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Journal and News Scan
This review demonstrates that preoperative anemia is associated with increased mortality, AKI, CVA, and infection after cardiac surgery. Preoperative anemia appears to be a modifiable risk factor.
Performance of curative surgery for early stage cancer varied considerably among counties in the US, and was related to socioeconomic factors, availability of surgeons, and non-metropolitan status.
Medicare claims data were reviewed for patients in Michigan who underwent inpatient surgery. Some patients were enrolled in prehabilitation programs consisting of home-based walking exercise, nutrition, smoking cessation, and stress reduction. Patients undergoing prehabilitation were compared to similar patients undergoing surgery at the same hospitals but who did not enroll in the program. Patients undergoing prehabilitation had shorter LOS, lower costs of care, and were more likely to be discharged to home.
The authors analyzed the outcomes of the continuous-flow left ventricular assist devices. The study includes 105 patients supported with HM2 (N=54), HM3 (N=25), and HW (N-26). Eighteen-month data suggested that HM3 had a better prognostic and adverse-event profile over other devices.
On December 9, the US Preventive Services Task Force (USPSTF) published updated recommendations on the screening of abdominal aortic aneurysm (AAA) based on patient's gender, age, history of smoking, and family history of AAA for symptomatic adults:
- In men aged 65-75 years who have EVER smoked => One-time screening for AAA with ultrasonography (B recommendation);
- In men aged 65-75 years who have NEVER smoked => Selective screening for AAA with ultrasonography (C recommendation);
- In women who have NEVER smoked and have NO family history of AAA => Routine ultrasonographic screening for AAA is NOT recommended (D recommendation);
- Current evidence is insufficient to assess the balance of benefits and harms of screening for AAA with ultrasonography in women aged 65-75 years who have ever smoked or have a family history of AAA (I statement).
Following the withdrawal of Professor Taggart’s name from the author list of the EXCEL trial, the BBC in the UK have filmed a full exposé of some of the background to this decision. Secretary General of EACTS, Dominic Pagano, has stated that if the allegations are true, then perhaps support should be withdrawn for the current guidelines that PCI is equivalent to bypass grafting.
It looks like the published results of this trial in The New England Journal of Medicine are unravelling and either this paper will need to be withdrawn and re-published, or extensive modifications must be made. Let us know what you think after reading this article.
Given the escalating importance of atrial fibrillation for surgeons, this genomics article may be of considerable interest in future.
Abe and associates reported the trends in the early outcomes of surgical repair for acute type A aortic dissection in 11,843 patients from the Japan Cardiovascular Surgery Database between 2008 and 2015. Operative mortality was 9.5% and 30-day mortality was 7.6%. The number of surgically treated cases increased by 45% during the interval. A signficant upward trend was found in patient age and the incidences of preoperative renal failure. Unadjusted operative mortality rate with arch replacement showed a significant downward trend (P = 0.01). Risk-adjusted mortality rate showed a downward trend both in ascending aortic or hemiarch and arch replacement, which did not reach statistical signficance.
In this multi-institutional randomized trial comparing talc slurry through a chest tube to talc pudrage during VATS, success rates at 90 days were similar.
Succinct commentary on the challenge of vascular access in ECMO circuits on the occasion of a manuscript on a novel design of a multi-access adaptor.