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Journal and News Scan
Volume-outcomes relationships for operative mortality were first identified more than a decade ago. This study updated the data using Medicare claims for more than 3 million patients. The inverse relationship between volume and outcomes was confirmed for all 8 procedures studied. The inverse ratio actually increased for 5 of 8 procedures despite overall improvements in outcomes. For esophagectomy mortality the OR for very low compared to very high volumes was 2.25 in 2000-2001 and 3.68 in 2008-2009.
This single institution study evaluated differences in 30-day and 90-day mortality after esophagectomy in nearly 1300 patients. 30-day mortality was 2.9%, hospital mortalit was 5.1%, and 90-day mortality was 7%. Late deaths were related to surgery (particularly the occurrence of anastomotic leakage), sudden death, and recurrent cancer. The sensitivity of 30-day mortality in detecting surgery-related deaths was only 33%.
A risk model of mortality associated with esophagectomy in Japan was developed using variables identified in the ACS NSQIP program. 30-day and overall surgical mortality rates were 1.2% and 3.4%, and the morbidity rate was 42%. Morbidity was higher after minimally invasive esophagectomy. Mortality was related to difficulty with ADLs, recent smoking, greater preoperative weight loss, male sex, and COPD.
This prospective multiinstitutional study evaluated outcomes of different devices used for endoscopic vein harvesting classified as open or closed tunnel devices. There was no difference in the incidence of early graft failure or late clinical outcomes. The poorer graft outcomes related to endoscopic vein harvesting are not attributable to device type.
This editorial, authored by a number of presidents/leaders of prominent medical societies, laments a recent position paper of the ESMO espousing medical oncologists as the natural team leaders of multidisciplinary oncologic care. It cautions other cancer specialists not to abandon their roles as advocates for their cancer patients.
The objective of this study was to investigate whether the consequences of patient prosthesis mismatch (PPM) following aortic valve replacement (AVR) differ according to patient age. The authors hypothesised that in older patients (aged 70 and above) the implications of PPM may be less important due to lower baseline physical function and competing mortality risks. This single centre study included 707 patients who underwent first-time AVR with follow-up out to 17.5 years. The incidence of PPM was 68% in patients aged 70 or older compared to 26% in patients aged less than 70. The authors found that in patients aged less than 70 with left ventricular dysfunction PPM was associated with reduced survival and increased congestive heart failure. Post-operative left ventricular mass regression was impaired in older patients in general and in those with PPM aged 70 or over with left ventricular dysfunction.
The consortium of authors of this paper determined the survival after Transcatheter valve in valve implantation inside a failed surgical bioprosthesis. The authors report a 1 month mortality rate of 7.6% and a major stroke rate of 1.7%. One-year survival was 83.2%, and 313 (92.6%) of survivors had a good functional status (NYHA I/II). Patients who had an aortic stenosis (n=181) had worse 1-year survival (76.6%) than patients with aortic regurgitation (91.2%) or combined stenosis/regurgigation (83.9%; p=0.01). Moreover, a small surgical bioprosthesis was associated with higher mortality.
It is with great sadness that we report the death of Donald Ross on the 7th of July 2014 in London. As well as creating the Ross procedure, he performed the UK's first heart transplant, which was the world's 10th heart transplant.
We would like to invite you to add your memories of this pioneer of cardiac surgery to the comments section below.
This is an interesting opinion piece about misplaced fears on the part of physicians and patients/families regarding the dangers of radiation exposure as part of diagnostic imaging.
To illustrate the potential need for regional quality improvement efforts in thoracic surgery, the authors conducted a study of lung resection in Washington state using a discharge database including nearly 8,500 pts over a 12-year period. Inpatient mortality decreased over time but there was no change in the incidence of prolonged length of stay. Costs increased over time. Hospitals were widely distributed into categories including fewer deaths/lower costs, fewer deaths/higher costs, more deaths/lower costs, and more deaths/higher costs. The data illustrate ample opportunity for improving quality and value modeled on hospitals with fewer deaths/lower costs.