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Journal and News Scan
In this article, Dr. Skelhorne-Gross et al. discuss the utility of a standardized minimal opioid pain prescription post minimally invasive thoracic surgery to limit postoperative opioid prescriptions. They provided patients with a standardized prescription of Hydromorphine (2mg x 15 tabs), Acetaminophen (1g tid x 7 days), and Ibuprofen (400mg po tid x 3 days), and demonstrate that the pain was successfully controlled in the majority of patients.
In this article, Jacobs et al. provide a multi-institutional outcomes review of 200 consecutive patients with confirmed COVID-19 supported with ECMO. The mean time on ECMO was 15 days with survival on VV-ECMO of 46.3% and survival on VA-ECMO of 25%. Predictors of survival included a lower median age and shorter median time from COVID-19 diagnosis to ECMO initiation.
This registry, involving multiple centers, aims to provide conclusive results reflecting the importance of critical preoperative conditions and different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD.
Based on data of patients with acute aortic dissection in a hospital of Nobeoka City from 2016-2018, Yamaguchi and associates found the incidence of acute aortic dissection was 17.6 per 100,000 (11.3 for type A, 6.2 for type B). This incidence is 4 times higher than reported in the Olmsted County study (3.5 per 100,000).
The Society of Thoracic Surgeons (STS), the Society of Cardiovascular Anesthesiologists (SCA), the American Society of ExtraCorporeal Technology (AmSECT), and the Society for the Advancement of Blood Management (SABM) published an update to the "2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines."
Data from the Esodata project used more than 8,000 patients undergoing esophagectomy for cancer to develop a risk prediction score for 90-day mortality. Development and validation groups were used. There were 10 variables that emerged as significant predictors, and weighted values were developed into the model. The model identified 5 risk levels for 90-day mortality, which may help in patient selection and in informed discussions.
Fascinating confirmation of null hypotheses including bleeding complications and survival in a Pennsylvanian cohort study, despite the easily predictable previous PCI, hock, and IABP prevalence in the emergency group. The statistical model is elaborate and complex. Perhaps a randomized trial could now be justified!
A useful detailed review (or state-of-the-art article) on revascularisation in extracardiac vascular stenoocclusive atheromatosis.