paper describes the emotional, behavioural, social and functional factors that have been established to play a role in outcomes following cardiac surgery. This forms a basis for future research, testing the value of these factors above and beyond the physiological parameters. By including such non-physiological factors, the accuracy of the existing risk scoring systems could potentially be improved.

First use of antidepressant medication in male partners of women with breast cancer in Denmark from 1998 to 2011.

OBJECTIVE: A diagnosis of breast cancer disrupts the life of the patient, but also the partner may experience adverse psychological effects. We examined partners' risk for first use of antidepressant medication, as a proxy for pharmacologically treated depression. METHODS: By linkage of national registers, we identified 1 420 592 depression-free men living with a cancer-free female partner in 1998 to 2011. During follow-up, breast cancer was diagnosed in female partners of 26 256 men. In Poisson regression models, we estimated the rate ratios for first use of antidepressant medication compared to partners of breast cancer-free women. Cox regression analyses examined associations between exposed partners' sociodemographic characteristics, somatic comorbidity, death of female partner, and first use of antidepressant medication. RESULTS: Male partners of women with breast cancer had an increased rate ratio of 1.08 (95% CI, 1.03-1.13) for first use of antidepressant medication compared to the background population, corresponding to excess absolute risk of 12 cases per 10 000 person-years. This increased risk persisted throughout 14 years of follow-up. Higher age, shorter education, somatic comorbidity, and death of female partner were associated with increased risk among men whose partner had breast cancer. CONCLUSION: The modest, but long term, increased risk for first use of antidepressant medication calls for attention by health care professionals to symptoms of depression among partners of breast cancer patients.