共查询到20条相似文献，搜索用时 10 毫秒
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Robert M.A. van der Boon Bertrand Marcheix Didier Tchetche Alaide Chieffo Nicolas M. Van Mieghem Nicolas Dumonteil Olivier Vahdat Francesco Maisano Patrick W. Serruys A. Pieter Kappetein Jean Fajadet Antonio Colombo Didier Carrié Ron T. van Domburg Peter P.T. de Jaegere 《The Annals of thoracic surgery》2014
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George Tolis Philip J. Spencer Jordan P. Bloom Serguei Melnitchouk David A. D&#x;Alessandro Mauricio A. Villavicencio Thoralf M. Sundt 《The Journal of thoracic and cardiovascular surgery》2018,155(5):2058-2065
Objective
Teaching the next generation operative cardiac surgery while maintaining the highest level of patient care is an ever-increasing challenge given the growing proportion of patients with multiple comorbidities, the loss of more straightforward cases to percutaneous interventions, and the pressure of public reporting. No study to date has compared the outcomes of similar cases performed entirely (“skin-to-skin”) by the resident with those performed entirely by the staff to confirm the safety of this practice.Methods
A total of 100 consecutive cardiac cases performed skin-to-skin by the resident (group R) were matched by procedure 1:1 to nonconsecutive cases performed by a single attending surgeon (group A). Patients were excluded from the analysis if there was overlap in any portion of the procedure by the trainee or the attending.Results
Patients in group A were similar to those in group R with respect to age, gender, body mass index, American Society of Anesthesiologists classification, left ventricular ejection fraction, and diabetes mellitus. Mean operative times were longer in group R (4.6 vs 2.7 hours, P < .001), as were cardiopulmonary bypass times (96 vs 50 minutes, P < .001) and aortic crossclamp times (78 vs 39 minutes, P < .001). There were no significant differences in red blood cell transfusions, reexplorations, stroke, length of stay, or wound infections. There were no in-hospital or 30-day deaths.Conclusions
Our data indicate that trainees can be educated in operative surgery under the current paradigm, despite longer operative times, without sacrificing outcome quality. It is reasonable to expect academic programs to continue providing trainees significant experience as primary operating surgeons. 相似文献10.
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Niv Ad Sari D. Holmes Jay Patel Deborah J. Shuman Paul S. Massimiano Elmer Choi David Fitzgerald Linda Halpin Lisa M. Fornaresio 《The Journal of thoracic and cardiovascular surgery》2017,153(3):597-605.e1
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.Methods
Patients undergoing first-time cardiac surgery from 2006 (full year before protocol) were compared with those in 2009 (after protocol) and propensity score matched to improve balance. Data were prospectively collected. Stability of transfusion incidence also was compared (2005-2006 vs 2008-2014).Results
After matching, 890 patients from each year were included. Use of blood products decreased from 54% in 2006 to 25% in 2009 (P < .001). Patients in 2009 had a lower incidence of postoperative renal failure (2.6% vs 4%, P = .04), reoperations for bleeding (2% vs 4%, P = .004), and readmissions at less than 30 days (6% vs 12%, P < .001). No differences were found for operative mortality, deep sternal wound infection, or permanent strokes. Patients in 2009 had greater improvement in physical (P = .001) and mental (P = .02) quality of life than patients in 2006. Reduction of blood products led to significant cost savings for packed erythrocytes (P < .001) and platelets (P < .001). After protocol implementation, transfusion incidence remained 30% or less, with less than 28% in most years.Conclusions
A multidisciplinary blood conservation program can significantly control blood transfusion rates, improve outcomes, and be sustained over time. Efforts are needed to implement evidence-based protocols to standardize and decrease blood use in cardiac surgery to improve outcomes and reduce cost. 相似文献14.
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J. Matthew Brennan MD MPH David R. Holmes Matthew W. Sherwood Fred H. Edwards John D. Carroll Fred L. Grover E. Murat Tuzcu Vinod Thourani Ralph G. Brindis David M. Shahian Lars G. Svensson Sean M. O’Brien Cynthia M. Shewan Kathleen HewittJames S. Gammie MD John S. Rumsfeld Eric D. Peterson Michael J. Mack 《The Annals of thoracic surgery》2014,98(6):2016-2022