The Annals of thoracic surgery
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Comparative Study
Using Benchmarking Standards to Evaluate Transition to Minimally Invasive Esophagectomy.
Minimally invasive esophagectomy (MIE) is performed in nearly 50% of patients worldwide. The effectiveness of the technique arises from a single randomized control trial and multiple single series cohorts. Consistent reporting of complications is varied. We describe our experience of transitioning to MIE compared with open esophagectomy (OE) with the use of Esophageal Complications Consensus Group (ECCG) standardized complication benchmark definitions. ⋯ These results compare favorably to those reported by ECCG. MIE can be the standard approach for surgical management of esophageal cancer. Introduction of the approach in each surgeon's practice should be benchmarked to international standards.
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Bleeding after cardiac surgery remains a challenge. Numerous studies suggest that higher level of C-reactive protein (CRP) increases cardiovascular risk. There is limited information revealing the association of preoperative CRP concentration and postoperative bleeding while undergoing on-pump coronary artery bypass grafting (CABG). This study aimed to investigate the relationship between preoperative CRP level and postoperative bleeding within 24 hours after CABG. ⋯ Our findings suggested that preoperative CRP concentration independently correlated with postoperative bleeding volume within 24 hours and that it could be a new potential coagulation biomarker for patients undergoing CABG surgery.
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Postsurgical readmissions are an increasingly scrutinized marker of health care quality. We sought to estimate the rate, risk factors, causes, and costs associated with readmissions after esophagectomy in a large, nationally representative cohort. ⋯ Nearly 1 in 5 patients undergoing esophagectomy are readmitted within 30 days of discharge, at a median cost of $9660 per readmission. Pulmonary complications account for the greatest number of readmissions and the greatest total cost burden. Targeting the causes of readmission, especially pulmonary causes, may help significantly reduce the total morbidity and health care costs associated with esophagectomy.
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Multicenter Study
"Nobody told me": Communication Issues Affecting Australian Cardiothoracic Surgery Patients.
Failure of communication can have potentially severe results in cardiothoracic surgery. Previous literature regarding patient safety highlighted communication as a common area for improvement. This study utilized a qualitative approach to analyze a national mortality audit data set to identify and describe communication issues that could potentially contribute to patient mortality following cardiothoracic surgery. ⋯ Poor communication was identified in patients who died after cardiothoracic surgery. Communication is an important modifiable factor in patient mortality. Efforts to address teamwork and communication have the potential to improve safety and quality of care for patients undergoing cardiothoracic surgery.
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We report a case of metachronous thin-walled cavity lung cancers exhibiting variable histopathology. A 70-year-old man visited our hospital because of a thin-walled cavity located in the right upper lobe, detected by chest computed tomography. ⋯ Histopathology after video-assisted thoracic surgery left S6 segmentectomy revealed adenocarcinoma. Patients with primary lung carcinoma may present with thin-walled cavities; postoperative screening can aid early the detection of metachronous primary lung cancers of variable origin.