Pub Date : 2026-02-01DOI: 10.1053/j.jvca.2025.11.011
Paul Potnuru MD , Loay Allafy MD , Mohammad Khudirat MD , Bhuvrit R. Dhakal MD , Mert Tore MD , Rita Chamoun MD
Design
A retrospective observational study using discharge weights and survey-specific analytic methods.
Setting
Analysis of the National Inpatient Sample, representing a nationally weighted cohort of U.S. hospitalizations from 2016 to 2021.
Participants
Adults aged 18 years or older who underwent isolated coronary artery bypass grafting (CABG) during the study period.
Intervention
No interventions were applied.
Measurements and Main Results
Postoperative delirium (POD) was identified using validated ICD-10 codes. Using regression models, annual trends in POD, factors associated with POD, and the association of POD with mortality, postoperative complications, length of stay, and hospitalization costs were estimated. Among 911,910 CABG hospitalizations, POD occurred in 4.91% of patients, with a significant increase from 2016 to 2021 (odds ratio [OR] = 1.04 per year; p < 0.001). After multivariable adjustment, the strongest associations with POD were pre-existing dementia (adjusted [a]OR = 4.28; p < 0.001), alcohol abuse (aOR = 3.38; p < 0.001), and psychotic disorders (aOR = 2.40; p < 0.001). POD was independently associated with higher mortality (aOR = 1.85; p < 0.001), major complications, four-day longer length of stay (p < 0.001), and $8,565 higher costs (p < 0.001).
Conclusions
POD after CABG is a common and costly complication. This study identifies high-risk patients and modifiable risk factors, emphasizing the need for targeted strategies to reduce the clinical and economic burdens from POD after CABG.
设计：回顾性观察研究，采用排放重量和调查特定的分析方法。背景：分析全国住院患者样本，代表2016年至2021年美国住院的全国加权队列。参与者：在研究期间接受过孤立冠状动脉旁路移植术（CABG）的18岁或以上的成年人。干预：未进行干预。测量和主要结果：术后谵妄（POD）使用经过验证的ICD-10代码进行识别。使用回归模型，估计POD的年度趋势、与POD相关的因素以及POD与死亡率、术后并发症、住院时间和住院费用的关系。在911,910例CABG住院患者中，POD发生率为4.91%，从2016年到2021年显著增加（比值比[OR] = 1.04 /年；p < 0.001）。多变量调整后，与POD相关性最强的是先前存在的痴呆（调整后[a]OR = 4.28; p < 0.001）、酗酒（aOR = 3.38; p < 0.001）和精神障碍（aOR = 2.40; p < 0.001）。POD与较高的死亡率（aOR = 1.85; p < 0.001）、主要并发症、住院时间延长4天（p < 0.001）和8,565美元的高费用（p < 0.001）独立相关。结论：冠状动脉搭桥术后POD是一种常见且昂贵的并发症。本研究确定了高危患者和可改变的危险因素，强调需要有针对性的策略来减少CABG后POD的临床和经济负担。
{"title":"Postoperative Delirium After Coronary Artery Bypass Grafting in the United States, 2016-2021: Trends, Risk Factors, and Outcomes","authors":"Paul Potnuru MD , Loay Allafy MD , Mohammad Khudirat MD , Bhuvrit R. Dhakal MD , Mert Tore MD , Rita Chamoun MD","doi":"10.1053/j.jvca.2025.11.011","DOIUrl":"10.1053/j.jvca.2025.11.011","url":null,"abstract":"<div><h3>Design</h3><div>A retrospective observational study using discharge weights and survey-specific analytic methods.</div></div><div><h3>Setting</h3><div>Analysis of the National Inpatient Sample, representing a nationally weighted cohort of U.S. hospitalizations from 2016 to 2021.</div></div><div><h3>Participants</h3><div>Adults aged 18 years or older who underwent isolated coronary artery bypass grafting (CABG) during the study period.</div></div><div><h3>Intervention</h3><div>No interventions were applied.</div></div><div><h3>Measurements and Main Results</h3><div>Postoperative delirium (POD) was identified using validated ICD-10 codes. Using regression models, annual trends in POD, factors associated with POD, and the association of POD with mortality, postoperative complications, length of stay, and hospitalization costs were estimated. Among 911,910 CABG hospitalizations, POD occurred in 4.91% of patients, with a significant increase from 2016 to 2021 (odds ratio [OR] = 1.04 per year; p < 0.001). After multivariable adjustment, the strongest associations with POD were pre-existing dementia (adjusted [a]OR = 4.28; p < 0.001), alcohol abuse (aOR = 3.38; p < 0.001), and psychotic disorders (aOR = 2.40; p < 0.001). POD was independently associated with higher mortality (aOR = 1.85; p < 0.001), major complications, four-day longer length of stay (p < 0.001), and $8,565 higher costs (p < 0.001).</div></div><div><h3>Conclusions</h3><div>POD after CABG is a common and costly complication. This study identifies high-risk patients and modifiable risk factors, emphasizing the need for targeted strategies to reduce the clinical and economic burdens from POD after CABG.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 561-570"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145648671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1053/j.jvca.2025.10.048
Nicolas Kumar MD , Amit Bardia MD, MPH , Jamel P. Ortoleva MD, FASE
{"title":"Patient Selection and Institutional Expertise as Critical Determinants of On-Table Extubation Success After Cardiac Surgery: A Synthesis of Contemporary Evidence","authors":"Nicolas Kumar MD , Amit Bardia MD, MPH , Jamel P. Ortoleva MD, FASE","doi":"10.1053/j.jvca.2025.10.048","DOIUrl":"10.1053/j.jvca.2025.10.048","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 478-480"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1053/j.jvca.2025.10.043
Rasha Kaddoura , Amr Salah Omar
{"title":"Prothrombin Complex Concentrate in Cardiac Surgery–Associated Bleeding: On the Verge of Routine Use","authors":"Rasha Kaddoura , Amr Salah Omar","doi":"10.1053/j.jvca.2025.10.043","DOIUrl":"10.1053/j.jvca.2025.10.043","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 765-766"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1053/j.jvca.2025.10.039
Eleni Asimacopoulos MD , Ravi R. Thiagarajan MBBS, MPH , Gianluca Bertolizio MD , Callie Rzasa MD , Meena Nathan MBBS , Kirsten C. Odegard MD, MBA
Objectives
To describe the incidence and survival of extracorporeal membrane oxygenation (ECMO) deployment in the operating room (OR) for failure to wean from cardiopulmonary bypass (CPB) after surgery for congenital heart disease (CHD).
Design
Retrospective, quaternary children’s hospital.
Participants
Children supported with ECMO in the OR after cardiac surgery during the 2000 to 2023 period.
Measurements and Main Results
In total, 123 children (0.8% of cardiac surgical cases in the study period) had ECMO initiated in the OR. Children supported with ECMO in the OR had a median age of 1.6 months (interquartile range [IQR], 0.2-10.0) and underwent complex cardiac surgery (Risk Adjustment in Cardiac Surgery 1, categories 3-6 [N = 108; 88%]). Seventy-seven patients (63%) had 2-ventricle circulation, 38 patients (31%) had single-ventricle circulation, and 8 (5%) patients had cavopulmonary circulation. The median CPB time was 253 minutes (IQR, 188-348) with an aortic cross-clamp time of 109 minutes (IQR, 71-172). ECMO duration for all patients was 5 days (IQR, 3-9). Sixty-one patients (50%) underwent cardiac catheterization, and 41 patients (34%) required surgery while on ECMO. Bleeding was common in all patients on ECMO. There were cardiac complications in 21% and neurologic complications in 24%. Eleven patients (9%) needed a heart transplant or transition to a ventricular assist device. Fifty-five (45%) of the patients survived to discharge.
Conclusion
While ECMO continues to be a life-saving intervention, children requiring ECMO in the OR after cardiac surgery for CHD face high mortality. The need for prolonged ECMO support, suggesting irreversible myocardial failure and neurologic injury, is associated with increased mortality.
{"title":"Extracorporeal Membrane Oxygenation Initiated in the Operating Room After Congenital Heart Surgery:A Single-Center Review of Survival Outcomes","authors":"Eleni Asimacopoulos MD , Ravi R. Thiagarajan MBBS, MPH , Gianluca Bertolizio MD , Callie Rzasa MD , Meena Nathan MBBS , Kirsten C. Odegard MD, MBA","doi":"10.1053/j.jvca.2025.10.039","DOIUrl":"10.1053/j.jvca.2025.10.039","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the incidence and survival of extracorporeal membrane oxygenation (ECMO) deployment in the operating room (OR) for failure to wean from cardiopulmonary bypass (CPB) after surgery for congenital heart disease (CHD).</div></div><div><h3>Design</h3><div>Retrospective, quaternary children’s hospital.</div></div><div><h3>Participants</h3><div>Children supported with ECMO in the OR after cardiac surgery during the 2000 to 2023 period.</div></div><div><h3>Measurements and Main Results</h3><div>In total, 123 children (0.8% of cardiac surgical cases in the study period) had ECMO initiated in the OR. Children supported with ECMO in the OR had a median age of 1.6 months (interquartile range [IQR], 0.2-10.0) and underwent complex cardiac surgery (Risk Adjustment in Cardiac Surgery 1, categories 3-6 [N = 108; 88%]). Seventy-seven patients (63%) had 2-ventricle circulation, 38 patients (31%) had single-ventricle circulation, and 8 (5%) patients had cavopulmonary circulation. The median CPB time was 253 minutes (IQR, 188-348) with an aortic cross-clamp time of 109 minutes (IQR, 71-172). ECMO duration for all patients was 5 days (IQR, 3-9). Sixty-one patients (50%) underwent cardiac catheterization, and 41 patients (34%) required surgery while on ECMO. Bleeding was common in all patients on ECMO. There were cardiac complications in 21% and neurologic complications in 24%. Eleven patients (9%) needed a heart transplant or transition to a ventricular assist device. Fifty-five (45%) of the patients survived to discharge.</div></div><div><h3>Conclusion</h3><div>While ECMO continues to be a life-saving intervention, children requiring ECMO in the OR after cardiac surgery for CHD face high mortality. The need for prolonged ECMO support, suggesting irreversible myocardial failure and neurologic injury, is associated with increased mortality.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 620-627"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145633922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1053/j.jvca.2025.10.021
Axel Semmelmann MD , Stefanie Scheid MD , Isabelle Moneke MD , Dag Winroth , Johannes Hell MD , Hartmut Bürkle , Wolfgang Baar MD , Torsten Loop
Objectives
Preoperative risk prediction in thoracic surgery remains difficult for individual patients, as most risk assessment models do not include perioperative factors. We hypothesized that the perioperative kinetics of growth differentiation factor 15 (GDF-15) in patients' serum predicts the risk of postoperative pulmonary complications.
Design
A single-center prospective observational cohort study.
Setting
University hospital.
Participants
One hundred one consecutive adult patients undergoing non-cardiac thoracic surgery.
Interventions
None.
Measurements
The primary endpoint, postoperative pulmonary complications (PPC), was a composite endpoint consisting of pneumonia, severe respiratory failure, reintubation, and Acute respiratory distress syndrome. Pre- and postoperative serum GDF-15 measurements were performed.
Main Results
During the median postoperative hospital stay of 8.7 days (median [IQR 6.6-10.4]), 23 patients with PPC were identified. Compared to the preoperative baseline, significantly higher mean concentrations of GDF-15 were observed in patients with PPC than in patients without PPC at the end of surgery (4371 [IQR 2560-6991] v 2776 [IQR 2004-3721] pg/mL, p = 0.003) and 72 hours after surgery (5040 [IQR 3482-6527] v 2810 [2178-3935] pg/mL, p < 0.001) with a significant association of the increase in GDF-15 and the hazard ratio for PPC. In a multivariate Cox proportional hazards model, an increase in GDF-15 levels >60% at the end of surgery (hazard ratio 5.9 (95% confidence interval 1.73-20.09) and an increase of >68% 72 hours after surgery (hazard ratio) 4.1 (95% confidence interval 1.36-12.62) was significantly associated with PPC after thoracic surgery.
Conclusions
In patients undergoing thoracic surgery, perioperative assessment of GDF-15 serum kinetics helps to stratify the postoperative risk of PPC.
目的：胸外科手术术前风险预测对于个体患者来说仍然很困难，因为大多数风险评估模型不包括围手术期因素。我们假设患者血清中生长分化因子15 （GDF-15）围手术期动力学可以预测术后肺部并发症的风险。设计：单中心前瞻性观察队列研究。单位：大学医院。参与者：101例连续接受非心脏胸外科手术的成人患者。干预措施:没有。测量：主要终点，术后肺部并发症（PPC），是一个复合终点，包括肺炎、严重呼吸衰竭、再插管和急性呼吸窘迫综合征。进行术前和术后血清GDF-15测定。主要结果：术后中位住院时间8.7天（中位[IQR 6.6-10.4]），共发现23例PPC患者。与术前基线相比，手术结束时PPC患者GDF-15的平均浓度（4371 [IQR 2560-6991] vs 2776 [IQR 2004-3721] pg/mL, p = 0.003）和术后72小时（5040 [IQR 3482-6527] v 2810 [278 -3935] pg/mL, p < 0.001）显著高于非PPC患者，GDF-15的升高与PPC的危险比显著相关。在多变量Cox比例风险模型中，手术结束时GDF-15水平升高> - 60%（风险比5.9(95%可信区间1.73-20.09)）和术后72小时GDF-15水平升高68%（风险比4.1(95%可信区间1.36-12.62)）与胸外科术后PPC显著相关。结论：胸外科手术患者围手术期GDF-15血清动力学评估有助于对术后PPC风险进行分层。
{"title":"Role of the Perioperative Growth Differentiation Factor-15 Kinetics in Identifying Patients at High Risk for Postoperative Pulmonary Complications Following Thoracic Surgery","authors":"Axel Semmelmann MD , Stefanie Scheid MD , Isabelle Moneke MD , Dag Winroth , Johannes Hell MD , Hartmut Bürkle , Wolfgang Baar MD , Torsten Loop","doi":"10.1053/j.jvca.2025.10.021","DOIUrl":"10.1053/j.jvca.2025.10.021","url":null,"abstract":"<div><h3>Objectives</h3><div>Preoperative risk prediction in thoracic surgery remains difficult for individual patients, as most risk assessment models do not include perioperative factors. We hypothesized that the perioperative kinetics of growth differentiation factor 15 (GDF-15) in patients' serum predicts the risk of postoperative pulmonary complications.</div></div><div><h3>Design</h3><div>A single-center prospective observational cohort study.</div></div><div><h3>Setting</h3><div>University hospital.</div></div><div><h3>Participants</h3><div>One hundred one consecutive adult patients undergoing non-cardiac thoracic surgery.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements</h3><div>The primary endpoint, postoperative pulmonary complications (PPC), was a composite endpoint consisting of pneumonia, severe respiratory failure, reintubation, and Acute respiratory distress syndrome. Pre- and postoperative serum GDF-15 measurements were performed.</div></div><div><h3>Main Results</h3><div>During the median postoperative hospital stay of 8.7 days (median [IQR 6.6-10.4]), 23 patients with PPC were identified. Compared to the preoperative baseline, significantly higher mean concentrations of GDF-15 were observed in patients with PPC than in patients without PPC at the end of surgery (4371 [IQR 2560-6991] <em>v</em> 2776 [IQR 2004-3721] pg/mL, p = 0.003) and 72 hours after surgery (5040 [IQR 3482-6527] <em>v</em> 2810 [2178-3935] pg/mL, p < 0.001) with a significant association of the increase in GDF-15 and the hazard ratio for PPC. In a multivariate Cox proportional hazards model, an increase in GDF-15 levels >60% at the end of surgery (hazard ratio 5.9 (95% confidence interval 1.73-20.09) and an increase of >68% 72 hours after surgery (hazard ratio) 4.1 (95% confidence interval 1.36-12.62) was significantly associated with PPC after thoracic surgery.</div></div><div><h3>Conclusions</h3><div>In patients undergoing thoracic surgery, perioperative assessment of GDF-15 serum kinetics helps to stratify the postoperative risk of PPC.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 643-651"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1053/j.jvca.2025.11.033
G. Gayathri MD, FTEE, DM, P. Divya Jacob MD, PDCC, FTEE, DM, V. Krishna Narayanan Nayanar MD, FTEE, DM, V. Vipin Raj MD, FTEE, DM, Saravana Babu MD, DM, FICA (Canada), NBE, FTEE, K.P. Unnikrishnan MD, DNBE, FTEE, FASE, Thomas Koshy DA, MD, PDCC, FIACTA, FTEE, FRCP
Objectives
To test the hypothesis of whether using a video laryngoscope reduces complications related to transesophageal echocardiography (TEE) probe insertion in children.
Design
Randomized controlled study.
Setting
Pediatric cardiac surgical operating rooms in a tertiary care level hospital.
Participants
One hundred thirty children aged 0 to 18 years undergoing elective cardiac surgery.
Interventions
TEE probe insertion.
Measurements and Main Results
The patients were randomized into 2 groups: conventional (C) group (n = 64) and video laryngoscopy (VL) group (n = 66). The primary endpoint of the study was the incidence of oropharyngeal injury. The secondary endpoints were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. The overall incidence of oropharyngeal injuries was 7.7%, with 4 injuries (6.3%) occurring in the C group and 6 injuries (9.1%) occurring in the VL group (p = 0.543). Most children (90.8%) required only 1 attempt to insert the TEE probe, with no significant difference between groups (p = 0.579). A higher percentage increase in mean blood pressure during probe insertion and a higher heart rate increase after probe insertion were observed in the VL group (p < 0.05). The most common relationship with the larynx was posterior (62%), followed by left posterolateral (20.9%) and right posterolateral (17.1%).
Conclusions
VL does not demonstrate superiority over conventional methods of TEE probe insertion in children regarding injury incidence or first-attempt success rate.
{"title":"Use of Video Laryngoscope to Reduce Complications of Transesophageal Echocardiography Probe Insertion in Children","authors":"G. Gayathri MD, FTEE, DM, P. Divya Jacob MD, PDCC, FTEE, DM, V. Krishna Narayanan Nayanar MD, FTEE, DM, V. Vipin Raj MD, FTEE, DM, Saravana Babu MD, DM, FICA (Canada), NBE, FTEE, K.P. Unnikrishnan MD, DNBE, FTEE, FASE, Thomas Koshy DA, MD, PDCC, FIACTA, FTEE, FRCP","doi":"10.1053/j.jvca.2025.11.033","DOIUrl":"10.1053/j.jvca.2025.11.033","url":null,"abstract":"<div><h3>Objectives</h3><div>To test the hypothesis of whether using a video laryngoscope reduces complications related to transesophageal echocardiography (TEE) probe insertion in children.</div></div><div><h3>Design</h3><div>Randomized controlled study.</div></div><div><h3>Setting</h3><div>Pediatric cardiac surgical operating rooms in a tertiary care level hospital.</div></div><div><h3>Participants</h3><div>One hundred thirty children aged 0 to 18 years undergoing elective cardiac surgery.</div></div><div><h3>Interventions</h3><div>TEE probe insertion.</div></div><div><h3>Measurements and Main Results</h3><div>The patients were randomized into 2 groups: conventional (C) group (n = 64) and video laryngoscopy (VL) group (n = 66). The primary endpoint of the study was the incidence of oropharyngeal injury. The secondary endpoints were the number of attempts required for successful TEE probe insertion and the relation between the esophageal inlet and the larynx. The overall incidence of oropharyngeal injuries was 7.7%, with 4 injuries (6.3%) occurring in the C group and 6 injuries (9.1%) occurring in the VL group (p = 0.543). Most children (90.8%) required only 1 attempt to insert the TEE probe, with no significant difference between groups (p = 0.579). A higher percentage increase in mean blood pressure during probe insertion and a higher heart rate increase after probe insertion were observed in the VL group (p < 0.05). The most common relationship with the larynx was posterior (62%), followed by left posterolateral (20.9%) and right posterolateral (17.1%).</div></div><div><h3>Conclusions</h3><div>VL does not demonstrate superiority over conventional methods of TEE probe insertion in children regarding injury incidence or first-attempt success rate.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 613-619"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145804675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1053/j.jvca.2025.08.050
Emma Sewart BA, MBBS, PGCert , Alexander Isted BSc, MBBS, MRCP, FRCA , Kitty H.F. Wong MBChB, MRCS, PGCert , Donald Whitaker FRCS, C-Th (Ed) , Robert J. Hinchliffe MD, FRCS , Gudrun Kunst MD, PhD, EDAIC, FRCA, FFICM , Ronelle Mouton MBChB, FCARCSI, PhD
Objectives
To evaluate the prevalence of smoking in the UK elective cardiac surgery population and its impact on postoperative outcomes.
Design
A retrospective observational cohort study.
Setting
Multicenter study using UK registry data from adults undergoing cardiac surgery.
Participants
People who underwent elective coronary artery bypass grafting, valve surgery, or surgery to the thoracic aorta between 2012 and 2022.
Interventions
Documented smoking status at the time of surgery.
Measurements and main results
Of 170,532 included patients, 7.7% were current smokers, 48.4% former smokers and 43.9% non-smokers. The prevalence of smoking did not change between 2012 and 2022. Current smokers present for surgery at a younger age. Despite a higher burden of comorbidities, smokers were not at increased risk of in-hospital mortality compared to former smokers or non-smokers. However, compared with non-smoking, smoking was associated with a higher risk of deep sternal wound infection (odds ratio [OR] 1.53; p < 0.01) and need for surgical debridement (OR 1.89; p < 0.01). Smokers were also more likely than non-smokers to require renal replacement therapy after aortic arch surgery (OR 1.37; p = 0.049). There was no difference in the incidence of other complications between smokers and non-smokers. The mean length of hospital stay was shorter in smokers than non-smokers (9.1 v 9.2 days; hazard ratio 0.97; p < 0.01).
Conclusions
Smoking was less common in the UK elective cardiac surgery population than in other surgical cohorts within the study period. Smokers presented for surgery at a younger age, were more comorbid and had a higher risk of serious wound infections.
目的评价英国择期心脏手术人群的吸烟率及其对术后预后的影响。设计：回顾性观察队列研究。多中心研究使用英国心脏手术成人登记数据。在2012年至2022年间接受过选择性冠状动脉搭桥术、瓣膜手术或胸主动脉手术的参与者。干预措施手术时记录吸烟状况。在纳入的170,532例患者中，7.7%为当前吸烟者，48.4%为曾经吸烟者，43.9%为不吸烟者。从2012年到2022年，吸烟的流行率没有变化。目前吸烟者在较年轻时接受手术。尽管有较高的合并症负担，但与前吸烟者或非吸烟者相比，吸烟者的住院死亡率风险并未增加。然而，与不吸烟相比，吸烟与胸骨深部伤口感染的风险更高（优势比[OR] 1.53; p < 0.01）和需要手术清创（OR: 1.89; p < 0.01）相关。在主动脉弓手术后，吸烟者比不吸烟者更有可能需要肾脏替代治疗（OR 1.37; p = 0.049）。其他并发症的发生率在吸烟者和非吸烟者之间没有差异。吸烟者的平均住院时间短于非吸烟者（9.1天vs 9.2天；风险比0.97;p < 0.01）。结论吸烟在英国选择性心脏手术人群中比在研究期间的其他手术队列中更少见。吸烟者在更年轻的时候接受手术，有更多的合并症，有更高的严重伤口感染的风险。
{"title":"Prevalence of Smoking and Impact on Outcomes after Elective Cardiac Surgery in the United Kingdom","authors":"Emma Sewart BA, MBBS, PGCert , Alexander Isted BSc, MBBS, MRCP, FRCA , Kitty H.F. Wong MBChB, MRCS, PGCert , Donald Whitaker FRCS, C-Th (Ed) , Robert J. Hinchliffe MD, FRCS , Gudrun Kunst MD, PhD, EDAIC, FRCA, FFICM , Ronelle Mouton MBChB, FCARCSI, PhD","doi":"10.1053/j.jvca.2025.08.050","DOIUrl":"10.1053/j.jvca.2025.08.050","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the prevalence of smoking in the UK elective cardiac surgery population and its impact on postoperative outcomes.</div></div><div><h3>Design</h3><div>A retrospective observational cohort study.</div></div><div><h3>Setting</h3><div>Multicenter study using UK registry data from adults undergoing cardiac surgery.</div></div><div><h3>Participants</h3><div>People who underwent elective coronary artery bypass grafting, valve surgery, or surgery to the thoracic aorta between 2012 and 2022.</div></div><div><h3>Interventions</h3><div>Documented smoking status at the time of surgery.</div></div><div><h3>Measurements and main results</h3><div>Of 170,532 included patients, 7.7% were current smokers, 48.4% former smokers and 43.9% non-smokers. The prevalence of smoking did not change between 2012 and 2022. Current smokers present for surgery at a younger age. Despite a higher burden of comorbidities, smokers were not at increased risk of in-hospital mortality compared to former smokers or non-smokers. However, compared with non-smoking, smoking was associated with a higher risk of deep sternal wound infection (odds ratio [OR] 1.53; p < 0.01) and need for surgical debridement (OR 1.89; p < 0.01). Smokers were also more likely than non-smokers to require renal replacement therapy after aortic arch surgery (OR 1.37; p = 0.049). There was no difference in the incidence of other complications between smokers and non-smokers. The mean length of hospital stay was shorter in smokers than non-smokers (9.1 <em>v</em> 9.2 days; hazard ratio 0.97; p < 0.01).</div></div><div><h3>Conclusions</h3><div>Smoking was less common in the UK elective cardiac surgery population than in other surgical cohorts within the study period. Smokers presented for surgery at a younger age, were more comorbid and had a higher risk of serious wound infections.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 481-491"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1053/S1053-0770(26)00011-X
{"title":"Articles to Appear in Future Issues","authors":"","doi":"10.1053/S1053-0770(26)00011-X","DOIUrl":"10.1053/S1053-0770(26)00011-X","url":null,"abstract":"","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Page xiv"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To define low-performing colleagues in cardiothoracic and vascular anesthesia (LPC-CTVA), evaluate institutional preparedness to identify and manage such individuals, and identify predictors of recognition, reporting, and response behaviors.
Design
International cross-sectional survey.
Setting
Web-based data collection from June to September 2024.
Participants
Of 878 responses, 537 (61.2%) were complete and analyzed, representing 57 countries.
Interventions
None.
Measurements and Main Results
A 43-item questionnaire was developed by a multidisciplinary team and distributed via professional societies, social media, and email. It assessed definitions of LPC-CTVA, institutional protocols, and preparedness to address underperformance. Consensus was defined as ≥70% agreement. Thirteen of the 18 statements met consensus. Common indicators included non-compliance with infection control (80.0%), outdated knowledge (80.3%), repeated procedural failures (80.0%), and persistent negligence (79.1%). Institutional support was limited: among 464 respondents, 22.2% reported active supervision for underperformance, 15.3% reported the presence of identification mechanisms, and 11.7% indicated the existence of formal management processes. Although 39.9% of 434 had encountered a low-performing colleague, only 23.1% of 447 had reported one. Preparedness to manage impaired colleagues was reported by 46.2% of 418 respondents, and preparedness to manage underperforming colleagues by 44.1% of 416 respondents. Key barriers included the belief that others would act (33.7% of 265), perceived ineffectiveness (28.3%), and fear of retaliation (21.9%). Preparedness was more prevalent among older, more experienced clinicians, those in leadership roles, and those with prior experience in reporting.
Conclusions
A consensus-based definition of LPC-CTVA has been established. However, institutional readiness and clinician confidence remain limited. Experience and structured systems enhance response capability.
{"title":"Perceptions, Definitions, and Preparedness Regarding Low-Performing and Impaired Colleagues in Cardiothoracic and Vascular Anesthesia: An International Survey","authors":"Evangelia Samara MD, PhD , Mona Momeni MD, PhD , Agathi Karakosta MD, PhD , Anna Smyrli MD , Konstantina Kolonia MD , Petros Tzimas MD, PhD , Jiapeng Huang MD, PhD , Vojislava Neskovic MD, PhD, DEAA, FESAIC , Manuel Granell Gil MD, PhD , Gianluca Paternoster MD , Abdelazeem Eldawlatly MD , Mikhail Kirov MD, PhD , Evgeny Grigoryev MD, PhD , Hushan Ao MD, PhD , Davy Cheng MD, FRCPC, FCAHS , Fawzia Aboulfetouh MD , Eric Benedet Lineburger MD, MSc, PhD, FASE , Jakob Wittenstein MD , Mert Senturk MD, PhD , Zerrin Sungur MD, PhD , Mohamed R. El Tahan MD","doi":"10.1053/j.jvca.2025.08.055","DOIUrl":"10.1053/j.jvca.2025.08.055","url":null,"abstract":"<div><h3>Objective</h3><div>To define low-performing colleagues in cardiothoracic and vascular anesthesia (LPC-CTVA), evaluate institutional preparedness to identify and manage such individuals, and identify predictors of recognition, reporting, and response behaviors.</div></div><div><h3>Design</h3><div>International cross-sectional survey.</div></div><div><h3>Setting</h3><div>Web-based data collection from June to September 2024.</div></div><div><h3>Participants</h3><div>Of 878 responses, 537 (61.2%) were complete and analyzed, representing 57 countries.</div></div><div><h3>Interventions</h3><div>None.</div></div><div><h3>Measurements and Main Results</h3><div>A 43-item questionnaire was developed by a multidisciplinary team and distributed via professional societies, social media, and email. It assessed definitions of LPC-CTVA, institutional protocols, and preparedness to address underperformance. Consensus was defined as ≥70% agreement. Thirteen of the 18 statements met consensus. Common indicators included non-compliance with infection control (80.0%), outdated knowledge (80.3%), repeated procedural failures (80.0%), and persistent negligence (79.1%). Institutional support was limited: among 464 respondents, 22.2% reported active supervision for underperformance, 15.3% reported the presence of identification mechanisms, and 11.7% indicated the existence of formal management processes. Although 39.9% of 434 had encountered a low-performing colleague, only 23.1% of 447 had reported one. Preparedness to manage impaired colleagues was reported by 46.2% of 418 respondents, and preparedness to manage underperforming colleagues by 44.1% of 416 respondents. Key barriers included the belief that others would act (33.7% of 265), perceived ineffectiveness (28.3%), and fear of retaliation (21.9%). Preparedness was more prevalent among older, more experienced clinicians, those in leadership roles, and those with prior experience in reporting.</div></div><div><h3>Conclusions</h3><div>A consensus-based definition of LPC-CTVA has been established. However, institutional readiness and clinician confidence remain limited. Experience and structured systems enhance response capability.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"40 2","pages":"Pages 522-538"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号