Eliciting Patient Experiences About Their Care After Cardiac Surgery.

BACKGROUND: Experience surveys provide an opportunity for patients to give their feedback about health care processes and services. Unfortunately, the most current surveys have been designed as "one-size fits-all" tools, and thus, do not take into account items pertaining to specific clinical groups. The objective of this study was to gain a deeper understanding of the specific aspects of care deemed important to cardiac surgery patients. METHODS: Individual semistructured telephone interviews were conducted with a cohort of patients who had previously underwent cardiac surgery. Interviews were recorded and transcribed. Using a phenomenological approach, a thematic analysis was used to generate a list of themes and subthemes deemed important by participants. RESULTS: Eight interviews were conducted in July and August 2019. Participants included 7 men and 1 woman, ranging from 55 to 84 years of age. Five key themes emerged from the data: (1) overall experience; (2) communication; (3) the physical hospital environment; (4) care needs and ongoing management; and (5) person-centred care. Our interviews revealed that participants had many overwhelmingly positive experiences with care. Through reports of their own experiences, participants highlighted important areas that might be improved. CONCLUSIONS: Our results confirm and expand upon those highlighted in quantitative research by our group. Findings and knowledge derived from this study might be used to inform quality improvement activities. These might also play a key role in the development of a patient experience survey, specifically for those who undergo cardiac surgery; thus addressing a potential limitation of surveys currently in use.

CONTEXTE: Les sondages sur l'expérience offrent l'occasion aux patients de transmettre leur point de vue au sujet des services et des processus de soins de santé. Malheureusement, la plupart des sondages actuels sont conçus comme des outils universels, et ne prenent donc pas en considération certains aspects propres à des groupes cliniques précis. L'objectif de cette étude est de mieux cerner les aspects précis des soins qui sont jugés importants par les patients qui ont subi une intervention chirurgicale cardiaque. MÉTHODOLOGIE: Des entretiens téléphoniques individuels semi-structurés ont été menés avec une cohorte de patients ayant subi une intervention chirurgicale cardiaque. Les entretiens ont été enregistrés et retranscrits. Une analyse thématique utilisant une approche phénoménologique a été effectuée pour générer une liste de thèmes et de sous-thèmes jugés importants par les participants. RÉSULTATS: Huit entretiens ont été réalisés en juillet et en août 2019. Les participants regroupaient sept hommes et une femme, âgés de 55 à 84 ans. Les données recueillies ont permis de cerner cinq thèmes clés : 1) expérience globale; 2) communication; 3) environnement physique à l'hôpital; 4) besoins en matière de soins et prise en charge continue; et 5) soins axés sur le patient. Nos entretiens ont révélé que les participants avaient eu plusieurs expériences de soins extrêmement positives. En relatant leurs propres expériences, les participants ont souligné d'importants aspects qui pourraient être améliorés. CONCLUSIONS: Nos résultats confirment ceux des recherches quantitatives effectuées par notre groupe, et viennent les étayer. Les données et les résultats générés par cette étude pourraient être utilisés pour mettre au point des mesures visant l'amélioration de la qualité. Ils pourraient également jouer un rôle important dans la création d'un sondage sur l'expérience des patients, et plus précisément l'expérience des patients ayant subi une intervention chirurgicale cardiaque, et ainsi remédier aux limites possibles des sondages utilisés à l'heure actuelle.

Patient-Reported Experiences With Coronary Artery Bypass Grafting and Valve Replacement.

BACKGROUND: The Canadian Patient Experience Survey-Inpatient Care is a validated measure for adult inpatient experience. Linking surveys with administrative data can examine the experience of patients in specific demographic or clinical groups. METHODS: We examined survey responses obtained over a 4-year period from patients who underwent coronary artery bypass graft and/or valve replacement in Alberta. The 56-question telephone survey was administered within 6 weeks of discharge. Surveys were linked with administrative records to identify the Canadian Classification of Intervention procedure codes, which were in scope. Responses to each question were reported as percentage in "top box," where "top box" represents the most positive answer choice (eg, "always" and "yes"). RESULTS: From April 2014 to March 2018, 1082 surveys were completed by patients who underwent coronary artery bypass graft and/or valve replacement. Respondents were predominantly male (73.8%), with a mean age of 64.7 ± 11.9 years. Overall, 73.3% of respondents rated their hospital care as 9 or 10 out of 10 (best), and 86.2% would "definitely recommend" the hospital to friends/family members. Top performing questions pertained to having a discussion about help needed after discharge (96.6% responding "yes") and receiving written discharge information (93.2% responding "yes"). Lack of quietness of the hospital environment at night (34.8% responding "always") and lack of staff sufficiently describing side effects of new medications (44.9% responding "always") were identified as potential areas for improvement. CONCLUSIONS: Our results provide patient-reported experiences about inpatient cardiac care in Alberta hospitals. The findings could inform quality improvement initiatives that are patient-centred.

Can the alpha angle assessment of cam impingement predict acetabular cartilage delamination?

BACKGROUND: Substantial acetabular cartilage damage is commonly present in patients suffering from femoral acetabular impingement (FAI). A better understanding of which patient is at risk of developing substantial cartilage damage is critical for establishing appropriate treatment guidelines. QUESTIONS/PURPOSES: We asked: (1) Does the cam deformity severity in FAI as assessed by alpha angle predict acetabular cartilage delamination? And (2) what are the clinical and radiographic findings in patients with acetabular cartilage delamination? METHODS: One hundred sixty-seven patients (129 males, 38 females) with a mean age of 38 years (range, 17-59 years) underwent joint preservation surgery for cam-type FAI. All data were collected prospectively. We assessed center-edge angle and Tönnis grade on AP radiographs and alpha angle on specialized lateral radiographs. Acetabular cartilage damage was assessed intraoperatively using the classification of Beck et al., with Type 3 and greater qualifying as delamination. RESULTS: For all hips, mean alpha angle was 65.5° (range, 41°-90°), and mean center-edge angle was 33.3° (range, 21°-52.5°). Patients with an alpha angle of 65° or greater had an odds ratio (OR) of 4.00 (95% CI, 1.26-12.71) of having Type 3 or greater damage. Increased age (OR, 1.04; 95% CI, 1.01-1.07) and male sex (OR, 2.24; 95% CI, 1.09-4.62) were associated with Type 3 or greater damage, while this was the opposite for acetabular coverage as assessed by center-edge angle (OR, 0.94; 95% CI, 0.89-0.99). CONCLUSIONS: Patients with cam-type FAI and an alpha angle of 65° or more are at increased risk of substantial cartilage damage while increasing acetabular coverage appears to have a protective effect. LEVEL OF EVIDENCE: Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

Unicompartmental knee arthroplasties revised to total knee arthroplasties compared with primary total knee arthroplasties.

We studied the technical operative features and the subjective outcomes of 63 patients requiring a revision to a total knee arthroplasty (TKA) for failed Oxford medial unicompartmental knee arthroplasty. We compared this revision study group to a contemporary control cohort of 126 patients who underwent primary TKAs. The 2 groups from the same institution had a minimum follow-up of 2 years and were retrospectively matched 1:2 for age, sex, body mass index, and follow-up time. Length of stay and hemoglobin level drop were similar. Technically, the revision group required larger polyethylene inserts (P < .001) and longer tourniquet times (P < .001) with 15 of these patients needing augments, grafts, and/or stems. Subjectively, the revision group's mean total Western Ontario and McMaster Universities Arthritis Index score was 25.8 ± 20.2, thus less satisfactory compared with the control group (19.8 ± 15.3) at a mean follow-up of 3.1 years (P = .03). A revision unicompartmental knee arthroplasty to TKA is technically more difficult and functionally less satisfactory at last follow-up when compared with a primary TKA.