Objectives: To explore the incidence, risk factors, and impact of elevated mean pulmonary artery pressure (mPAP) on 30-day mortality in liver transplantation (LT).
Design: A retrospective study.
Setting: University tertiary medical center.
Participants: Adult patients who underwent between 2013 and 2023.
Intervention: No intervention.
Measurements And Main Results: Data for consecutive adults who underwent LT (n = 1243) between 2013 and 2023 were extracted from our institutional Discovery Data Repository. Elevated mPAP was defined as ≥40 mmHg or a ≥20% increase from baseline during the first hour following reperfusion. The 30-day mortality rate was recorded. Risk factors were identified using multivariable logistic regression. The study cohort had a mean age of 55.2 ± 11.9 years and a mean model for end-stage liver disease sodium (MELD-Na) score of 34.8 ± 6.1. Ninety-one patients (7.3%) developed an elevated postreperfusion mPAP. Multivariable logistic regression revealed that preoperative elevated PAP estimated by echocardiogram, preoperative serum creatinine, and the use of epinephrine during LT were significant risk factors. Thirty-two patients (1.9%) died within 30 days after LT. Elevated postreperfusion mPAP was significantly associated with 30-day mortality (odds ratio, 6.056; 95% confidence interval, 2.349-15.611; p < 0.001).
Conclusions: mPAP is frequently elevated after graft reperfusion during LT, but its influence on clinical outcomes remains unclear. This retrospective study found a 7.3% rate of high PAP following reperfusion in LT, and high postreperfusion PAP was associated with 30-day mortality.
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http://dx.doi.org/10.1053/j.jvca.2024.08.041 | DOI Listing |
Ann Surg Open
December 2024
From the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.
Objective: Our objective was to assess potential racial bias within the Risk Analysis Index (RAI).
Background: Patient risk measures are rarely tested for racial bias. Measures of frailty, like the RAI, need to be evaluated for poor predictive performance among Black patients.
Ann Surg Open
December 2024
Division of Minimally Invasive Surgery, Department of Surgery, Duke University, Durham, NC.
Objective: To investigate the relationship between obesity and postoperative mortality in the context of high procedural complexity and comorbidity burden.
Background: The "obesity paradox" suggests better postoperative outcomes in patients with higher body mass index (BMI), despite obesity's associated health risks. Research remains scarce on the influence of procedural complexity and comorbidities on the obesity-postoperative mortality relationship.
Ann Surg Open
December 2024
From the Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Objective: The aim was to evaluate the sustainability of the pancreatic Enhanced Recovery After Surgery (ERAS) program and the effect of ERAS items on patient morbidity and hospital stay.
Background: The current ERAS guideline recommendations encompass 27 items to improve recovery after pancreatoduodenectomy (PD).
Methods: Patients who underwent pancreatic resection at the University Hospital Hamburg-Eppendorf between February 2016 and June 2023 were included.
In Tanzania, acute myocardial infarction (AMI) is under-diagnosed, and uptake of evidence-based care is sub-optimal. Using an implementation science approach, an intervention was developed to address local barriers to care: the Multicomponent Intervention for Improving Myocardial Infarction Care in Tanzania (MIMIC). This single-arm pre-post trial was conducted in a northern Tanzanian emergency department (ED).
View Article and Find Full Text PDFBMC Infect Dis
December 2024
Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
Background: The World Health Organization (WHO) has identified carbapenem-resistant Pseudomonas aeruginosa (CRPA) as one of the three critical priority pathogens. There is scarce literature evaluating the treatment outcomes in patients with CRPA infections treated with traditional non-carbapenem β-lactam (NCBL) agents. Thus, this study aims to assess the effectiveness of traditional NCBL compared to novel β-lactam agents (NVL) for treating non-carbapenem β-lactam -susceptible CRPA.
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