The Annals of thoracic surgery
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Diversity within health care organizations has many proven benefits, yet women and other groups remain underrepresented in cardiothoracic surgery. We sought to explore responses from a Society of Thoracic Surgeons (STS) survey to identify myths and barriers for informing organizational strategies in the STS and cardiothoracic surgery. We performed a qualitative review of narrative survey responses within three domains surrounding diversity in cardiothoracic surgery: myths, barriers, and strategies for improvement. ⋯ Suggested strategies toward improvement were culture change prioritizing diversity (22%) and training the leaders (14%). Notably, 15% of response codes reflected the belief that disparities do not exist; thus, the issue should not be prioritized by the organization. The results do not necessarily reflect the beliefs of most of the STS membership; nonetheless, they provide important insight critical to guide any efforts toward eliminating disparities within cardiothoracic surgery and improving the care of our patients.
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The Society of Thoracic Surgeons (STS) National Database was established in 1989 as an initiative for quality improvement and patient safety for cardiothoracic surgery. The STS National Database has 4 components, each focusing on a distinct discipline-Adult Cardiac Surgery, General Thoracic Surgery, Congenital Heart Surgery, and mechanical circulatory support with the STS Interagency Registry for Mechanical Circulatory Support (Intermacs)/Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Database. In December 2015, The Annals of Thoracic Surgery began publishing a monthly series of scholarly articles on outcomes analysis, quality improvement, and patient safety. This article provides the fourth annual summary of the status of the STS National Database.
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Computed Tomography-Assessed Skeletal Muscle Mass as a Predictor of Outcomes in Lung Cancer Surgery.
Sarcopenia is characterized by loss of skeletal muscle and strength, associated with aging, poor nutrition, sedentary lifestyle, and long-term illness. We sought to evaluate the current evidence on the prevalence of sarcopenia assessed by computed tomography (CT) imaging in patients undergoing lung cancer resection and its predictive value for perioperative and long-term outcomes. ⋯ Sarcopenia can be frequently detected in patients undergoing lung cancer resection with the use of CT-based muscle measurements. Sarcopenia was associated with greater risk of perioperative complications and worse long-term prognosis.
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Comparative Study
Long-term Outcomes of Mechanical Vs Biologic Aortic Valve Prosthesis in Patients Older Than 70 Years.
Biologic prostheses are preferred for surgical aortic valve replacement (SAVR) in patients more than 70 years of age in clinical practice. This study investigated differences in long-term outcomes between SAVR-treated patients more than 70 years of age who received mechanical or biologic prosthetic valves. ⋯ Mechanical aortic valve prosthesis is associated with worse long-term survival and increased bleeding after SAVR in patients more than 70 years old. The study results suggest caution when considering mechanical aortic valve prostheses in elderly patients.
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Comparative Study Clinical Trial Observational Study
Liposomal Bupivacaine Enhances the Pain-Control Benefits of Uniportal Thoracoscopic Lobectomy.
Liposomal bupivacaine field block is gaining popularity as a critical element of enhanced recovery after surgery protocols in thoracic surgery. Uniportal thoracoscopic surgery has been reported to result in less narcotic consumption compared with traditional video-assisted thoracoscopic surgery. The objective of this study was to evaluate the postoperative narcotic consumption of patients undergoing uniportal thoracoscopic lobectomy with the use of 0.25% bupivacaine vs patients treated with liposomal bupivacaine. ⋯ The study investigators have previously demonstrated decreased narcotic consumption with the use of uniportal technique over traditional multi-incision thoracoscopic surgery. The use of liposomal bupivacaine for posterior serratus and intercostal field blocks enhanced pain control and decreased narcotic consumption.