Effect of bivalirudin on coagulation in neonatal (cord) and adult human blood in vitro.

Introduction: Bivalirudin is recommended as an alternative to heparin in cardiac surgery with cardiopulmonary bypass. Although it has been used in infants and children for this indication, there is a paucity of data on the pharmacologic effects of bivalirudin in neonates. Given the immaturity of the hemostatic system in neonates, we hypothesized that coagulation responses to bivalirudin in this population would be different than in adults.

Measuring Childbirth Outcomes Using Administrative and Birth Certificate Data.

Background: The number of pregnancy-related deaths and severe maternal complications continues to rise in the United States, and the quality of obstetrical care across U.S. hospitals is uneven.

Rates of major obstetrical complications vary almost fivefold among US hospitals.

Of the approximately four million women who give birth each year in the United States, nearly 13 percent experience one or more major complications. But the extent to which the rates of major obstetrical complications vary across hospitals in the United States is unknown. We used multivariable logistic regression models to examine the variation in obstetrical complication outcomes across US hospitals among a large, nationally representative sample of more than 750,000 obstetrical deliveries in 2010.

Racial disparities in the use of blood transfusion in major surgery.

Background: Racial disparities in healthcare in the United States are widespread and have been well documented. However, it is unknown whether racial disparities exist in the use of blood transfusion for patients undergoing major surgery.

Methods: We used the University HealthSystem Consortium database (2009-2011) to examine racial disparities in perioperative red blood cells (RBCs) transfusion in patients undergoing coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy.

The effective concentration of tranexamic acid for inhibition of fibrinolysis in neonatal plasma in vitro.

Background: Neonates are at high risk for bleeding complications after cardiovascular surgery. Activation of intravascular fibrinolysis is one of the principal effects of cardiopulmonary bypass that causes poor postoperative hemostasis. Antifibrinolytic medications such as tranexamic acid are often used as prophylaxis against fibrinolysis, but concentration/effect data to guide dosing are sparse for adults and have not been published for neonates.

Preoperative thrombocytopenia and postoperative outcomes after noncardiac surgery.

Background: Most studies examining the prognostic value of preoperative coagulation testing are too small to examine the predictive value of routine preoperative coagulation testing in patients having noncardiac surgery.

Methods: Using data from the American College of Surgeons National Surgical Quality Improvement database, the authors performed a retrospective observational study on 316,644 patients having noncardiac surgery who did not have clinical indications for preoperative coagulation testing. The authors used multivariable logistic regression analysis to explore the association between platelet count abnormalities and red cell transfusion, mortality, and major complications.

Variation of blood transfusion in patients undergoing major noncardiac surgery.

Objective: To examine the hospital variability in use of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelet transfusions in patients undergoing major noncardiac surgery.

Background: Blood transfusion is commonly used in surgical procedures in the United States. Little is known about the hospital variability in perioperative transfusion rates for noncardiac surgery.

Labor epidural anesthesia, obstetric factors and breastfeeding cessation.

Breastfeeding benefits both infant and maternal health. Use of epidural anesthesia during labor is increasingly common and may interfere with breastfeeding. Studies analyzing epidural anesthesia's association with breastfeeding outcomes show mixed results; many have methodological flaws.

Association between Leapfrog safe practices score and hospital mortality in major surgery.

Background: The Leapfrog Group reports on hospitals' adoption of the National Quality Forum Patient Safety Practices. However, it is unknown whether hospital compliance with these safe practices is associated with improved outcomes in patients undergoing major surgery.

Methods: We analyzed the association between hospital mortality and Leapfrog Safe Practices among patients undergoing coronary artery bypass graft surgery (n=18,565), abdominal aortic aneurysm repair (n=2777), and hip replacement (n=25,067) in hospitals participating in the 2007 Leapfrog Hospital Survey using logistic regression.

Association between intraoperative blood transfusion and mortality and morbidity in patients undergoing noncardiac surgery.

Background: The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively.

Methods: This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery.

Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery.

Background: Previous studies have demonstrated that obesity is paradoxically associated with a lower risk of mortality after noncardiac surgery. This study will determine the impact of the modified metabolic syndrome (defined as the presence of obesity, hypertension, and diabetes) on perioperative outcomes.

Methods: This study is based on data from 310,208 patients in the American College of Surgeons National Surgical Quality Improvement Program database.

The effective concentration of epsilon-aminocaproic Acid for inhibition of fibrinolysis in neonatal plasma in vitro.

Introduction: Pediatric patients, particularly neonates, are at high risk for bleeding complications after cardiovascular surgery because of their immature hemostatic system, small size, and the complex operations they require. Activation of intravascular fibrinolysis is one of the principle effects of cardiopulmonary bypass that causes poor postoperative hemostasis. This complication has long been recognized and treated with antifibrinolytic medications, including the lysine analog epsilon aminocaproic acid (EACA).

Epidural multiorifice catheters function as single-orifice catheters: an in vitro study.

In an in vitro study, we determined the flow rates required to use selective orifices of multiorifice catheters. Saline was infused at rates between 1 and 360 mL/h through Portex and Braun 20-gauge multiorifice catheters using Baxter, Abbott Laboratories, and Alaris infusion pumps. The numbers of orifices used via infusion and manual injection, and the pressure within the catheter during continuous infusion, were recorded.

A randomized, double-masked, multicenter comparison of the safety of continuous intrathecal labor analgesia using a 28-gauge catheter versus continuous epidural labor analgesia.

Background: Continuous intrathecal labor analgesia produces rapid analgesia or anesthesia and allows substantial flexibility in medication choice. The US Food and Drug Administration, in 1992, removed intrathecal microcatheters (27-32 gauge) from clinical use after reports of neurologic injury in nonobstetric patients. This study examined the safety and efficacy of a 28-gauge intrathecal catheter for labor analgesia in a prospective, randomized, multicenter trial.

Racial differences in the use of epidural analgesia for labor.

Background: There is strong evidence that pain is undertreated in black and Hispanic patients. The association between race and ethnicity and the use of epidural analgesia for labor is not well described.

Methods: Using the New York State Perinatal Database, the authors examined whether race and ethnicity were associated with the likelihood of receiving epidural analgesia for labor after adjusting for clinical characteristics, demographics, insurance coverage, and provider effect.