Journal of the American College of Surgeons
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Comparative Study
Postoperative hyponatremia predicts an increase in mortality and in-hospital complications after cardiac surgery.
The association between postoperative hyponatremia (Na < 135 mEq/L) and outcomes after cardiac surgery has not been established. We studied the prevalence of postoperative hyponatremia and its effects on outcomes after cardiac surgery. ⋯ Hyponatremia is common after cardiac surgery and is an independent predictor of increased mortality, length of hospital stay, and postoperative complications.
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Multicenter Study Comparative Study
Use of a massive transfusion protocol in nontrauma patients: activate away.
Recently, concern has been raised that the use of massive transfusion protocols (MTPs) in nontrauma (ie, general medical/surgical [GMS]) patients might be inefficient due to protocol overactivation (activation in patients who do not ultimately receive massive transfusion). The current study was designed to investigate whether an MTP could be used effectively in GMS patients without detrimentally impacting resource allocation. ⋯ Despite finding that our MTP is overactivated in GMS patients, we could identify no unique disadvantages to its use with respect to resource allocation. In fact, a potential advantage to MTP activation exists, as products are issued more quickly with less variability. Our findings of increased platelet waste were not unique to GMS patients and should be used as a metric for quality improvement.
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Comparative Study
Predictors of operative mortality in cardiac surgical patients with prolonged intensive care unit duration.
Several systems have been developed to predict mortality after intensive care unit (ICU) admission in medical and surgical patients. However, a similar tool specific to cardiac surgical patients with prolonged ICU duration does not exist. The purpose of the current study was to identify independent perioperative predictors of operative mortality among cardiac surgical patients with prolonged ICU duration. ⋯ Operative mortality can be predicted by select risk factors for cardiac surgical patients with prolonged ICU duration. Patient age, preoperative intra-aortic balloon pump, postoperative cardiac arrest, prolonged ventilation, and stroke have the strongest association with mortality. Identification of these factors in the perioperative setting can enhance resource use and improve mortality after cardiac surgery.
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Comparative Study
Evolution of the incidence, management, and mortality of blunt thoracic aortic injury: a population-based analysis.
In the last decade, CT angiography has become the dominant diagnostic modality for blunt aortic injury and endovascular repair has become the leading aortic repair strategy. The impact of these shifts on incidence, aortic repair rate, and mortality remains poorly characterized. Our objective was to perform a population-based analysis of secular trends in the incidence, management, and in-hospital mortality of blunt thoracic aortic injury. ⋯ The increasing frequency of patients managed nonoperatively and decreasing risk-adjusted mortality in these patients suggests that defining the evolving role of nonoperative management should be a major focus of research in the endovascular era.
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Comparative Study
Synchronous and antecedent nonthyroidal malignancies in patients with papillary thyroid carcinoma.
There is a known association between the development of papillary thyroid cancer (PTC) after a primary nonthyroidal cancer (NTC). However, the prevalence of synchronous or antecedent NTCs in patients with PTC is undetermined, as are the clinicopathologic characteristics of PTC in these patients. ⋯ The prevalence of synchronous or antecedent NTCs in patients surgically treated for PTC is 13.9%. These patients present with PTC tumor characteristics similar to those without additional NTCs, and should therefore be managed equivalently. In addition, surgeons should be aware of the frequency of synchronous PTC with these types of tumors and consider evaluation of the neck at the time of NTC diagnosis.