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Journal and News Scan
In a QI study of nearly 5,400 operations, 188 adverse events were recorded. Of these, over 56% were associated with human error. Of all human performance deficiencies, cognitive error accounted for over half.
A standardized perioperative management protocol for pts taking direct oral anticoagulants for atrial fibrillation entailed no bridging with other anticoagulants. It resulted in low and acceptable rates of major bleeding (<2%) and stroke (<1%).
Ever wonder why your patients get respiratory infections postoperatively? Here's another risk factor. Almost 95% of hospital caregivers completed at least one shift while ill with an acute upper respiratory infection during flu season, despite hospital policies against such behavior. This was more common among physicians than among nurses.
JTCVS just published a call for proposals of joining the Cardiac Surgery Intersociety Alliance (CSIA) as pilot sites. CSIA is jointly overseen by the AATS, EACTS, STS, the Asian Society for Cardiovascular and Thoracic Surgery, and the World Heart Federation. The mission of CSIA is to evaluate, endorse, and work with potential sites in low-income countries to increase access to sustainable heart surgery, with particular emphasis on rheumatic heart disease.
The FDA-approved use of TAVR has now expanded to low-risk patients with severe aortic stenosis. This includes both Edwards Lifesciences' Sapien 3 and Sapien 3 Ultra as well as Medtronic's Evolut R and Evolut PRO.
Nelson and colleagues analyzed data from The Society of Thoracic Surgeons Congenital Heart Surgery Database on 3446 aortic valve replacement procedures performed between 2000 and 2016. The authors found that practice patterns varied widely, though autograft usage was higher at high-volume centers. Additionally, homografts were found to have higher rates of mortality and major complications than other valve types.
Using a machine learning algorithm, resource utilization among more than 1 million Medicare patients undergoing one of 6 operations including CABG and lung resection was analyzed. Super users comprised 4.8% of the cohort but consumed 31.7% of the resources. Risk factors for super use included paraplegia/hemiplegia, weight loss, and CHF combined with chronic kidney disease.
Regionalization of care for complex problems remains an open question in most countries. This review demonstrated that, for high risk cancer operations in the US, the Leapfrog group's volume standards did not differentiate between surgical mortality outcomes for lung and esophageal cancer surgery. However, differences were evident comparing lowest and highest volume quintiles for operative mortality associated with these procedures. The percentage of hospitals meeting Leapfrog volume criteria increased for lung cancer surgery but recently decreased for esophageal cancer surgery; the latter finding is a reversal of an organic trend towards regionalization of esophageal cancer care over the prior decade and is of concern.
A comprehensive audio lecture from an academic pathologist on non-malignant pulmonary lesions.
The translational value for cardiac transplantation of this prospective multi-centre clinical study of vasodilation in amyloidosis remains to be evaluated.