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51. Cardiac Surgery ERAS

Author

Gregory, Alexander J., Engelman, Daniel T., Williams, Judson B., Arora, Rakesh C., Boyle, Edward M., Jr., Ljungqvist, Olle, editor, Francis, Nader K., editor, and Urman, Richard D., editor

Published
2020
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52. Clinical Outcomes and Cost Analysis in Patients with Heart Failure Undergoing Transcatheter Edge-to-Edge Repair for Mitral Valve Regurgitation.

Author

Dokollari, Aleksander, Sicouri, Serge, Rodriguez, Roberto, Gnall, Eric, Coady, Paul, Mahmud, Farah, Kjelstrom, Stephanie, Montone, Georgia, Yamashita, Yoshiyuki, Harish, Jarrett, Bacchi, Beatrice, Arora, Rakesh C, Shah, Ashish, Ghorpade, Nitin, Abramson, Sandra, Hawthorne, Katie, Goldman, Scott, Gray, William, Cabrucci, Francesco, and Bonacchi, Massimo

Subjects
HEART failure patients, MITRAL valve, INTENSIVE care units, HOSPITAL costs, MYOCARDIAL infarction, HEART failure, MITRAL valve insufficiency
Abstract

Objective: To analyze the clinical and cost outcomes of transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) in heart failure (HF) patients. Methods: All 162 HF patients undergoing TEER for MR between January 2019 and March 2023 were included. A propensity-adjusted analysis was used to compare 32 systolic vs. 97 diastolic vs. 33 mixed (systolic + diastolic) HF patients. Systolic, diastolic, and mixed HF patients were defined according to AHA guidelines. The primary outcome was the long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs, all-cause mortality + stroke + myocardial infarction + repeat intervention). Results: The mean age was 76.3 vs. 80.9 vs. 76 years old, and the mean ejection fraction (EF) was 39.5% vs. 59.8% vs. 39.7% in systolic vs. diastolic vs. mixed HF, respectively. Postoperatively, the diastolic vs. systolic HF group had a higher intensive care unit stay (21 vs. 0 h; HR 67.5 (23.7, 111.4)]; lower ventilation time [2 vs. 2.3 h; HR 49.4 (8.6, 90.2)]; lower EF [38% vs. 58.5%; HR 9.9 (3.7, 16.1)]. In addition, the diastolic vs. mixed HF groups had a lower incidence of EF < 50% (11 vs. 27 patients; HR 6.6 (1.6, 27.3) and a lower use of dialysis (one vs. three patients; HR 18.1 (1.1, 287.3), respectively. At a mean 1.6 years follow-up, all-cause death [HR 39.8 (26.2, 60.5)], MACCEs [HR 50.3 (33.7–75.1)], and new pacemaker implantations [HR 17.3 (8.7, 34.6)] were higher in the mixed group. There was no significant total hospital cost difference among the systolic (USD 106,859) vs. diastolic (USD 91,731) vs. mixed (USD 120,522) HF groups (p = 0.08). Conclusions: TEER for MR evidenced the worst postoperative and follow-up clinical outcomes in the mixed HF group compared to diastolic and systolic HF groups. No total hospital cost differences were observed. [ABSTRACT FROM AUTHOR]

Published
2024
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54. The Role of the Cardiac Surgery Patient in Pain Management: The Patient Perspective.

Author

Walton, Laura L., Duff, Elsie, Arora, Rakesh C., and McMillan, Diana E.

Subjects
SURGERY, PATIENTS, RESEARCH funding, QUALITATIVE research, POSTOPERATIVE pain, STATISTICAL sampling, INTERVIEWING, DESCRIPTIVE statistics, PSYCHOLOGICAL adaptation, PATIENT-centered care, PAIN management, COMMUNICATION, RESEARCH, RESEARCH methodology, PHENOMENOLOGY, DATA analysis software, CARDIAC surgery, PATIENTS' attitudes, CARDIAC rehabilitation
Abstract

One and a half million cardiac surgeries are completed worldwide each year where undertreated postoperative pain increases the risk of patient morbidity and mortality. Patient-centered pain management is recommended to improve patient outcomes but there is insufficient information regarding how the patient views their role. The objective of this study is to explore cardiac surgery patients' perspectives on their role in postoperative pain management. This study used an interpretive phenomenological design and convenience sampling. Six participants who had undergone cardiac surgery were recruited from a cardiac rehabilitation program in Western Canada. The first author conducted semi-structured digitally recorded interviews. Sociodemographic characteristics and measures of anxiety and depression were also collected. Emergent thematic analysis of the qualitative data generated three themes: attitude, coping and care, and communication. The findings of this study address a gap in the literature with regard to patients' perceived roles in pain management. There is a complex relationship between patient attitude, coping and care, and communication which, in turn, influences how patients view their role within the pain management continuum. These themes contribute to the development of the patient role within the pain management continuum and form an integrated feedback loop. The patient's attitude contributes to their ability to cope with pain and participate in pain assessment and management. Furthermore, their ability to cope and desire to participate influences the development of their attitude. These findings may enhance providers' understanding of the patient's perspective and improve pain management outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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65. ERAS® Cardiac Society Turnkey Order Set for Surgical Site Infection Prevention: Proceedings from the AATS ERAS Conclave 2023

Author

Crisafi, Cheryl, primary, Grant, Michael C., additional, Rea, Amanda, additional, Morton-Bailey, Vicki, additional, Gregory, Alexander J., additional, Arora, Rakesh C., additional, Chatterjee, Subhasis, additional, Lother, Sylvain A., additional, Cangut, Busra, additional, Engelman, Daniel T., additional, Salenger, Rawn, additional, Lobdell, Kevin W., additional, McConnell, Gina, additional, Crotwell, Shannon, additional, Reddy, Seenu, additional, and Lazar, Harold, additional

Published
2024
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66. Enhanced Recovery After Surgery Cardiac Society turnkey order set for prevention and management of postoperative atrial fibrillation after cardiac surgery: Proceedings from the American Association for Thoracic Surgery ERAS Conclave 2023

Author

Chatterjee, Subhasis, primary, Cangut, Busra, additional, Rea, Amanda, additional, Salenger, Rawn, additional, Arora, Rakesh C., additional, Grant, Michael C., additional, Morton-Bailey, Vicki, additional, Hirji, Sameer, additional, Engelman, Daniel T., additional, Gregory, Alexander J., additional, Lobdell, Kevin W., additional, Hui, Dawn, additional, Puskas, John, additional, Gaudino, Mario, additional, Crisafi, Cheryl, additional, and Reddy, V. Seenu, additional

Published
2024
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76. Handoffs From the Operating Room to the Intensive Care Unit After Cardiothoracic Surgery: From The Society of Thoracic Surgeons Workforce on Critical Care

Author

Chatterjee, Subhasis, Shake, Jay G., Arora, Rakesh C., Engelman, Daniel T., Firstenberg, Michael S., Geller, Charles M., Hirose, Hitoshi, Lonchyna, Vassyl A., Lytle, Francis T., Milewski, Rita K.C., Moosdorf, Rainer G.H., Rabin, Joseph, Sanjanwala, Rohan, Galati, Marianne, and Whitman, Glenn J.

Published
2019
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79. An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial (Preprint)

Author

El-Gabalawy, Renée, primary, Sommer, Jordana L, additional, Hebbard, Pamela, additional, Reynolds, Kristin, additional, Logan, Gabrielle S, additional, Smith, Michael S D, additional, Mutter, Thomas C, additional, Mutch, W Alan, additional, Mota, Natalie, additional, Proulx, Catherine, additional, Gagnon Shaigetz, Vincent, additional, Maples-Keller, Jessica L, additional, Arora, Rakesh C, additional, Perrin, David, additional, Benedictson, Jada, additional, and Jacobsohn, Eric, additional

Published
2023
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85. ERAS Cardiac society turnkey order set for patient blood management: Proceedings from the AATS ERAS Conclave 2023

Author

Salenger, Rawn, primary, Hirji, Sameer, additional, Rea, Amanda, additional, Cangut, Busra, additional, Morton-Bailey, Vicki, additional, Gregory, Alexander J., additional, Arora, Rakesh C., additional, Grant, Michael C., additional, Raphael, Jacob, additional, Engelman, Daniel T., additional, Chatterjee, Subhasis, additional, Lobdell, Kevin W., additional, Crisafi, Cheryl, additional, McConnell, Gina, additional, Crotwell, Shannon, additional, and Reddy, Seenu, additional

Published
2023
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86. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies

Author

Slooter, Arjen J. C., Otte, Wim M., Devlin, John W., Arora, Rakesh C., Bleck, Thomas P., Claassen, Jan, and Duprey, Matthew S.

Subjects
Names, Medical centers, Delirium, Medical schools, Medical colleges
Abstract

Author(s): Arjen J. C. Slooter [sup.1], Wim M. Otte [sup.2], John W. Devlin [sup.3] [sup.4], Rakesh C. Arora [sup.5] [sup.6], Thomas P. Bleck [sup.7], Jan Claassen [sup.8], Matthew S. Duprey [...]

Published
2020
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92. Morbid obesity's impact on COVID-19 patients requiring venovenous extracorporeal membrane oxygenation: The covid-19 critical care consortium database review.

Author

Javidfar, Jeffrey, Zaaqoq, Akram M, Labib, Ahmed, Barnett, Adrian G, Hayanga, JW Awori, Eschun, Greg, Yamashita, Michael H, Jacobs, Jeffrey P, Heinsar, Silver, Suen, Jacky Y, Fraser, John F, Bassi, Gianluigi Li, Arora, Rakesh C, and Peek, Giles J

Subjects
ADULT respiratory distress syndrome treatment, OBESITY complications, ADULT respiratory distress syndrome, EXTRACORPOREAL membrane oxygenation, CRITICALLY ill, PATIENTS, BODY mass index, RESEARCH funding, SCIENTIFIC observation, DESCRIPTIVE statistics, SURVIVAL analysis (Biometry), COVID-19, APACHE (Disease classification system), DISEASE risk factors
Abstract

Introduction: Obesity is associated with a worse prognosis in COVID-19 patients with acute respiratory distress syndrome (ARDS). Veno-venous (V-V) Extracorporeal Membrane Oxygenation (ECMO) can be a rescue option, however, the direct impact of morbid obesity in this select group of patients remains unclear. Methods: This is an observational study of critically ill adults with COVID-19 and ARDS supported by V-V ECMO. Data are from 82 institutions participating in the COVID-19 Critical Care Consortium international registry. Patients were admitted between 12 January 2020 to 27 April 2021. They were stratified based on Body Mass Index (BMI) at 40 kg/m2. The endpoint was survival to hospital discharge. Results: Complete data available on 354 of 401 patients supported on V-V ECMO. The characteristics of the high BMI (>40 kg/m2) and lower BMI (≤40 kg/m2) groups were statistically similar. However, the 'high BMI' group were comparatively younger and had a lower APACHE II score. Using survival analysis, older age (Hazard Ratio, HR 1.49 per-10-years, CI 1.25–1.79) and higher BMI (HR 1.15 per-5 kg/m2 increase, CI 1.03 – 1.28) were associated with a decreased patient survival. A safe BMI threshold above which V-V ECMO would be prohibitive was not apparent and instead, the risk of an adverse outcome increased linearly with BMI. Conclusion : In COVID-19 patients with severe ARDS who require V-V ECMO, there is an increased risk of death associated with age and BMI. The risk is linear and there is no BMI threshold beyond which the risk for death greatly increases. [ABSTRACT FROM AUTHOR]

Published
2024
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93. Sex differences in post-acute neurological sequelae of SARS-CoV-2 and symptom resolution in adults after coronavirus disease 2019 hospitalization: an international multi-centre prospective observational study.

Author

Cho, Sung-Min, Premraj, Lavienraj, Battaglini, Denise, Fanning, Jonathon Paul, Suen, Jacky, Bassi, Gianluigi Li, Fraser, John, Robba, Chiara, Griffee, Matthew, Solomon, Tom, Semple, Malcolm G, Baillie, Kenneth, Sigfrid, Louise, Scott, Janet T, Citarella, Barbara Wanjiru, Merson, Laura, Arora, Rakesh C, Whitman, Glenn, Thomson, David, and White, Nicole

Published
2024
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95. Acute Effect of High-Intensity Interval Versus Moderate-Intensity Continuous Exercise on Blood Pressure and Arterial Compliance in Middle-Aged and Older Hypertensive Women With Increased Arterial Stiffness

Author

Costa, Eduardo C., Kent, David E., Boreskie, Kevin F., Hay, Jacqueline L., Kehler, Dustin S., Edye-Mazowita, Alex, Nugent, Kristina, Papadopoulos, Josaphine, Stammers, Andrew N., Oldfield, Chris, Arora, Rakesh C., Browne, Rodrigo A.V., and Duhamel, Todd A.

Published
2020
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96. The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge

Author

Morandi, Alessandro, Davis, Daniel, Bellelli, Giuseppe, Arora, Rakesh C., Caplan, Gideon A., Kamholz, Barbara, Kolanowski, Ann, Fick, Donna Marie, Kreisel, Stefan, MacLullich, Alasdair, Meagher, David, Neufeld, Karen, Pandharipande, Pratik P., Richardson, Sarah, Slooter, Arjen J.C., Taylor, John P., Thomas, Christine, Tieges, Zoë, Teodorczuk, Andrew, Voyer, Philippe, and Rudolph, James L.

Published
2017
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