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Journal and News Scan
January 30, 2016
Submitted by: Mark Ferguson
Readmission after lung resection is associated with increased costs and is used as a benchmark for quality. Outcomes of more than 22,000 lobectomies were evaluated for factors associated with readmission. 30- and 90-day readmission rates were 11.5% and 19.8%. Causes for readmission were pulmonary (24%), cardiovascular (16%), and surgical/procedural-related complications (15%). Preop characteristics associated with readmission were male gender and Medicaid payer status. Surgical approach and specific postoperative complications were not associated with readmission.
January 28, 2016
Submitted by: Ruben Osnabrugge
In this Cardiothoracic Surgical Trials Network (CTSN) trial 251 patients with ischemic mitral regurgitation were randomized to mitral-valve repair or mitral-valve replacement. The current publication reports the 2-year outcomes of the trial.
This trial shows that there was no significant difference in two-year survival between repair and replacement (19.0% vs 23.2%, HR 0.79, 0.46-1.35), although the trial was not powered to study survival. There was no difference in left ventricular end-systolic volume index between the two treatments. Recurring moderate or severe mitral regurgitation was seen more frequently in the repair group (58.8% versus 3.8%, p<0.001), as well as more cardiovascular admissons and heart-failure related adverse events.
January 23, 2016
Submitted by: Stuart Head
In a propensity-matched analysis of the national database of Sweden, Glaser et al found that survival among patients aged 50-69 who underwent aortic valve replacement was significantly better in those receiving a mechanical versus biological valves. In a subgroup analysis this was evident in patients aged 50-59 but not in those aged 60-69. These results are crucial in the current era in which surgeons lower the age cut-off for implanting bioprosthetic valves.
January 23, 2016
Submitted by: Stuart Head
In an analysis from the SYNTAX trial that randomized PCI vs CABG in patients with complex coronary disease, Milojevic et al found that patients had significantly higher rates of cardiac death after PCI, which was particularly caused by significantly higher rates of myocardial infarction-related death. This analysis is the first in-depth study on specific causes of death from a trial comparing PCI and CABG.
January 23, 2016
Submitted by: Lisa Brown
Retrospective study of surgery versus SBRT for clinical stage I NSCLC using the National Cancer Data Base (NCDB). Propensity score matching was used to create 5355 matched pairs. In that analysis, median survival for those undergoing surgery was 62.3 months versus 33.1 months in those undergoing SBRT. The 3-year survival was 68.5% in the surgery group and 46.0% in the SBRT group. An additional propensity score matching was used to create 4555 matched pairs of patients undergoing sublobar resection (wedge or segmentectomy) versus SBRT. In that analysis, median survival for those undergoing sublobar resection was 48.3 months versus 33.9 months in those undergoing SBRT. The 3-year survival was 61.7% in the surgery group and 47.0% in the SBRT group. The main finding of this study was that patients undergoing surgery for clinical stage I NSCLC have longer overall survival than those undergoing SBRT. The authors state that a limitation of the study is that despite propensity matching, there are unmeasured variables that contributed to treatment allocation.
January 18, 2016
Submitted by: CTSNet Staff
In January 2015, the Society of Thoracic Surgeons (STS) began to publicly report outcomes of pediatric and congenital cardiac surgery using the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) Mortality Risk Model. Because the STS CHSD Mortality Risk Model adjusts for procedural factors and patient-level factors, it is critical that centers are aware of the important impact of incomplete entry of data in the fields for patient-level factors. These factors are used to estimate expected mortality, and incomplete coding of these factors can lead to inaccurate assessment of case mix and estimation of expected mortality. In order to assure an accurate assessment of case mix and estimate of expected mortality, it is critical to assure accurate completion of the fields for patient factors, including preoperative factors.
January 14, 2016
Submitted by: Mark Ferguson
This systematic review assessed outcomes of surgery for thymomas treated with open vs minimally invasive approaches. The vast majority of tumors were Masaoka I and II. Minimally invasive approaches were associated with shorter LOS and less blood loss. Complication rates were similar between the groups, as were rates of R0 resection and recurrence.
January 13, 2016
Submitted by: Tom C. Nguyen
Comprehensive review article on the role of periperative statin therapy in patients undergoing coronary revascularization.
January 12, 2016
Submitted by: Ruben Osnabrugge
The authors of this paper aimed to study the frequency and predictors of internal mammary artery (IMA) failure in 1539 patients who underwent IMA revascularization of the left anterior descending (LAD) artery. IMA failure was defined as >75% stenosis at a follow-up of 12-18 months. They found that IMA failure occured in 8.6%. IMA failure was associated with LAD stenosis <75% (odds ratio 1.76), not having diabetes mellitus (OR 1.82) and an additional bypass graft to the diagonal branch (OR 1.92). IMA failure was associated with higher rates of acute clinical events after follow-up angiography. The investigators conclude that these findings suggest that the benefit of CABG in moderate LAD stenosis without functional ischemia could be matter of debate.
January 12, 2016
Submitted by: Mark Ferguson
30-day and 90-day mortality rates were compared using information from the National Cancer Data Base 2007-2011. Among nearly 16,000 esophagectomies, the 30-day mortality rate was 4.2% and the 90-day rate was 8.9%. 90-day mortality was uniquely associated with tumor location, tumor stage, and receipt of neoadjuvant therapy.