The Annals of thoracic surgery
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Reoperations on the aortic root and distal thoracic aorta late after initial root surgery in patients with Marfan syndrome might carry high periprocedural risks and be associated with adverse early and midterm clinical outcome. ⋯ Aortic reoperations in patients with Marfan syndrome can be performed with acceptable midterm outcomes. Performed as a bailout procedure, stent grafting was not associated with increased mortality. The only strong predictor of mortality after reoperations is acute dissection at the time of the initial treatment.
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Recent policy interventions have reduced payments to hospitals with higher-than-predicted risk-adjusted readmission rates. However, whether readmission rates reliably discriminate deficiencies in hospital quality is uncertain. We sought to determine the reliability of 30-day readmission rates after cardiac operations as a measure of hospital performance and evaluate the effect of hospital caseload on reliability. ⋯ The vast majority of hospitals do not achieve a minimum acceptable level of reliability for 30-day readmission rates. Despite recent enthusiasm, readmission rates are not a reliable measure of hospital quality in cardiac surgery.
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It is important to characterize in-hospital mortality after cardiac surgery and understand the relationships between postoperative length of intensive care unit stay, postoperative length of hospital stay, and the likelihood of in-hospital mortality. ⋯ Most in-hospital mortality occurs during the first week after cardiac surgery with few mortalities occurring after a protracted hospital course. Postoperative complications have a limited ability to explain the variability in mortality timing. Increased length of postoperative intensive care unit stay and hospital stay after cardiac surgery are associated with an increased likelihood of in-hospital mortality.
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Iatrogenic intraoperative tracheal injuries are rare in cardiac operations. Management of this complication is not well described because of the low incidence and lack of reported cases. ⋯ Soft tissue coverage of the trachea was obtained, the original cardiac operation was completed, and she was otherwise managed conservatively. She recovered without further complication and was discharged home 1 week after the surgical procedure.