The Annals of thoracic surgery
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This study sought to identify the changing characteristic patterns and locations of stenosis after tracheostomy or intubation and to assess the risk factors associated with perioperative complication and restenosis after primary resection and reconstruction. ⋯ Recent advances in percutaneous tracheostomy have increased the numbers of patients presenting with proximal tracheal stenosis, thus necessitating more complex subglottic resection and reconstruction. The anastomotic and overall complication rate remains low despite these more complex operations.
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The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It contains data pertaining to more than 435,000 total operations. The most recent biannual feedback report to participants (Spring 2017, Report of the Twenty-Sixth Harvest) included analysis of data submitted from 127 hospitals in North America. ⋯ Additional publications reported the most recent development, evaluation, and application of metrics for quality measurement and reporting of pediatric and congenital heart operation outcomes and center level performance. Use of the STS CHSD for outcomes research and for quality measurement continues to expand as database participation has grown to include nearly all centers in North America, and the available wealth of data in the database continues to grow. This article reviews outcomes research and quality improvement articles published in 2016 that are based on STS CHSD data.
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Multicenter Study
Risk Index for Postoperative Acute Kidney Injury After Valvular Surgery Using Cardiopulmonary Bypass.
Acute kidney injury (AKI) after valvular surgical procedures with cardiopulmonary bypass carries potentially high mortality and morbidity rates. This study investigated the risk factors for AKI, and the study investigators developed a risk index to predict postoperative AKI. ⋯ Based on these risk factors, the study investigators were able to predict the postoperative incidence of renal dysfunction after valvular operations with cardiopulmonary bypass.
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Multimodal enhanced recovery pathways (ERP) improve clinical outcomes and hospital length of stay for patients undergoing lung resection. However, data supporting their economic impact is lacking. This study evaluated the effect of an ERP on costs of lung resection. ⋯ A multidisciplinary ERP is associated with improved clinical outcomes and societal cost savings compared with conventional perioperative management for elective lung resection.
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Major aortopulmonary collateral arteries (MAPCAs) are frequently found in association with pulmonary atresia with ventricular septal defect (PA/VSD). However, some patients with MAPCAs do not have PA/VSD but have a variety of other "atypical" anatomic diagnoses. ⋯ The data demonstrate the wide diversity of anatomy seen in patients with MAPCAs when evaluating diagnoses other than PA/VSD. Two-thirds of the patients had single ventricle and was associated with a relatively high mortality.