The Annals of thoracic surgery
-
The United States Congress recently passed the bill titled H. R.2: the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to repeal the Sustainable Growth Rate (SGR). ⋯ As a result, all physicians were annually subject to the aggregate cuts in compensation depending on rate of economic growth in the country, requiring Congress to pass legislation each year to defer the scheduled pay cuts. Will MACRA, however, truly be a reprieve to providers from the threat of annual cuts in reimbursement of between 21% and 30%, or will it result in a Pyrrhic victory for both providers and patients after the financial impact of the repeal has been realized and the quality of health care delivery and true access to care for our seniors have been evaluated? This article from The Society of Thoracic Surgeons Workforce on Health Policy, Advocacy, and Reform attempts to summarize MACRA and considers its impact on the specialty of cardiothoracic surgery.
-
Postoperative stroke remains one of the most devastating complications after cardiac surgery. Variations in stroke rates and ability to rescue from mortality after stroke between surgical centers are not understood. This study evaluated patient risk and institutional factors associated with likelihood of postoperative stroke as well as hospital variation in risk-adjusted stroke and rates of failure to rescue (FTR) after stroke after cardiac surgery. ⋯ Institutional variation, more so than individual patient risk factors, is highly associated with postoperative stroke and FTR rates after stroke after cardiac surgery. Postoperative stroke remains significantly associated with mortality and morbidity. Institutional practice patterns may confer a disproportionate influence on postoperative stroke independent of case mix. Understanding differences between high and low performing centers is essential to improving outcomes, costs, and hospital quality.
-
Screening programs have increased the identification of small or indistinct pulmonary lesions that are difficult to localize. We report our experience in their preoperative localization by radiotracer and resection. ⋯ Radiotracer localization of pulmonary lesions is a simple and feasible procedure with a high rate of success. Optimal candidates are patients with suspicious-looking nodules detected by screening or incidental CT resulting frm the high rate of nonsolid morphology and small size.
-
Review Meta Analysis
Effects of Renal Replacement Therapy in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis.
The use of renal replacement therapy (RRT) in patients receiving extracorporeal membrane oxygenation (ECMO) is increasing, but the effect of RRT on ECMO is controversial. We performed a meta-analysis to determine whether RRT is related to higher mortality in patients receiving ECMO. We searched MEDLINE, EMBASE, the Cochrane Library, and KoreaMed and found 43 observational studies with 21,624 patients receiving ECMO and then compared inpatient mortality rates of patients receiving ECMO both with and without RRT. ⋯ Among patients with RRT use rates of 30% and higher, the overall mortality rates for all patients receiving ECMO tended to decrease. We found that the increase in the RR for RRT tended to be greater the longer the initiation of RRT was delayed. We suggest that in patients receiving ECMO who have high RRT use rates, RRT may decrease mortality rates.
-
This systematic review examined the clinical and hemodynamic performance of the stentless Freedom SOLO (Sorin Group, Milan, Italy) aortic bioprosthesis. The occurrence of postoperative thrombocytopenia was also analyzed. ⋯ Thrombocytopenia is more severe than in other aortic prostheses; however, this is without clinical consequences. Within a few years, the 15-year follow-up of this bioprosthesis will be known, which will be key to evaluating its long-term durability.