Articles: outcome.
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Journal of neurosurgery · May 2017
Impact of subclinical coronary artery disease on the clinical outcomes of carotid endarterectomy.
OBJECTIVE Controversy persists regarding the optimal management of subclinical coronary artery disease (CAD) prior to carotid endarterectomy (CEA) and the impact of CAD on clinical outcomes after CEA. This study aimed to evaluate the short-term surgical risks and long-term outcomes of patients with subclinical CAD who underwent CEA. METHODS The authors performed a retrospective study of data from a prospective CEA registry. ⋯ These patients did have a higher incidence of perioperative cardiac damage (13.6% vs 0.5%, p < 0.01), but they had similar primary endpoint incidences during the perioperative period (2.5% vs.1.8%, p = 0.65) and similar estimated 4-year primary endpoint rates (13.6% vs 12.4%, p = 0.76) as the patients without subclinical CAD. Kaplan-Meier survival analysis showed that the 2 groups had similar rates of overall survival (p = 0.75). CONCLUSIONS Patients with subclinical CAD can undergo CEA with acceptable short- and long-term outcomes provided they receive selective coronary revascularization and optimal perioperative medical treatment.
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Surgical management of spinal metastasis is complex and can be associated with significant postoperative morbidity. Analyzing readmission rates may serve as a proxy for postoperative morbidity and functional decline, allowing patients and physicians to make informed decisions about treatment. ⋯ Readmissions provide an important window into understanding postoperative morbidity among patients with metastatic disease of the spine. This study offers an important starting point for understanding the nuances of patients' postoperative outcomes.
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Pediatr Crit Care Me · May 2017
Acute Decompensation in Pediatric Cardiac Patients: Outcomes After Rapid Response Events.
We studied rapid response events after acute clinical instability outside ICU settings in pediatric cardiac patients. Our objective was to describe the characteristics and outcomes after rapid response events in this high-risk cohort and elucidate the cardiac conditions and risk factors associated with worse outcomes. ⋯ Congenital heart disease, previous cardiac surgery, and recent discharge from ICU were common among pediatric cardiac rapid responses. Progression to cardiopulmonary arrest during rapid response, need for ICU care, kidney injury after rapid response, and mortality were high. Single ventricle physiology was independently associated with increased mortality.
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Laparoscopic distal pancreatectomy (LDP) is becoming the standard treatment for left-sided pancreatic disease. Learning curve identification is essential to ensure a safe and steady expansion. However, large (n > 30) single-surgeon learning curve series are lacking. ⋯ Operative outcomes of LDP remained stable with increasing surgical complexity over time. Postoperative outcomes, such as complications and length of hospital stay, improved after the first 30 cases. When describing learning curves, short- and long-term outcomes should be considered.