Articles: postoperative-complications.
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Multicenter Study
The association between platelet dysfunction and adverse outcomes in cardiac surgical patients.
Haemostatic activation during cardiopulmonary bypass is associated with prothrombotic complications. Although it is not possible to detect and quantify haemostatic activation directly, platelet dysfunction, as measured with point-of-care-assays, may be a useful surrogate. In this study, we assessed the association between cardiopulmonary bypass-associated platelet dysfunction and adverse outcomes in 3010 cardiac surgical patients. ⋯ The median (IQR [range]) percentage platelet dysfunction was less for those without the outcome as compared with those with the outcome; 14% (8-28% [1-99%]) vs. 19% (11-45% [2-98%]), p < 0.001. After risk adjustment, platelet dysfunction was independently associated with the composite outcome (p < 0.001), such that for each 1% increase in platelet dysfunction there was an approximately 1% increase in the composite outcome (OR 1.012; 95%CI 1.006-1.018). This exploratory study suggests that cardiopulmonary bypass-associated platelet dysfunction has prognostic value and may be a useful clinical measure of haemostatic activation in cardiac surgery.
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Multicenter Study
The effect of obstructive sleep apnea on readmissions and atrial fibrillation after cardiac surgery.
To understand the effect of obstructive sleep apnea on readmission rates and post-operative atrial fibrillation in the cardiac surgical population. ⋯ Patients with OSA are at increased risk of 30-day readmission and post-operative atrial fibrillation following cardiac surgery compared to those without OSA. Although the importance of OSA is increasingly recognized, it remains a significant risk factor for post-operative readmissions and morbidity. Further research is needed to optimize perioperative management of patients with OSA, but these results highlight the importance of this disease on patient outcomes and healthcare costs.
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J. Thorac. Cardiovasc. Surg. · Sep 2019
Multicenter Study Comparative StudyCauses of death in intermediate-risk patients: The Randomized Surgical Replacement and Transcatheter Aortic Valve Implantation Trial.
Examine the causes and timing of death in the Surgical Replacement and Transcatheter Aortic Valve Implantation intermediate-risk randomized trial for transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). ⋯ Mortality rates were similar for patients treated with TAVR or SAVR at any time period including at 1 year. Early cause of death was more commonly technical failure after TAVR and due to complications after SAVR. Recovery phase cause of death was dominated by complications from TAVR and SAVR. Late cause of death appeared to be independent of the procedure in both groups.
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Geriatr Gerontol Int · Sep 2019
Multicenter StudyGeriatric Nutritional Risk Index, a predictive assessment tool, for postoperative complications after abdominal surgery: A prospective multicenter cohort study.
Patients awaiting abdominal surgery are often malnourished, which puts them at a high risk of postoperative complications. The aim of the present study was to investigate the effects of preoperative nutritional status using the Geriatric Nutritional Risk Index (GNRI) on postoperative complications and the course of recovery for patients undergoing abdominal surgery. ⋯ Malnutrition indicated by the GNRI might be predictive of postoperative complications after abdominal surgery and the delay of postoperative course. Geriatr Gerontol Int 2019; 19: 924-929.
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J. Am. Coll. Cardiol. · Aug 2019
Multicenter Study Observational StudyThromboembolic Risk After Atriopulmonary, Lateral Tunnel, and Extracardiac Conduit Fontan Surgery.
Thromboembolic events contribute greatly to morbidity and mortality following Fontan surgery for univentricular hearts. ⋯ The EC Fontan was independently associated with a lower thromboembolic risk after controlling for time-varying effects of atrial arrhythmias and thromboprophylaxis.