Disparities in 180-day Infection Rates Following Coronary Artery Bypass Grafting and Aortic Valve Replacement.

Objective: To compare sex and racial differences in 180-day infection rates after coronary artery bypass grafting (CABG) and aortic valve replacement (AVR).

Methods: A Statewide Society of Thoracic Surgeons Adult Cardiac Surgery Database was linked to Medicare claims data to identify 8,887 beneficiaries undergoing CABG and AVR (surgical or transcatheter) between 2017 and 2021. The primary outcome was the incidence of 180-day infection.

Interhospital Variability in 180-day Infections Following Cardiac Surgery.

Objective: This study sought to: (1) evaluate hospital-level variation in infections following cardiac surgery and (2) develop and evaluate a 180-day infection quality metric.

Methods: This study evaluated Medicare claims that were merged with institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database files among patients undergoing cardiac surgery across 33 Michigan centers. The primary outcome was an infection within 180 days of surgery.

Outcomes of nonemergency cardiac surgery after overnight operative workload: A statewide experience.

Objective: Cardiac surgeons experience unpredictable overnight operative responsibilities, with variable rest before same-day, first-start scheduled cases. This study evaluated the frequency and associated impact of a surgeon's overnight operative workload on the outcomes of their same-day, first-start operations.

Methods: A statewide cardiac surgery quality database was queried for adult cardiac surgical operations between July 1, 2011, and March 1, 2021.

Predictors and Variation in Cardiac Rehabilitation Participation After Transcatheter Aortic Valve Replacement.

Background: Cardiac rehabilitation (CR) is strongly recommended for a spectrum of cardiovascular conditions and procedures including aortic valve replacement.

Objectives: The purpose of this study was to characterize patient and hospital factors associated with CR participation after transcatheter aortic valve replacement (TAVR) and determine which factors explain hospital-level variation in CR participation.

Methods: We linked clinical and administrative claims data from patients who underwent TAVR at 24 Michigan hospitals between January 1, 2016 and June 30, 2020 and obtained rates of CR enrollment within 90 days of discharge.

First-hand accounts of structural stigma toward people who use opioids on Reddit.

People who use opioids face multilevel stigma that negatively affects their health and well-being and drives opioid-related overdose. Little research has focused on lived experience of the structural levels of stigma toward opioid use. This study identified and qualitatively analyzed Reddit content about structural stigma toward opioid use.

Advancing cardiotomy suction practices for coronary surgery via multidisciplinary collaborative learning.

Objective: Professional standards recommend stopping cardiotomy suction at the termination of cardiopulmonary bypass before protamine administration based on perceived safety concerns. This study evaluated a multidisciplinary collaborative quality-improvement intervention promoting this agreed-upon cardiotomy suction practice during coronary artery bypass grafting (CABG).

Methods: A statewide intervention (eg, unblinded surgeon and perfusionist feedback, evidence-based lectures, evaluating barriers to change) involved 32 centers participating in the PERForm (ie, Perfusion Measures and Outcomes) Registry to standardize cardiotomy suction practices at cardiopulmonary bypass termination during CABG.

Carboxylate Shift Dynamics in Biomimetic Co(μ-OH) Complexes.

Carboxylate shift mechanisms provide low-energy pathways to accommodate changes in oxidation state and coordination number required during catalysis in metalloenzyme active sites. These processes are challenging to observe in their native enzymes and molecular models can provide insight into their mechanistic details. We report here the direct observation of a carboxylate shift reaction in biomimetic yet structurally stable dicobalt complexes featuring both monodentate and bridging acetate ligands, as well as intramolecular hydrogen-bonding interactions.

The association of intraoperative and early postoperative events with risk of pneumonia following cardiac surgery.

Background: Pneumonia, the most common infection following cardiac surgery, is associated with major morbidity and mortality. Although prior work has identified preoperative risk factors for pneumonia, the present study evaluated the role and associated impact of intraoperative and postoperative risk factors on pneumonia after cardiac surgery.

Methods: This observational cohort study evaluated 71,165 patients undergoing coronary and/or aortic valve surgery across 33 institutions between 2011 and 2021.

del Nido versus blood cardioplegia in cardiac surgery: A multicenter analysis of over 40,000 patients.

Objectives: The use of del Nido cardioplegia in adult cardiac surgery is rising in popularity. The objective of this large multicenter study was to evaluate the use and associated outcomes of del Nido versus blood cardioplegia in adult cardiac surgery.

Methods: Patients undergoing coronary artery bypass grafting (CABG) and/or valve (mitral, aortic), and/or nondescending thoracic aortic surgery (July 2014 to March 2022) across 39 centers were extracted from the Perfusion Measures and Outcomes registry.

Determinants and Outcomes Associated With Skilled Nursing Facility Use After Coronary Artery Bypass Grafting: A Statewide Experience.

Background: Skilled nursing facility (SNF) care is frequently used after cardiac surgery, but the patterns and determinants of use have not been well understood. The objective of this study was to evaluate determinants and outcomes associated with SNF use after isolated coronary artery bypass grafting.

Methods: A retrospective analysis of Medicare Fee-For-Service claims linked to the Society of Thoracic Surgeons clinical data was conducted on isolated coronary artery bypass grafting patients without prior SNF use in Michigan between 2011 and 2019.

Smartphone Apps for Smoking Cessation: Systematic Framework for App Review and Analysis.

Background: Cigarette smoking is a leading cause of preventable death, and identifying novel treatment approaches to promote smoking cessation is critical for improving public health. With the rise of digital health and mobile apps, these tools offer potential opportunities to address smoking cessation, yet the functionality of these apps and whether they offer scientifically based support for smoking cessation are unknown.

Objective: The goal of this research was to use the American Psychiatric Association app evaluation model to evaluate the top-returned apps from Android and Apple app store platforms related to smoking cessation and investigate the common app features available for end users.

Risk and Safety Perceptions Contribute to Transfusion Decisions in Coronary Artery Bypass Grafting.

Variability persists in intraoperative red blood cell (RBC) transfusion rates, despite evidence supporting associated adverse sequelae. We evaluated whether beliefs concerning transfusion risk and safety are independently associated with the inclination to transfuse. We surveyed intraoperative transfusion decision-makers from 33 cardiac surgery programs in Michigan.

The Role of Race on Acute Kidney Injury After Cardiac Surgery.

Background: Acute kidney injury (AKI) frequently complicates cardiac surgery and is more common among Black patients. We evaluated determinants of race-based differences in AKI rates.

Methods: Serum creatinine-based criteria were used to identify adult cardiac surgical patients having postoperative AKI in the Perfusion Measures and Outcomes (PERForm) Registry (July 1, 2014, to June 30, 2019).

Intramolecular Hydrogen-Bond Interactions Tune Reactivity in Biomimetic Bis(μ-hydroxo)dicobalt Complexes.

Active site hydrogen-bond (H-bond) networks represent a key component by which metalloenzymes control the formation and deployment of high-valent transition metal-oxo intermediates. We report a series of dinuclear cobalt complexes that serve as structural models for the nonheme diiron enzyme family and feature a Co(μ-OH) diamond core stabilized by intramolecular H-bond interactions. We define the conditions required for the kinetically controlled synthesis of these complexes: [Co(μ-OH)(μ-OAc)(κ-OAc)(py)][PF] (), where OAc = acetate and py = pyridine with -substituent R, and we describe a homologous series of in which the -R substituent on pyridine is modulated.

Determinants of Hospital Variation in Cardiac Rehabilitation Enrollment During Coronary Artery Disease Episodes of Care.

Background: Cardiac rehabilitation (CR) is associated with improved outcomes for patients with coronary artery disease (CAD). However, CR enrollment remains low and there is a dearth of real-world data on hospital-level variation in CR enrollment. We sought to explore determinants of hospital variability in CR enrollment during CAD episodes of care: medical management of acute myocardial infarction (AMI-MM), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG).

Quality Improvement: Arterial Grafting Redux, 2010:2019.

Background: The evidence base favoring utilization of multiple arterial conduits in coronary artery bypass grafting has strengthened in recent years. Nevertheless, utilization of arterial conduits in the US lags behind that of many European peers. We describe a statewide collaborative based approach to improving utilization.

Evaluating Changes in del Nido Cardioplegia Practices in Adult Cardiac Surgery.

There has been a rapid adoption of the use of del Nido cardioplegia (DC) among adults undergoing cardiac surgery. We leveraged a multicenter database to evaluate differences over time in the choice and impact of cardioplegia type (DC vs. blood) among patients undergoing cardiac surgery.

Determinants of hospital variability in perioperative red blood cell transfusions during coronary artery bypass graft surgery.

Objective: To identify to what extent distinguishing patient and procedural characteristics can explain center-level transfusion variation during coronary artery bypass grafting surgery.

Methods: Observational cohort study using the Perfusion Measures and Outcomes Registry from 43 adult cardiac surgical programs from July 1, 2011, to July 1, 2017. Iterative multilevel logistic regression models were constructed using patient demographic characteristics, preoperative risk factors, and intraoperative conservation strategies to progressively explain center-level transfusion variation.

Evaluating the Impact of Pneumonia Prevention Recommendations After Cardiac Surgery.

Background: Pneumonia is the most prevalent healthcare-associated infection after coronary artery bypass grafting (CABG), but the relative effectiveness of strategies to reduce its incidence remains unclear. We evaluated the relationship between healthcare-associated infection recommendations and risk of pneumonia after CABG.

Methods: Pneumonia prevention practice recommendations were developed based on literature review and analysis of semistructured interviews with key health care personnel across centers with low (<5.

Alcohol abuse and disorder of granulopoiesis.

Granulocytes are the major type of phagocytes constituting the front line of innate immune defense against bacterial infection. In adults, granulocytes are derived from hematopoietic stem cells in the bone marrow. Alcohol is the most frequently abused substance in human society.

Collaborative Quality Improvement Reduces Postoperative Pneumonia After Isolated Coronary Artery Bypass Grafting Surgery.

Background: To date, studies evaluating outcome improvements associated with participation in physician-led collaboratives have been limited by the absence of a contemporaneous control group. We examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program.

Methods And Results: We evaluated 911 754 coronary artery bypass operations (July 1, 2011, to June 30, 2017) performed across 1198 hospitals participating in a voluntary national physician reporting program (Society of Thoracic Surgeons [STS]), including 33 that participated in a Michigan-based collaborative (MI-Collaborative).

Understanding the Association Between Frailty and Cardiac Surgical Outcomes.

Background: Previous work identified a direct relationship between frailty and adverse outcomes in cardiac surgery, but assessment of the effect across subgroups of patients has largely been ignored. This study identified whether the association of frailty (measured by gait speed) with adverse outcomes differed across subgroups of patients.

Methods: The study evaluated 53,932 patients who underwent cardiac operations between 2011 and 2016 across 33 Michigan institutions.

Evolving trends in aortic valve replacement: A statewide experience.

Background: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) for the treatment of aortic stenosis in patients at intermediate, high, and extreme risk for mortality from SAVR. We examined recent trends in aortic valve replacement (AVR) in Michigan.

Methods: The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) database was used to determine the number of SAVR and TAVR cases performed from January 2012 through June 2017.

Organizational Contributors to the Variation in Red Blood Cell Transfusion Practices in Cardiac Surgery: Survey Results From the State of Michigan.

Background: While large volumes of red blood cell transfusions are given to preserve life for cardiac surgical patients, indications for lower volume transfusions (1-2 units) are less well understood. We evaluated the relationship between center-level organizational blood management practices and center-level variability in low volume transfusion rates.

Methods: All 33 nonfederal, Michigan cardiac surgical programs were surveyed about their blood management practices for isolated, nonemergent coronary bypass procedures, including: (1) presence and structure of a patient blood management program, (2) policies and procedures, and (3) audit and feedback practices.