Frailty in the Cardiac Surgical Patient: Comparison of Frailty Tools and Associated Outcomes.

Background: Frailty measurement in cardiac surgery is poorly studied. The study purposes were to identify a simple but accurate frailty tool by comparing the simplified frailty index, Study of Osteoporotic Fractures (SOF), to a more complex frailty index, the Cardiovascular Health Study (CHS), and outcomes of frail patients to nonfrail patients.

Methods: Patients aged 65 years or older admitted for elective coronary artery bypass grafting (CABG), valvular surgery (valve), or a combination of CABG/valve were recruited and administered the SOF and CHS indexes.

Confirmatory factor analysis of the Minnesota living with heart failure questionnaire among patients following open heart surgery for valve dysfunction.

Introduction: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) was designed to assess the impact of the adverse effects of heart failure (HF). Numerous reports suggest an additional third factor with the proposed third factor representing a social dimension. The purpose of this study was to use confirmatory factor analysis (CFA) to validate the factor structure of the MLWHFQ, and examine a proposed third factor structure.

The impact of a multidisciplinary blood conservation protocol on patient outcomes and cost after cardiac surgery.

Objective: Although associations between transfusion and inferior outcomes have been documented, there is a lack of blood transfusion standardization in cardiac surgery. At the Inova Heart and Vascular Institute, a multidisciplinary, criterion-driven algorithm for transfusion management was implemented. We examined the effect of our blood conservation protocol on transfusion rates and outcomes after cardiac surgery and on stability of transfusion over time.

Outcome Management in Cardiac Surgery Using the Society of Thoracic Surgeons National Database.

Health care reform has helped streamline patient care and reimbursement by encouraging providers to provide the best outcome for the best value. Institutions with cardiac surgery programs need a methodology to monitor and improve outcomes linked to reimbursement. The Society of Thoracic Surgeons National Database (STSND) is a tool for monitoring outcomes and improving care.

Comparison of EuroSCORE II, Original EuroSCORE, and The Society of Thoracic Surgeons Risk Score in Cardiac Surgery Patients.

Background: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was developed to reflect a more current dataset and evidence-based improvements in cardiac surgery. In the United States, The Society of Thoracic Surgeons (STS) risk score is more accepted owing to relatively high predictive value despite less user friendliness and inapplicability to some cardiac surgeries. We compared the precision of EuroSCORE II with EuroSCORE I and the STS risk score for operative mortality.

The Effects of Frailty in Patients Undergoing Elective Cardiac Surgery.

Background: The Society of Thoracic Surgeons (STS) recommends using gait speed as a marker of frailty to identify cardiac surgery patients at risk for adverse outcomes. However, a single marker of frailty may not provide consistently reliable risk information. We evaluated the impact of frailty and gait speed on patient outcomes after elective cardiac surgery.

Operative risk and preoperative hematocrit in bypass graft surgery: Role of gender and blood transfusion.

Background: The association between lower preoperative hematocrit (Hct) and risk for morbidity/mortality after cardiac surgery is well established. We examined whether the impact of low preoperative Hct on outcome is modified by blood transfusion and operative risk in women and men undergoing nonemergent CABG surgery.

Methods: Patients having nonemergent, first-time, isolated CABG were included (N=2757).

Should asymptomatic patients discharged with lower hemoglobin expect worse outcomes after valve surgery?

Objective: Blood transfusion in cardiac surgery patients is associated with increased morbidity and cost. The decision to transfuse patients after surgery varies but is often based on low hemoglobin (Hgb) levels, regardless of symptom status. This study examined whether asymptomatic patients discharged with lower Hgb levels had increased risk for perioperative complications and 1-year mortality.

Potential Impact of Modifiable Clinical Variables on Length of Stay After First-Time Cardiac Surgery.

Background: Recent financial challenges highlight the importance of accurate prediction of length of hospital stay (LOS). We assessed reliability of The Society of Thoracic Surgeons (STS) risk prediction for extended and shorter LOS and examined whether modifiable clinical variables are associated with LOS in first-time cardiac surgery patients.

Methods: Isolated aortic valve, mitral valve, and coronary artery bypass graft surgery patients since 2008 were included (n = 3,472).

Effect of patient age on blood product transfusion after cardiac surgery.

Objective: Blood product transfusion after cardiac surgery is associated with increased morbidity and mortality. Transfusion thresholds are often lower for the elderly, despite the lack of clinical evidence for this practice. This study examined the role of age as a predictor for blood transfusion.

Preoperative hematocrit as a predictor of perioperative morbidities following nonemergent coronary artery bypass surgery.

Background: Preoperative hematocrit (HCT) has predicted inferior outcome following cardiac surgery. However, the potential for preoperative HCT to be a marker for sicker patients was not well explored. This study examined the impact of HCT on outcome following nonemergent coronary artery bypass grafting (CABG) and whether the association is modified by operative risk or intraoperative blood transfusion.

Practice changes in blood glucose management following open heart surgery: from a prospective randomized study to everyday practice.

Objectives: Targeted blood glucose (BG) levels following cardiac surgery continues to be debated. According to the Society of Thoracic Surgeons (STS) guidelines, BG should be kept <180 mg/dl following cardiac surgery. However, our practice and others shifted to a stricter BG control (90-110 mg/dl) based on data suggesting an association with improved outcome.

Ventilator-associated pneumonia among cardiac surgery patients: what can we do for prevention?

Ventilator-associated pneumonia is associated with high mortality and morbidity and significantly increases intensive care unit length of stay and costs of care. In a pre- and postintervention study, we found that the majority of patients (63%) had an antecedent condition that necessitated emergent intubation prior to surgery. Efforts should be directed to developing strategies to minimize the risk of ventilator-associated pneumonia in emergent intubations, decrease reintubations, and reduce the use of blood products.

Patient disposition and long-term outcomes after valve surgery in octogenarians.

Background: Valve surgery is performed routinely in octogenarians. This study explored variables affecting patient discharge disposition (home versus other facility) and whether patient disposition was related to long-term survival.

Methods: Patients 80 years or older who presented for aortic valve or mitral valve surgery from 2002 to 2010 were included.

Comparison of blood glucose management strategies to achieve control following cardiac surgery (computerized versus paper).

Introduction: Blood glucose control can be time-consuming and difficult to achieve. We hypothesized that a computerized system to obtain glucose control would enable faster "time to target" and produce less variability in blood glucose levels.

Methods: Patients who underwent cardiac surgery at a community hospital between January and December 2007 (n = 1131) with glucose control obtained under a paper protocol were compared with similar patients operated on between January and December 2008 (n = 769) whose glucose control was obtained with a computer-driven protocol.

The use of spirometry testing prior to cardiac surgery may impact the Society of Thoracic Surgeons risk prediction score: a prospective study in a cohort of patients at high risk for chronic lung disease.

Objectives: Chronic lung disease is a significant comorbidity in patients undergoing cardiac surgery. Chronic lung disease is currently being classified and reported to the Society of Thoracic Surgeons database by using either clinical interview or spirometric testing. We sought to compare the chronic lung disease classification captured by the 2 methods.

Impact of body mass index on clinical outcome and health-related quality of life following open heart surgery.

The effect of increased body mass index (BMI) on survival following open heart surgery is unclear. We explored the relationship between BMI, survival following elective open heart surgery, and health-related quality of life. Our results suggest that increased BMI need not be a deterrent for undergoing open heart surgery.

Nurses' perceptions of glycemic control in patients who have undergone cardiac surgery.

Background/significance: Previous work investigating the effect of glycemic control in patients who underwent cardiac surgery has demonstrated that obtaining and maintaining blood glucose values between 80 and 120 is imperative in achieving excellent clinical outcomes in a patient who have undergone cardiac surgery. However, the caregiver's workload associated with meeting this goal is only now beginning to be understood.

Methods: This qualitative study used focus groups held on 3 consecutive days to interview nurses in the cardiovascular intensive care unit and cardiovascular step-down unit about their thoughts on glycemic control.

Survival and quality of life following elective open-heart surgery.

Eight hundred thirty-six patients who had open-heart surgery were available for analysis of health-related quality of life (HRQL) data and survival at the 1-year follow-up. Elective open-heart surgery patients with decreasing HRQL at 1 year following surgery may experience a survival disadvantage in comparison with those patients experiencing positive gains. Clinical care should extend beyond the immediate postoperative period.

Public health reporting: the United States perspective.

The release of 2 landmark reports by the Institute of Medicine titled, "To Err Is Human: Building a Safer Health System" and "Crossing the Quality Chasm" were instrumental in the identification of safety and quality issues. Since their release, federal and state programs of public reporting of performance measures have attempted to close the quality gap of care that is inappropriate, not timely, or lacking an evidence base. Cardiac surgery has long been the focus of public scrutiny, and now, as we move from an era of managed care to public reporting, reimbursement for cardiac surgery procedures will be tied to performance.

The association between early outcome, health-related quality of life, and survival following elective open-heart surgery.

We investigated the impact of perioperative complications on patients' health-related quality of life (HRQL) and intermediate-term survival after cardiac surgery. Improved results for cardiac surgery are well demonstrated in low rates of operative mortality and morbidity. However, the association between perioperative morbid events, HRQL at 1 year, and survival is unclear.

Gender differences for Rapid After Bypass Back Into Telemetry tract following cardiac surgery.

The Rapid After Bypass Back Into Telemetry program is based on a simple clinical algorithm to predict same-day transfer of patients to the cardiac telemetry unit following cardiac surgery. This program proved to be an excellent predictor for decreased postoperative complications, shorter intensive care unit and hospital stay, and lower costs. We believe that any candidate for cardiac surgery should be screened for eligibility to participate in the program with special focus on female patients to further improve their outcomes.

Preoperative state of mind among patients undergoing CABG: effect on length of stay and postoperative complications.

This study was undertaken to determine if a pessimistic self-assessment prior to an elective coronary artery bypass graft (CABG) was predictive of postoperative complications and increased length of stay (LOS). Subjects (n = 565), aged 65 and older and undergoing elective CABG, were stratified into 2 groups (optimistic, pessimistic) based on their mental health subscale scores prior to surgery. After adjusting for age, gender, and severity of disease, the average LOS for pessimistic patients was 1.

National databases and clinical practice specialist: decreasing postoperative atrial fibrillation following cardiac surgery.

In this article, we document how an interdisciplinary committee of health professionals led to an approximate 50% reduction in the incidence of postoperative atrial fibrillation (AF) following a cardiac surgery procedure by using preoperative loading and dosing of PO amiodarone and beta blockade. Patients in this report (n = 3397) included all coronary artery bypass surgery (CABG) and valve replacement/repair procedures from January 1, 2000 to June 30, 2002. The incidence of postoperative AF for a CABG or valve replacement/repair procedure was 19.

Cardiac surgery outcomes.

Accrediting organizations and payers are demanding valid and reliable data that demonstrate the value of services. Federal agencies, healthcare industry groups, and healthcare watchdog groups are increasing the demand for public access to outcomes data. A new and growing outcomes dynamic is the information requested by prospective patients in an increasingly consumer-oriented business.