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STS 2015

STS 2015

New research was presented at STS 2015, the annual meeting of the Society of Thoracic Surgeons, from January 24 to 28 in San Diego. The features below highlight some of the studies that emerged from the conference. Home Discharge for Some Pulmonary Resections The Particulars: Some patients who develop air leaks after pulmonary resection cannot be discharged home after their procedure because they are at risk of developing emphysema or an enlarged pneumo-thorax. A digital outpatient device may allow for safe discharge to home for some of these patients. Data Breakdown: For a study, patients who underwent pulmonary resection were discharged home on a digital air leak system with self-contained suction (DSS). The most common indications for the DSS were air leak monitoring (70%) and subcutaneous emphysema (24%), and the average air leak size was 400 cc/breath. Only 9% of patients developed complications at home that required readmission. Take Home Pearl: A DSS device appears to be safe and effective for home therapy of persistent or large air leaks following pulmonary resection. Predicting Post-Lobectomy Length of Stay The Particulars: Determining the factors that contribute to longer length of stay (LOS) after lobectomy may provide strategies for reducing LOS in the future. Data Breakdown: In a study of more than 6,700 lobectomy cases, researchers found that frailty, emergency surgery, operative time, and receipt of thoracotomy were preoperative predictors of LOS outliner status. This status for LOS was defined as occurring in more than the 75th percentile of cases, which was clarified as 9 days. Take Home Pearl: Several preoperative factors appear to predict longer LOS for patients undergoing lobectomy and...
Postoperative AFib After Cardiac Surgery

Postoperative AFib After Cardiac Surgery

According to published research, new onset post-operative atrial fibrillation (POAF) is one of the most common complications following cardiac surgery, with incidence rates ranging between 10% and 30% in this patient population. The risk of atrial fibrillation increases with age, and the elderly population is a group that is increasingly undergoing cardiac operations. “Studies have shown that POAF is an important determinant of postoperative length of stay, resource utilization, and readmission rates, but the magnitude of this impact has not been well characterized,” says Gorav Ailawadi, MD. He says a better understanding is needed regarding the impact of POAF on patient outcomes, hospital resources, and healthcare costs. Finding ways to reduce POAF incidence may improve outcomes and decrease associated costs. A Closer Look The Virginia Cardiac Surgery Quality Initiative (VCSQI) is a voluntary consortium of 17 cardiac surgery centers in Virginia that exchanges and compares data in an effort to improve patient outcomes, quality, and costs. The VCSQI—which links to the national Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database—aims to identify quality improvement opportunities and find ways to enhance surgical processes of care. Dr. Ailawadi and colleagues had a study published in Annals of Thoracic Surgery that used these data to examine the impact of POAF on mortality, hospital resources, and costs among multiple centers. For the study, investigators examined more than 49,000 patient records from the STS-certified database for cardiac operations from 2001 to 2012 and stratified patients by the presence of POAF versus non-POAF. New onset POAF occurred in one-out-of-five cardiac surgery patients and was associated with an increased risk of additional complications. “After risk...
Touch

Touch

Surgery is a contact sport. It seems obvious that surgeons touch their patients. We enter their bodies in a way that is both impersonal and incredibly intimate. But beyond the act of operating on someone, touch is a therapeutic tool. I never leave a patient’s room or the exam room without touching my patient in a nonclinical way. It may be a handshake, a light touch on the arm, a reassuring squeeze to the top of a foot as I pass the end of their bed. It has become so internalized that I hardly notice. But the patient does. They tell me that it helps them recognize that they are still a person and not totally consumed by their disease. The longer the patient is ill, the more important the touch becomes. I always knew I wanted to be a surgeon. From the time I started grade school, it’s all I ever wanted to be. It was one thing to want to be something but another to really understand what it meant to reach inside another body. The first time, as a third year medical student, that a cardiac surgeon invited me to lay my hand on the beating heart, I fell in love. The feel of the life pumping through the chambers was intoxicating. “Touch is a therapeutic tool. It may be a handshake, a light touch on the arm, a reassuring squeeze to the top of a foot as I pass the end of their bed.”   Over time, with training, I learned to distinguish the feel of diseased from healthy tissue; the hard scabrous feel of...
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