The Annals of thoracic surgery
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Recombinant activated factor VII (rFVIIa) decreases requirements for allogeneic blood transfusion and chest reexploration in patients undergoing cardiac surgery. Whether rFVIIa increases the risk of postoperative adverse events is unclear. We tested whether rFVIIa administration was associated with increased mortality and neurologic and renal morbidity in patients undergoing cardiac surgery. Risk of thromboembolic complications and the dose-response of rFVIIa on mortality and morbidity were also evaluated. ⋯ Administration of rFVIIa is associated with increased mortality and renal morbidity in patients undergoing cardiac surgery.
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Comparative Study
Short-term outcomes using magnetic sphincter augmentation versus Nissen fundoplication for medically resistant gastroesophageal reflux disease.
In 2012 the United States Food and Drug Administration approved implantation of a magnetic sphincter to augment the native reflux barrier based on single-series data. We sought to compare our initial experience with magnetic sphincter augmentation (MSA) with laparoscopic Nissen fundoplication (LNF). ⋯ MSA results in similar objective control of GERD, symptom resolution, and improved quality of life compared with LNF. MSA seems to restore a more physiologic sphincter that allows physiologic reflux, facilitates belching, and creates less bloating and flatulence. This device has the potential to allow individualized treatment of patients with GERD and increase the surgical treatment of GERD.
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Predictive factors for red blood cell transfusion in children undergoing noncomplex cardiac surgery.
Red blood cell (RBC) transfusion is frequently required in pediatric cardiac surgery and is associated with altered outcome and increased costs. Determining which factors predict transfusion in this context will enable clinicians to adopt strategies that will reduce the risk of RBC transfusion. This study aimed to assess predictive factors associated with RBC transfusion in children undergoing low-risk cardiac surgery with cardiopulmonary bypass (CPB). ⋯ The present study identified several factors that were significantly associated with perioperative RBC transfusion. Based on these factors, we designed a predictive score that can be used to develop a patient-based blood management program with the aim of reducing the incidence of RBC transfusion.
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Postoperative death is an important outcome after esophagectomy, and the Centers for Medicare & Medicaid Services currently uses 30-day mortality as a quality indicator for this operation. However, 30-day mortality may underestimate a patient's true postoperative death risk. The purpose of this study was to evaluate different mortality definitions using a large registry of patients undergoing esophagectomy for cancer. ⋯ There are clinically meaningful differences between postoperative mortality definitions after esophagectomy. Thirty-day mortality significantly underestimates a patient's true risk of death because this number more than doubles at 90 days in this elderly, Medicare population. Although neither 90-day nor 30-day mortality are adequate quality measures after esophagectomy, 90-day mortality is a better outcome measure because it provides a better understanding of true death risk for the surgeon and patient.
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This study aimed to predict variation in the thoracic surgery workforce requirements with the introduction of a national chest computed tomographic (CT) screening program for individuals at high risk of lung cancer. ⋯ With the implementation of a CT screening program there will be an increase in operable lung cancers, resulting in increased surgical volume. A national strategy for the thoracic surgery workforce is necessary to ensure that an appropriate number of surgeons are being trained to meet the future needs of the national population.