Early and late outcomes with prolonged open chest management after cardiac surgery
Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved..
OBJECTIVES: Open chest management (OCM) is an important intervention for patients who are unable to undergo sternal closure after cardiac surgery. This study reviews the factors associated with a prolonged need for this intervention and investigates its association with early and late mortality.
METHODS: Patients undergoing OCM from January 2009 to December 2014 were reviewed. Differences in the median duration of OCM when a perioperative variable was present versus its absence were determined and variables significant at P ≤ .1 were analyzed using Poisson regression for factors associated with prolonged OCM. Multivariable logistic regression and Cox proportional hazards models were developed to investigate perioperative factors that were associated with early and late mortality.
RESULTS: A total of 201 patients (5%) required OCM and the overall median duration of this intervention was 3 days. The use a temporary assist device (median, 7 vs 2 days; P < .001), pneumonias (median, 11 vs 3 days; P < .001), sternal re-explorations (median, 6 vs 2 days; P < .001), and renal failure (median, 6 vs 3 days; P = .02) were among the factors that were highly associated with prolonged OCM using Poisson regression. Thirty-day mortalities occurred in 32 patients (16%) and were significantly associated with emergency surgery (P = .03), sternal re-explorations (P = .001), and OCM duration (median, 6 vs 3 days; P = .02). On multivariable logistic regression and Cox analysis, delaying sternal closure by 1-day increments increased the risk of early and late mortality by 11% (P = .01), and 9% (P < .001), respectively.
CONCLUSIONS: Prolonged OCM was associated with increasing perioperative morbidity and a higher risk of early and late mortality.
| Errataetall: |
CommentIn: J Thorac Cardiovasc Surg. 2017 Sep;154(3):922-924. - PMID 28579264 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2017 |
|---|---|
| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:154 |
|---|---|
| Enthalten in: |
The Journal of thoracic and cardiovascular surgery - 154(2017), 3 vom: 21. Sept., Seite 915-924 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Wong, Joshua K [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Clinical outcomes |
|---|
| Anmerkungen: |
Date Completed 05.08.2019 Date Revised 05.08.2019 published: Print-Electronic CommentIn: J Thorac Cardiovasc Surg. 2017 Sep;154(3):922-924. - PMID 28579264 Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jtcvs.2017.03.143 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM272596086 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM272596086 | ||
| 003 | DE-627 | ||
| 005 | 20231224235215.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231224s2017 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jtcvs.2017.03.143 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0908.xml |
| 035 | |a (DE-627)NLM272596086 | ||
| 035 | |a (NLM)28579263 | ||
| 035 | |a (PII)S0022-5223(17)30704-3 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Wong, Joshua K |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Early and late outcomes with prolonged open chest management after cardiac surgery |
| 264 | 1 | |c 2017 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 05.08.2019 | ||
| 500 | |a Date Revised 05.08.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Thorac Cardiovasc Surg. 2017 Sep;154(3):922-924. - PMID 28579264 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: Open chest management (OCM) is an important intervention for patients who are unable to undergo sternal closure after cardiac surgery. This study reviews the factors associated with a prolonged need for this intervention and investigates its association with early and late mortality | ||
| 520 | |a METHODS: Patients undergoing OCM from January 2009 to December 2014 were reviewed. Differences in the median duration of OCM when a perioperative variable was present versus its absence were determined and variables significant at P ≤ .1 were analyzed using Poisson regression for factors associated with prolonged OCM. Multivariable logistic regression and Cox proportional hazards models were developed to investigate perioperative factors that were associated with early and late mortality | ||
| 520 | |a RESULTS: A total of 201 patients (5%) required OCM and the overall median duration of this intervention was 3 days. The use a temporary assist device (median, 7 vs 2 days; P < .001), pneumonias (median, 11 vs 3 days; P < .001), sternal re-explorations (median, 6 vs 2 days; P < .001), and renal failure (median, 6 vs 3 days; P = .02) were among the factors that were highly associated with prolonged OCM using Poisson regression. Thirty-day mortalities occurred in 32 patients (16%) and were significantly associated with emergency surgery (P = .03), sternal re-explorations (P = .001), and OCM duration (median, 6 vs 3 days; P = .02). On multivariable logistic regression and Cox analysis, delaying sternal closure by 1-day increments increased the risk of early and late mortality by 11% (P = .01), and 9% (P < .001), respectively | ||
| 520 | |a CONCLUSIONS: Prolonged OCM was associated with increasing perioperative morbidity and a higher risk of early and late mortality | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Video-Audio Media | |
| 650 | 4 | |a clinical outcomes | |
| 650 | 4 | |a delayed sternal closure | |
| 650 | 4 | |a long-term survival | |
| 650 | 4 | |a open chest management | |
| 650 | 4 | |a postoperative complications | |
| 700 | 1 | |a Joshi, Devang J |e verfasserin |4 aut | |
| 700 | 1 | |a Melvin, Amber L |e verfasserin |4 aut | |
| 700 | 1 | |a Aquina, Christopher T |e verfasserin |4 aut | |
| 700 | 1 | |a Archibald, William J |e verfasserin |4 aut | |
| 700 | 1 | |a Lidder, Alcina K |e verfasserin |4 aut | |
| 700 | 1 | |a Probst, Christian P |e verfasserin |4 aut | |
| 700 | 1 | |a Massey, Howard T |e verfasserin |4 aut | |
| 700 | 1 | |a Hicks, George L |e verfasserin |4 aut | |
| 700 | 1 | |a Knight, Peter A |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t The Journal of thoracic and cardiovascular surgery |d 1959 |g 154(2017), 3 vom: 21. Sept., Seite 915-924 |w (DE-627)NLM000033510 |x 1097-685X |7 nnns |
| 773 | 1 | 8 | |g volume:154 |g year:2017 |g number:3 |g day:21 |g month:09 |g pages:915-924 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jtcvs.2017.03.143 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 154 |j 2017 |e 3 |b 21 |c 09 |h 915-924 | ||