RÉSUMÉ
Hip fractures remain a substantial health concern, particularly among elderly individuals with osteoporosis, leading to high global mortality rates. This study aimed to analyze the association between body mass index (BMI) and postoperative mortality in patients who underwent surgery for hip fractures. A total of 680 patients treated at a single institution between January 2018 and December 2022 were included. Factors such as age, BMI, sex, Charlson Comorbidity Index (CCI), preoperative hemoglobin levels, American Society of Anesthesiologists score, anesthesia method, duration of surgery, and time from injury to surgery were assessed. Underweight status, male sex, higher CCI, and general anesthesia were significantly associated with 1-year and in-hospital mortality. Notably, underweight individuals exhibited a higher risk of mortality than normal-weight individuals, and female patients had lower mortality rates. This study underscores the importance of considering BMI, along with other demographic and clinical factors, in predicting postoperative mortality among patients with hip fractures, aiding the development of tailored management strategies to improve outcomes and reduce complications in this vulnerable patient population.
Sujet(s)
Indice de masse corporelle , Fractures de la hanche , Humains , Fractures de la hanche/mortalité , Fractures de la hanche/chirurgie , Mâle , Femelle , Sujet âgé , Sujet âgé de 80 ans ou plus , Mortalité hospitalière , Études rétrospectives , Facteurs de risque , Complications postopératoires/mortalité , Complications postopératoires/épidémiologie , Facteurs sexuels , Maigreur/complications , Maigreur/mortalité , Facteurs âgesRÉSUMÉ
BACKGROUND AND OBJECTIVES: Hypoglycemia is a known risk of intensive postoperative glucose control in neurosurgical patients. However, the impact of postoperative hypoglycemia after craniotomy remains unexplored. This study aimed to determine the association between postoperative hypoglycemia and mortality in patients undergoing elective craniotomy. METHODS: This study involved adult patients who underwent elective craniotomy at the West China Hospital, Sichuan University, between January 2011 and March 2021. We defined moderate hypoglycemia as blood glucose levels below 3.9 mmol/L (70 mg/dL) and severe hypoglycemia as blood glucose levels below 2.2 mmol/L (40 mg/dL). The primary outcome was postoperative 90-day mortality. RESULTS: This study involved 15 040 patients undergoing an elective craniotomy. Overall, 504 (3.4%) patients experienced moderate hypoglycemia, whereas 125 (0.8%) patients experienced severe hypoglycemia. Multivariable analysis revealed that both moderate hypoglycemia (adjusted odds ratio [aOR] 1.86, 95% CI 1.24-2.78) and severe (aOR 2.94, 95% CI 1.46-5.92) hypoglycemia were associated with increased 90-day mortality compared with patients without hypoglycemia. Moreover, patients with moderate (aOR 2.78, 95% CI 2.28-3.39) or severe (aOR 16.70, 95% CI 10.63-26.23) hypoglycemia demonstrated a significantly higher OR for major morbidity after adjustment, compared with those without hypoglycemia. Patients experiencing moderate (aOR 3.20, 95% CI 2.65-3.88) or severe (aOR 14.03, 95% CI 8.78-22.43) hypoglycemia had significantly longer hospital stays than those without hypoglycemia. The risk of mortality and morbidity showed a tendency to increase with the number of hypoglycemia episodes in patients undergoing elective craniotomy (P for trend = .01, <.001). CONCLUSION: Among patients undergoing an elective craniotomy, moderate hypoglycemia and severe hypoglycemia are associated with increased mortality, major morbidity, and prolonged hospital stays. In addition, the risk of mortality and major morbidity increases with the number of hypoglycemia episodes.
Sujet(s)
Craniotomie , Interventions chirurgicales non urgentes , Hypoglycémie , Complications postopératoires , Humains , Craniotomie/effets indésirables , Craniotomie/mortalité , Hypoglycémie/mortalité , Femelle , Mâle , Adulte d'âge moyen , Complications postopératoires/mortalité , Complications postopératoires/épidémiologie , Interventions chirurgicales non urgentes/effets indésirables , Interventions chirurgicales non urgentes/mortalité , Adulte , Sujet âgé , Glycémie/analyse , Études rétrospectives , Chine/épidémiologie , Facteurs de risqueRÉSUMÉ
BACKGROUND: Multimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery. METHODS: This was a pre-planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30-day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery. RESULTS: Of 24,227 patients, 7006 (28.9%) had one long-term condition and 10,486 (43.9%) had multimorbidity (two or more long-term health conditions). The most common conditions were primary cancer (39.6%); hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had a higher incidence of frailty compared with patients ≤ 1 long-term health condition. Mortality was higher in patients with one long-term health condition (adjusted odds ratio 1.93 (95%CI 1.16-3.23)) and multimorbidity (adjusted odds ratio 2.22 (95%CI 1.35-3.64)). Frailty and ASA physical status 3-5 mediated an estimated 31.7% of the 30-day mortality in patients with one long-term health condition (adjusted odds ratio 1.30 (95%CI 1.12-1.51)) and an estimated 36.9% of the 30-day mortality in patients with multimorbidity (adjusted odds ratio 1.61 (95%CI 1.36-1.91)). There was no improvement in 30-day mortality in patients with multimorbidity who received pre-operative medical assessment. CONCLUSIONS: Multimorbidity is common and outcomes are poor among surgical patients across Europe. Addressing multimorbidity in elective and emergency patients requires innovative strategies to account for frailty and disease control. The development of such strategies, that integrate care targeting whole surgical pathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials are warranted to determine the effectiveness of targeted management for surgical patients with multimorbidity.
Sujet(s)
Multimorbidité , Complications postopératoires , Humains , Études prospectives , Europe/épidémiologie , Mâle , Femelle , Sujet âgé , Complications postopératoires/épidémiologie , Complications postopératoires/mortalité , Adulte d'âge moyen , Sujet âgé de 80 ans ou plus , Adulte , Abdomen/chirurgieRÉSUMÉ
BACKGROUND: Various factors contribute to the development of mortality and morbidity in hip fracture surgeries. This study aims to investigate the effects of modifiable factors such as the type of anesthesia, anesthesia management, surgical method, and timing of surgery on 30-day mortality rates, intensive care unit admissions, and complications. METHODS: A total of 400 patients who underwent hip fracture surgery between January 2021 and December 2023 at a Training and Research Hospital were retrospectively analyzed. Patients were divided into two groups: those followed in the ward, named Group 1 (n=304), and those in the intensive care unit, named Group 2 (n=96). Recorded data included demographic characteristics, American Society of Anesthesiologists (ASA) physical status scores, types of comorbidities, anesthesia type, surgical method, surgical delay time, duration of surgery, blood transfusion requirements, and complications. RESULTS: Patients in Group 2 had higher mean age, comorbidity, and mortality rates compared to Group 1 (p<0.001). In terms of types of comorbidities, the rate of intensive care unit admission was higher in patients with coronary artery disease and chronic renal failure (p<0.001). Mean surgical delay and length of hospital stay were also higher in Group 2 (p<0.001). In multivariate logistic regression analysis, age (p<0.001, Odds Ratio [OR]=1.91, Confidence Interval [CI]=1.046-1.137), ASA score (p<0.001, OR=3.872, CI=1.913-7.838), duration of surgical delay (p<0.001, OR=2.029, CI=1.365-3.017), surgical method (p=0.003, OR=2.003, C=1.258-3.188), and length of hospital stay (p=0.006, OR=1.147, CI=1.04-1.266) were determined as predictive factors for 30-day mortality. CONCLUSION: This study found that age, ASA classification, length of hospital stay, surgical method, and surgical delay were predictive factors for both morbidity and mortality. Among these, surgical delay time appears to be a modifiable parameter when all factors are considered.
Sujet(s)
Fractures de la hanche , Unités de soins intensifs , Humains , Mâle , Femelle , Fractures de la hanche/chirurgie , Fractures de la hanche/mortalité , Sujet âgé , Unités de soins intensifs/statistiques et données numériques , Études rétrospectives , Sujet âgé de 80 ans ou plus , Adulte d'âge moyen , Durée du séjour/statistiques et données numériques , Complications postopératoires/épidémiologie , Complications postopératoires/mortalité , Facteurs de risque , Mortalité hospitalière , Turquie/épidémiologie , Comorbidité , Délai jusqu'au traitement/statistiques et données numériquesRÉSUMÉ
BACKGROUND: Dialysis patients are at high risk for surgery, but their outcomes after splenectomy are unclear. We compared postoperative complications between dialysis and non-dialysis patients. METHODS: Data were retrieved from the National Surgical Quality Improvement Program for this retrospective cohort. Adult patients undergoing elective splenectomy between 2005 and 2020 were included. RESULTS: Among 10,339 included patients, 143(1.4%) were on chronic dialysis. Postoperative mortality was higher in dialysis vs. non-dialysis patients (9.1% vs. 1.8%). Dialysis patients were more likely to have 30-day major morbidity, infectious and non-infectious complications, reoperation, and prolonged hospital stay. On multivariable regression, dialysis dependence significantly increased odds of mortality, major morbidity, blood transfusion, prolonged length of stay, reoperation, and failure-to-rescue (FTR). CONCLUSION: Dialysis patients were at higher risk of postoperative morbidity following splenectomy. Additionally, the risk of FTR in this patient population is also significantly more compared to non-dialysis patients.
Sujet(s)
Complications postopératoires , Dialyse rénale , Splénectomie , Humains , Splénectomie/effets indésirables , Femelle , Mâle , Complications postopératoires/épidémiologie , Complications postopératoires/étiologie , Complications postopératoires/mortalité , Adulte d'âge moyen , Études rétrospectives , Sujet âgé , Adulte , Défaillance rénale chronique/thérapie , Défaillance rénale chronique/complications , Durée du séjourRÉSUMÉ
In Europe, CRC is the second most common cause of cancer death, and surgery remains the mainstay curative treatment. Age and frailty are associated with an increased risk of postoperative morbidity and 1-year mortality. Chronological age is not sufficient to assess the risk of postoperative complications. The CGA has been developed to better identify frail patients. Geriatric co-management have been developed to optimize the post-operative outcomes. We analyzed the real-life of geriatric co-management within an ERAS program on surgical outcomes at 90 days and oncologic outcomes at 1 year in patients aged 70 years or older after surgery for CRC. This was a retrospective study based on a prospective cohort. Fifty-one patients with a G8 score ≤ 14 were referred to geriatricians for preoperative CGA (Frail Group). They were compared with 151 patients with a G8 score ≥ 15 (Robust Group). In the Frail Group, patients were significantly older with more comorbidities than the patients in the Robust Group. Oncologic characteristics, treatments and global post-operative outcomes were comparable between the two groups. One year after surgery mortality and recurrence rates were similar between the two groups. Our study suggests that geriatric co-management is feasible and contributes to the reduction of postoperative morbimortality. Moreover, performing the CGA after G8 score screening and completion of geriatric interventions resulted in similar 90-day postoperative outcomes, in frail patients than in robust patients. Our results confirmed the benefit of geriatric co-management, involving G8 screening, CGA, and ERAS, for frail older patients undergoing surgery for CRC.
Sujet(s)
Tumeurs colorectales , Personne âgée fragile , Fragilité , Évaluation gériatrique , Complications postopératoires , Humains , Sujet âgé , Mâle , Femelle , Tumeurs colorectales/chirurgie , Tumeurs colorectales/mortalité , Sujet âgé de 80 ans ou plus , Évaluation gériatrique/méthodes , Complications postopératoires/épidémiologie , Complications postopératoires/mortalité , Études rétrospectivesRÉSUMÉ
BACKGROUND: Reports from case series suggest that operative outcomes are comparable amongst different age groups following surgery with curative intent for non-small cell lung cancer (NSCLC). The purpose of this study was to compare morbidity and mortality after NSCLC surgery in older patients (≥ 75 years) versus younger patients (< 75 years) and identify independent predictive risk factors. METHODS: We identified 2015 patients with postoperative stages IA to IIIA according to AJCC/UICC 7th edition who had undergone NSCLC surgery with curative intent at a single specialized lung cancer center from January 2010 to December 2015. A matched-pair analysis was performed on 227 older patients and corresponding 227 younger patients. Short-term surgical outcomes were postoperative morbidity, length of hospital stay, 30-day and 90-day mortality. Long-term operative outcomes were disease-free and overall survival. RESULTS: 454 patients were included in the matched-pair analysis. 36% of younger patients developed postoperative complications versus 42% in older patients (p = 0.163). Age was not significantly associated with the occurrence of postoperative complications. Median length of hospital stay was 14 days in older patients and 13 days in younger patients (p = 0.185). 90-day mortality was 2.2% in younger patients compared to 4% in older patients (p = 0.424). In patients aged 75 and older impaired performance status (ECOG ≥ 1) was associated with decreased overall survival (HR = 2.15, CI 1.34-3.46), as were preoperative serum C-reactive protein / albumin ratio ≥ 0.3 (HR = 1.95, CI 1.23-3.11) and elevated preoperative serum creatinine levels ≥ 1.1 mg/dl (HR = 1.84, CI 1.15-2.95). In the younger cohort male sex (HR = 2.26, CI 1.17-4.36), postoperative stage III disease (HR 4.61, CI 2.23-9.54) and preoperative anemia (hemoglobin < 12 g/dl) (HR 2.09, CI 1.10-3.96) were associated with decreased overall survival. CONCLUSIONS: Lung resection for NSCLC in older patients is associated with postoperative morbidity and mortality comparable to those of younger patients. In older patients, physical activity, comorbidities and nutritional status are related to survival and should influence the indication for surgery rather than age alone.
Sujet(s)
Carcinome pulmonaire non à petites cellules , Durée du séjour , Tumeurs du poumon , Complications postopératoires , Humains , Carcinome pulmonaire non à petites cellules/chirurgie , Carcinome pulmonaire non à petites cellules/mortalité , Carcinome pulmonaire non à petites cellules/anatomopathologie , Mâle , Tumeurs du poumon/chirurgie , Tumeurs du poumon/mortalité , Tumeurs du poumon/anatomopathologie , Femelle , Sujet âgé , Complications postopératoires/épidémiologie , Complications postopératoires/mortalité , Taux de survie , Adulte d'âge moyen , Analyse appariée , Pronostic , Facteurs âges , Sujet âgé de 80 ans ou plus , Durée du séjour/statistiques et données numériques , Études de suivi , Facteurs de risque , Pneumonectomie/mortalité , Pneumonectomie/effets indésirables , Études rétrospectives , Stadification tumorale , Morbidité , Carcinome épidermoïde/chirurgie , Carcinome épidermoïde/mortalité , Carcinome épidermoïde/anatomopathologieRÉSUMÉ
INTRODUCTION: Diabetes mellitus (DM) in patients undergoing cardiac transcatheter or surgical interventions usually is correlated with poor outcomes. Transcatheter aortic valve implantation (TAVI) has been developed as a therapy choice for inoperable, high-, or intermediate-risk surgical patients with severe aortic stenosis (AS). OBJECTIVE: To evaluate the impact of DM and hemoglobin A1c (HbA1c) on outcomes and survival after TAVI. METHODS: Five hundred and fifty-two symptomatic severe AS patients who underwent TAVI, of whom 164 (29.7%) had DM, were included in this retrospective study. Follow-up was performed after 30 days, six months, and annually. RESULTS: The device success and risks of procedural-related complications were similar between patients with and without DM, except for acute kidney injury, which was more frequent in the DM group (2.4% vs. 0%, P=0.021). In-hospital and first-year mortality were similar between the groups (4.9% vs. 3.6%, P=0.490 and 15.0% vs. 11.2%, P=0.282, respectively). There was a statistical difference between HbA1c ≥ 6.5 and HbA1c ≤ 6.49 groups in total mortality (34.4% vs. 15.8%, P<0.001, respectively). The only independent predictors were Society of Thoracic Surgeons score (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.09-1.51; P=0.003) and HbA1c level ≥ 6.5 (HR 10.78, 95% CI 2.58-21.50; P=0.003) in multivariable logistic regression analysis. CONCLUSION: In this study, we conclude that DM was not correlated with an increased mortality risk or complication rates after TAVI. Also, it was shown that mortality was higher in patients with HbA1c ≥ 6.5, and it was an independent predictor for long-term mortality.
Sujet(s)
Sténose aortique , Diabète , Hémoglobine glyquée , Remplacement valvulaire aortique par cathéter , Humains , Remplacement valvulaire aortique par cathéter/mortalité , Remplacement valvulaire aortique par cathéter/effets indésirables , Mâle , Femelle , Études rétrospectives , Sténose aortique/chirurgie , Sténose aortique/mortalité , Sujet âgé de 80 ans ou plus , Sujet âgé , Résultat thérapeutique , Diabète/mortalité , Hémoglobine glyquée/analyse , Facteurs de risque , Complications postopératoires/mortalité , Facteurs temps , Indice de gravité de la maladie , Mortalité hospitalièreRÉSUMÉ
INTRODUCTION: A year ago, in a sample of 113 patients, our research group found that a high number of lymphocytes in the immediate postoperative period was correlated to a poor prognosis in cardiovascular surgeries. This study is an expansion of the initial study in order to confirm this finding. METHODS: We analyzed the data of 338 consecutive patients submitted to cardiovascular surgeries with cardiopulmonary bypass performed at Hospital Universitário Ciências Médicas (Belo Horizonte/Brazil) from 2015 to 2017. We analyzed 39 variables with the outcomes death, hospital stay, and intensive care unit stay. RESULTS: The value of lymphocytes in the immediate postoperative period > 2175.0/mm³ was an indicator of poor prognosis in this sample (P<0.001). The variables female sex, age, high level of European System for Cardiac Operative Risk Evaluation II, increased stay in the intensive care unit and in the ward, elevation of creatinine in the preoperative period and at intensive care unit discharge, elevation of the percentage of immediate postoperative period segmented neutrophils, high immediate postoperative period neutrophil/lymphocyte ratio, fasting hyperglycemia, preoperative critical condition, reintubation, mild or transient acute renal failure, surgical infection, cardiopulmonary bypass, and aortic cross-clamping and mechanical ventilation durations also had an impact on the mortality outcome. CONCLUSION: The value of lymphocytes in the immediate postoperative period > 2175.0/mm3 was an indicator of poor prognosis in cardiovascular surgery with cardiopulmonary bypass.
Sujet(s)
Pontage cardiopulmonaire , Durée du séjour , Humains , Pontage cardiopulmonaire/mortalité , Pontage cardiopulmonaire/effets indésirables , Femelle , Mâle , Adulte d'âge moyen , Sujet âgé , Numération des lymphocytes , Pronostic , Lymphocytes , Période postopératoire , Facteurs de risque , Procédures de chirurgie cardiovasculaire/mortalité , Études rétrospectives , Complications postopératoires/mortalité , Adulte , Unités de soins intensifs/statistiques et données numériquesRÉSUMÉ
OBJECTIVE: To compare long-term cardiovascular (CV) outcomes between men and women with aortic stenosis (AS) undergoing aortic valve replacement (AVR) by the type of valve implant. METHODS: The study population consisted of 14 123 non-selected patients with AS undergoing first-time AVR and included in the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry during 2008-2016. Comparisons were made between men and women and type of valve implant (ie, surgical implantation with a mechanical (mSAVR) (n=1 966) or biological valve (bioSAVR) (n=9 801)) or by a transcatheter approach (TAVR) (n=2 356). Outcomes included all-cause mortality, ischaemic stroke, major bleeding, thromboembolic events, heart failure and myocardial infarction, continuously adjusted for significant comorbidities and medical treatment. RESULTS: In the mSAVR cohort, there were no significant sex differences in any CV events. In the bioSAVR cohort, a higher risk of death (HR: 1.14; 95% CI: 1.04 to 1.26, p=0.007) and major bleeding (HR: 1.41; 95% CI: 1.18 to 1.69, p<0.001) was observed in men. In the TAVR cohort, men suffered a higher risk of death (HR: 1.24; 95% CI: 1.07 to 1.45, p=0.005), major bleeding (HR: 1.35; 95% CI: 1.00 to 1.82, p=0.022) and thromboembolism (HR: 1.35, 95% CI: 1.00 to 1.82, p=0.047). CONCLUSION: No significant long-term difference in CV events was noted between men and women undergoing AVR with a mechanical aortic valve. In both the bioSAVR and TAVR cohort, mortality was higher in men who also had an increased incidence of several other CV events.
Sujet(s)
Sténose aortique , Valve aortique , Implantation de valve prothétique cardiaque , Enregistrements , Humains , Sténose aortique/chirurgie , Sténose aortique/mortalité , Mâle , Femelle , Suède/épidémiologie , Sujet âgé , Facteurs sexuels , Sujet âgé de 80 ans ou plus , Facteurs de risque , Valve aortique/chirurgie , Valve aortique/imagerie diagnostique , Implantation de valve prothétique cardiaque/effets indésirables , Implantation de valve prothétique cardiaque/méthodes , Résultat thérapeutique , Appréciation des risques/méthodes , Remplacement valvulaire aortique par cathéter/effets indésirables , Remplacement valvulaire aortique par cathéter/méthodes , Remplacement valvulaire aortique par cathéter/mortalité , Prothèse valvulaire cardiaque , Facteurs temps , Études de suivi , Pronostic , Complications postopératoires/épidémiologie , Complications postopératoires/mortalité , Incidence , Taux de survie/tendances , Études rétrospectivesRÉSUMÉ
BACKGROUND: Outcomes from transcatheter aortic valve replacement (TAVR) in low-surgical risk patients with bicuspid aortic stenosis beyond 2 years are limited. OBJECTIVES: This study aimed to evaluate 3-year clinical and echocardiographic outcomes from the Evolut Low Risk Bicuspid Study. METHODS: The Evolut Low Risk Bicuspid Study is a prospective, multicenter, single-arm study conducted in 25 U.S. CENTERS: Patients with severe aortic stenosis at low surgical risk with bicuspid aortic valve anatomy (all subtypes) underwent TAVR with a self-expanding, supra-annular Evolut R or PRO (Medtronic) bioprosthesis. An independent clinical events committee adjudicated all deaths and endpoint-related adverse events, and a central echocardiographic core laboratory assessed hemodynamic endpoints. RESULTS: An attempted implant was performed in 150 patients from December 2018 to October 2019. The mean age was 70.3 ± 5.5 years, 48% (72/150) of the patients were women, and the mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 1.3% (Q1-Q3: 0.9%-1.7%). Sievers type 1 was the dominant bicuspid morphology (90.7%, 136/150). The Kaplan-Meier rates of all-cause mortality or disabling stroke were 1.3% (95% CI: 0.3%-5.3%) at 1 year, 3.4% (95% CI: 1.4%-8.1%) at 2 years, and 4.1% (95% CI: 1.6%-10.7%) at 3 years. The incidence of new permanent pacemaker implantation was 19.4% (95% CI: 12.4%-29.6%) at 3 years. There were no instances of moderate or severe paravalvular aortic regurgitation at 2 and 3 years after TAVR. CONCLUSIONS: The 3-year results from the Evolut Low Risk Bicuspid Study demonstrate low rates of all-cause mortality or disabling stroke and favorable hemodynamic performance.
Sujet(s)
Sténose aortique , Valve aortique , Maladie de la valve aortique bicuspide , Bioprothèse , Prothèse valvulaire cardiaque , Hémodynamique , Conception de prothèse , Remplacement valvulaire aortique par cathéter , Humains , Femelle , Mâle , Sténose aortique/chirurgie , Sténose aortique/imagerie diagnostique , Sténose aortique/physiopathologie , Sténose aortique/mortalité , Remplacement valvulaire aortique par cathéter/effets indésirables , Remplacement valvulaire aortique par cathéter/mortalité , Remplacement valvulaire aortique par cathéter/instrumentation , Sujet âgé , Facteurs de risque , Études prospectives , Facteurs temps , Résultat thérapeutique , Valve aortique/chirurgie , Valve aortique/imagerie diagnostique , Valve aortique/physiopathologie , Valve aortique/malformations , Appréciation des risques , Maladie de la valve aortique bicuspide/chirurgie , Maladie de la valve aortique bicuspide/physiopathologie , États-Unis/épidémiologie , Indice de gravité de la maladie , Complications postopératoires/mortalité , Récupération fonctionnelle , Sujet âgé de 80 ans ou plus , Adulte d'âge moyen , Valvulopathies/physiopathologie , Valvulopathies/imagerie diagnostique , Valvulopathies/chirurgie , Valvulopathies/mortalitéRÉSUMÉ
Objective. To evaluate patient characteristics and 5-year outcomes after surgical mitral valve (MV) repair for leaflet prolapse at a medium-sized cardiothoracic center. Background. Contemporary reports on the outcome of MV repair at medium-sized cardiothoracic centers are sparse. Methods. Patients receiving open-heart surgery with MV repair due to primary mitral regurgitation caused by leaflet prolapse between 2015 and 2021, without active endocarditis, were included. Clinical data, complications, re-interventions, mortality, and echocardiographic data were retrospectively registered from electronical patient charts, both pre-operatively and from post-operative follow-ups. Results. One hundred and three patients were included, 83% male, with a mean age of 62 years. All-cause mortality was 9% during a median follow-up time of 4.9 years. Re-intervention rate on the MV was 4%. Post-operative complications before last available follow-up visit at median 3.0 years were infrequent, with new-onset atrial fibrillation/flutter in 16%, post-operative MV regurgitation grade II or above in 17% and post-operative tricuspid regurgitation grade II or above in 14%. Conclusions. These data demonstrate that surgical MV repair for leaflet prolapse at a medium-sized cardiothoracic center was associated with low re-intervention rate and few severe complications. The presented results are comparable to data from surgical high-volume centers, indicating that surgical MV repair can be safely performed at selected medium-sized cardiothoracic centers.
Sujet(s)
Hôpitaux universitaires , Annuloplastie mitrale , Insuffisance mitrale , Prolapsus de la valve mitrale , Valve atrioventriculaire gauche , Complications postopératoires , Humains , Mâle , Adulte d'âge moyen , Femelle , Prolapsus de la valve mitrale/chirurgie , Prolapsus de la valve mitrale/mortalité , Prolapsus de la valve mitrale/imagerie diagnostique , Prolapsus de la valve mitrale/physiopathologie , Résultat thérapeutique , Facteurs temps , Études rétrospectives , Sujet âgé , Valve atrioventriculaire gauche/chirurgie , Valve atrioventriculaire gauche/imagerie diagnostique , Valve atrioventriculaire gauche/physiopathologie , Norvège , Insuffisance mitrale/chirurgie , Insuffisance mitrale/imagerie diagnostique , Insuffisance mitrale/physiopathologie , Insuffisance mitrale/mortalité , Complications postopératoires/mortalité , Complications postopératoires/étiologie , Annuloplastie mitrale/effets indésirables , Annuloplastie mitrale/mortalité , Annuloplastie mitrale/instrumentation , Facteurs de risque , Implantation de valve prothétique cardiaque/effets indésirables , Implantation de valve prothétique cardiaque/mortalité , Implantation de valve prothétique cardiaque/instrumentation , Récupération fonctionnelleRÉSUMÉ
Background: Cardiac open-heart surgery, which usually involves thoracotomy and cardiopulmonary bypass, is associated with a high incidence of postoperative mortality and adverse events. In recent years, sarcopenia, as a common condition in older patients, has been associated with an increased incidence of adverse prognosis. Methods: We conducted a search of databases including PubMed, Embase, and Cochrane, with the search date up to January 1, 2024, to identify all studies related to elective cardiac open-heart surgery in older patients. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence. Results: A total of 12 cohort studies were included in this meta-analysis for analysis. This meta-analysis revealed that patients with sarcopenia had a higher risk of postoperative mortality. Furthermore, the total length of hospital stay and ICU stay were longer after surgery. Moreover, there was a higher number of patients requiring further healthcare after discharge. Regarding postoperative complications, sarcopenia patients had an increased risk of developing renal failure and stroke. Conclusion: Sarcopenia served as a tool to identify high-risk older patients undergoing elective cardiac open-heart surgery. By identifying this risk factor early on, healthcare professionals took targeted steps to improve perioperative function and made informed clinical decisions.Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023426026.
Sujet(s)
Procédures de chirurgie cardiaque , Interventions chirurgicales non urgentes , Complications postopératoires , Sarcopénie , Sujet âgé , Sujet âgé de 80 ans ou plus , Humains , Procédures de chirurgie cardiaque/effets indésirables , Interventions chirurgicales non urgentes/effets indésirables , Durée du séjour , Complications postopératoires/mortalité , Pronostic , Facteurs de risque , Sarcopénie/imagerie diagnostique , TomodensitométrieRÉSUMÉ
BACKGROUND: Type I and type II diabetes mellitus (DM) patients have a higher prevalence of cardiovascular diseases, as well as a higher mortality risk of cardiovascular diseases and interventions. This study provides an update on the impact of DM on clinical outcomes, including mortality, complications and reinterventions, using data on percutaneous and surgical cardiac interventions in the Netherlands. METHODS: This is a retrospective, nearby nationwide study using real-world observational data registered by the Netherlands Heart Registration (NHR) between 2015 and 2020. Patients treated for combined or isolated coronary artery disease (CAD) and aortic valve disease (AVD) were studied. Bivariate analyses and multivariate logistic regression models were used to evaluate the association between DM and clinical outcomes both unadjusted and adjusted for baseline characteristics. RESULTS: 241,360 patients underwent the following interventions; percutaneous coronary intervention(N = 177,556), coronary artery bypass grafting(N = 39,069), transcatheter aortic valve implantation(N = 11,819), aortic valve replacement(N = 8,028) and combined CABG and AVR(N = 4,888). The incidence of DM type I and II was 21.1%, 26.7%, 17.8%, 27.6% and 27% respectively. For all procedures, there are statistically significant differences between patients living with and without diabetes, adjusted for baseline characteristics, at the expense of patients with diabetes for 30-days mortality after PCI (OR = 1.68; p <.001); 120-days mortality after CABG (OR = 1.35; p <.001), AVR (OR = 1.5; p <.03) and CABG + AVR (OR = 1.42; p =.02); and 1-year mortality after CABG (OR = 1.43; p <.001), TAVI (OR = 1.21; p =.01) and PCI (OR = 1.68; p <.001). CONCLUSION: Patients with DM remain to have unfavourable outcomes compared to nondiabetic patients which calls for a critical reappraisal of existing care pathways aimed at diabetic patients within the cardiovascular field.
Sujet(s)
Pontage aortocoronarien , Maladie des artères coronaires , Diabète de type 1 , Diabète de type 2 , Intervention coronarienne percutanée , Enregistrements , Remplacement valvulaire aortique par cathéter , Humains , Mâle , Femelle , Sujet âgé , Études rétrospectives , Résultat thérapeutique , Intervention coronarienne percutanée/mortalité , Intervention coronarienne percutanée/effets indésirables , Facteurs de risque , Facteurs temps , Maladie des artères coronaires/mortalité , Maladie des artères coronaires/thérapie , Maladie des artères coronaires/chirurgie , Adulte d'âge moyen , Appréciation des risques , Sujet âgé de 80 ans ou plus , Pontage aortocoronarien/effets indésirables , Pontage aortocoronarien/mortalité , Pays-Bas/épidémiologie , Diabète de type 2/mortalité , Diabète de type 2/diagnostic , Diabète de type 2/complications , Diabète de type 2/thérapie , Remplacement valvulaire aortique par cathéter/effets indésirables , Remplacement valvulaire aortique par cathéter/mortalité , Diabète de type 1/mortalité , Diabète de type 1/diagnostic , Diabète de type 1/complications , Diabète de type 1/thérapie , Incidence , Maladie de la valve aortique/chirurgie , Maladie de la valve aortique/mortalité , Complications postopératoires/mortalité , Hôpitaux à haut volume d'activitéRÉSUMÉ
PURPOSE OF REVIEW: To examine the evolving landscape of cardiac surgery, focusing on the increasing complexity of patients and the role of mechanical circulatory support (MCS) in managing perioperative low cardiac output syndrome (P-LCOS). RECENT FINDINGS: P-LCOS is a significant predictor of mortality in cardiac surgery patients. Preoperative risk factors, such as cardiogenic shock and elevated lactate levels, can help identify those at higher risk. Proactive use of MCS, rather than reactive implementation after P-LCOS develops, may lead to improved outcomes by preventing severe organ hypoperfusion. The emerging concept of "protected cardiac surgery" emphasizes early identification of these high-risk patients and planned MCS utilization. Additionally, specific MCS strategies are being developed and refined for various cardiac conditions, including AMI-CS, valvular surgeries, and pulmonary thromboendarterectomy. SUMMARY: This paper explores the shifting demographics and complexities in cardiac surgery patients. It emphasizes the importance of proactive, multidisciplinary approaches to identify high-risk patients and implement early MCS to prevent P-LCOS and improve outcomes. The concept of protected cardiac surgery, involving planned MCS use and shared decision-making, is highlighted. The paper also discusses MCS strategies tailored to specific cardiac procedures and the ethical considerations surrounding MCS implementation.
Sujet(s)
Bas débit cardiaque , Procédures de chirurgie cardiaque , Humains , Procédures de chirurgie cardiaque/effets indésirables , Bas débit cardiaque/prévention et contrôle , Complications postopératoires/prévention et contrôle , Complications postopératoires/mortalité , Dispositifs d'assistance circulatoire , Choc cardiogénique/mortalité , Oxygénation extracorporelle sur oxygénateur à membrane , Facteurs de risque , Appréciation des risquesRÉSUMÉ
BACKGROUND: Off-pump coronary artery bypass grafting (OPCABG) presents distinct hemodynamic characteristics, yet the relationship between intraoperative hypotension and short-term adverse outcomes remains clear. Our study aims to investigate association between intraoperative hypotension and postoperative acute kidney injury (AKI), mortality and length of stay in OPCABG patients. METHODS: Retrospective data of 494 patients underwent OPCABG from January 2016 to July 2023 were collected. We analyzed the relationship between intraoperative various hypotension absolute values (MAP > 75, 65 < MAP ≤ 75, 55 < MAP ≤ 65, MAP ≤ 55 mmHg) and postoperative AKI, mortality and length of stay. Logistic regression assessed the impacts of exposure variable on AKI and postoperative mortality. Linear regression was used to analyze risk factors on the length of intensive care unit stay (ICU) and hospital stay. RESULTS: The incidence of AKI was 31.8%, with in-hospital and 30-day mortality at 2.8% and 3.5%, respectively. Maintaining a MAP greater than or equal 65 mmHg [odds ratio (OR) 0.408; p = 0.008] and 75 mmHg (OR 0.479; p = 0.024) was significantly associated with a decrease risk of AKI compared to MAP less than 55 mmHg for at least 10 min. Prolonged hospital stays were linked to low MAP, while in-hospital mortality and 30-day mortality were not linked to IOH but exhibited correlation with a history of myocardial infarction. AKI showed correlation with length of ICU stay. CONCLUSIONS: MAP > 65 mmHg emerges as a significant independent protective factor for AKI in OPCABG and IOH is related to length of hospital stay. Proactive intervention targeting intraoperative hypotension may provide a potential opportunity to reduce postoperative renal injury and hospital stay. TRIAL REGISTRATION: ChiCTR2400082518. Registered 31 March 2024. https://www.chictr.org.cn/bin/project/edit?pid=225349 .
Sujet(s)
Atteinte rénale aigüe , Pontage coronarien à coeur battant , Hypotension artérielle , Complications peropératoires , Durée du séjour , Complications postopératoires , Humains , Atteinte rénale aigüe/épidémiologie , Atteinte rénale aigüe/mortalité , Mâle , Études rétrospectives , Femelle , Hypotension artérielle/épidémiologie , Pontage coronarien à coeur battant/effets indésirables , Durée du séjour/statistiques et données numériques , Adulte d'âge moyen , Complications postopératoires/épidémiologie , Complications postopératoires/mortalité , Sujet âgé , Complications peropératoires/épidémiologie , Complications peropératoires/mortalité , Études de cohortes , Mortalité hospitalière , Facteurs de risqueRÉSUMÉ
PURPOSE: We conducted a randomized prospective trial (KLASS-07 trial) to compare laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. In this interim report, we describe short-term results in terms of morbidity and mortality. METHODS AND METHODS: The sample size was 442 participants. At the time of the interim analysis, 314 patients were enrolled and randomized. After excluding patients who did not undergo planned surgeries, we performed a modified per-protocol analysis of 151 and 145 patients in the LADG and TLDG groups, respectively. RESULTS: The baseline characteristics, including comorbidity status, did not differ between the LADG and TLDG groups. Blood loss was somewhat higher in the LADG group, but statistical significance was not attained (76.76±72.63 vs. 62.91±65.68 mL; P=0.087). Neither the required transfusion level nor the operation or reconstruction time differed between the 2 groups. The mini-laparotomy incision in the LADG group was significantly longer than the extended umbilical incision required for specimen removal in the TLDG group (4.79±0.82 vs. 3.89±0.83 cm; P<0.001). There were no between-group differences in the time to solid food intake, hospital stay, pain score, or complications within 30 days postoperatively. No mortality was observed in either group. CONCLUSIONS: Short-term morbidity and mortality rates did not differ between the LADG and TLDG groups. The KLASS-07 trial is currently underway. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03393182.
Sujet(s)
Gastrectomie , Laparoscopie , Tumeurs de l'estomac , Humains , Tumeurs de l'estomac/chirurgie , Tumeurs de l'estomac/mortalité , Gastrectomie/méthodes , Gastrectomie/effets indésirables , Gastrectomie/mortalité , Laparoscopie/méthodes , Laparoscopie/effets indésirables , Laparoscopie/mortalité , Femelle , Mâle , Adulte d'âge moyen , Sujet âgé , Études prospectives , Complications postopératoires/épidémiologie , Complications postopératoires/mortalité , Complications postopératoires/étiologie , Morbidité , AdulteRÉSUMÉ
Background: Heart transplantation is the preferred treatment for end-stage heart failure. This study investigated the intra-operative risk factors affecting post-transplantation mortality. Methods: This single-center retrospective cohort study examined 239 heart transplant patients over eight years, from 2011-2019, at the oldest dedicated cardiovascular center, Shahid Rajaee Hospital (Tehran, Iran). The primary evaluated clinical outcomes were rejection, readmission, and mortality one month and one year after transplantation. For data analysis, univariate logistic regression analyses were conducted. Results: In this study, 107 patients (43.2%) were adults, and 132 patients (56.8%) were children. Notably, reoperation due to bleeding was a significant predictor of one-month mortality in both children (OR=7.47, P=0.006) and adults (OR=172.12, P<0.001). Moreover, the need for defibrillation significantly increased the risk of one-month mortality in both groups (children: OR=38.00, P<0.001; adults: OR=172.12, P<0.001). Interestingly, readmission had a protective effect against one-month mortality in both children (OR=0.02, P<0.001) and adults (OR=0.004, P<0.001). Regarding one-year mortality, the use of extracorporeal membrane oxygenation (ECMO) was associated with a higher risk in both children (OR=7.64, P=0.001) and adults (OR=12.10, P<0.001). For children, reoperation due to postoperative hemorrhage also increased the risk (OR=5.14, P=0.020), while defibrillation was a significant risk factor in both children and adults (children: OR=22.00, P<0.001; adults: OR=172.12, P<0.001). The median post-surgery survival was 22 months for children and 24 months for adults. Conclusion: There was no correlation between sex and poorer outcomes. Mortality at one month and one year after transplantation was associated with the following risk factors: the use of ECMO, reoperation for bleeding, defibrillation following cross-clamp removal, and Intensive Care Unit (ICU) stay. Readmission, on the other hand, had a weak protective effect.
Sujet(s)
Transplantation cardiaque , Humains , Transplantation cardiaque/statistiques et données numériques , Transplantation cardiaque/méthodes , Transplantation cardiaque/mortalité , Transplantation cardiaque/effets indésirables , Transplantation cardiaque/tendances , Mâle , Femelle , Facteurs de risque , Études rétrospectives , Iran/épidémiologie , Enfant , Adulte , Adulte d'âge moyen , Réadmission du patient/statistiques et données numériques , Adolescent , Enfant d'âge préscolaire , Réintervention/statistiques et données numériques , Réintervention/mortalité , Réintervention/méthodes , Jeune adulte , Complications postopératoires/mortalité , Défaillance cardiaque/mortalité , Défaillance cardiaque/chirurgieRÉSUMÉ
BACKGROUND: The relationship between age of a heart transplant (HT) program and outcomes has not been explored. METHODS: We performed a retrospective cohort analysis of the United Network for Organ Sharing database of all adult HTs between 2009 and 2019. For each patient, we created a variable that corresponded to program age: new (<5), developing (≥5 but <10) and established (≥10) years. RESULTS: Of 20 997 HTs, 822 were at new, 908 at developing, and 19 267 at established programs. Patients at new programs were significantly more likely to have history of cigarette smoking, ischemic cardiomyopathy, and prior sternotomy. These programs were less likely to accept organs from older donors and those with a history of hypertension or cigarette use. As compared to patients at new programs, transplant patients at established programs had less frequent rates of treated rejection during the index hospitalization (HR 0.43 [95% CI, 0.36-0.53] p < 0.001) and at 1 year (HR 0.58 [95% CI, 0.49-0.70], p < 0.001), less frequently required pacemaker implantations (HR 0.50 [95% CI, 0.36-0.69], p < 0.001), and less frequently required dialysis (HR 0.66 [95% CI, 0.53-0.82], p < 0.001). However, there were no significant differences in short- or long-term survival between the groups (log-rank p = 0.24). CONCLUSION: Patient and donor selection differed between new, developing, and established HT programs but had equivalent survival. New programs had increased likelihood of treated rejection, pacemaker implantation, and need for dialysis. Standardized post-transplant practices may help to minimize this variation and ensure optimal outcomes for all patients.
Sujet(s)
Transplantation cardiaque , Humains , Transplantation cardiaque/mortalité , Femelle , Mâle , Études rétrospectives , Adulte d'âge moyen , Études de suivi , Taux de survie , Adulte , Pronostic , Acquisition d'organes et de tissus/statistiques et données numériques , Survie du greffon , Facteurs de risque , Rejet du greffon/mortalité , Rejet du greffon/étiologie , Complications postopératoires/mortalité , Donneurs de tissus/ressources et distribution , Facteurs âges , Sujet âgéRÉSUMÉ
Risk assessment is difficult yet would provide valuable data for both the surgeons and the patients in major hepatobiliary surgeries. An ideal risk calculator should improve workflow through efficient, timely, and accurate risk stratification. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator (SRC) and Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) are surgical risk stratification tools used to assess postoperative morbidity. In this study, preoperative data from 300 patients undergoing major hepatobiliary surgeries performed at a single tertiary university hospital were retrospectively collected from electronic patient records and entered into the ACS-SRC and P-POSSUM systems, and the resulting risk scores were calculated and recorded accordingly. The ACS-NSQIP-M1 (C-statisticsâ =â 0.725) and M2 (C-statisticsâ =â 0.791) models showed better morbidity discrimination ability than P-POSSUM-M1 (C-statisticsâ =â 0.672) model. The P-POSSUM-M2 (C-statisticsâ =â 0.806) model showed better differentiation success in morbidity than other models. The ACS-NSQIP-M1 (C-statisticsâ =â 0.888) and M2 (C-statisticsâ =â 0.956) models showed better mortality discrimination than P-POSSUM-M1 (C-statisticsâ =â 0.776) model. The P-POSSUM-M2 (C-statisticsâ =â 0.948) model showed better mortality differentiation success than the ACS-NSQIP-M1 and P-POSSUM-M1 models. The use of ACS-SRC and P-POSSUM calculators for major hepatobiliary surgeries offers quantitative data to assess risks for both the surgeon and the patient. Integrating these calculators into preoperative evaluation practices can enhance decision-making processes for patients. The results of the statistical analyses indicated that the P-POSSUM-M2 model for morbidity and the ACS-NSQIP-M2 model for mortality exhibited superior overall performance.