ABSTRACT
Background@#We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. @*Methods@#Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity- matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). @*Results@#Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. @*Conclusion@#A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.
ABSTRACT
Background@#It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization. @*Methods@#Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospectively to investigate technical details, clinical outcomes, and graft patency. @*Results@#Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30- day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011). @*Conclusion@#LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA- based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.
ABSTRACT
Purpose@#To investigate the impact of preoperative underlying hypertension (HTN) and body mass index (BMI) on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNUx). @*Materials and Methods@#From May 2003 to December 2018, 453 UTUC patients who underwent RNUx at a single institution were enrolled in the study. All patients were divided into 2 groups according to preoperative HTN and BMI (cutoff 24 kg/m2) and perioperative parameters and recurrence outcomes were compared. Multivariate Cox proportional hazard analysis was performed to identify the significance of HTN and BMI regarding UTUC recurrence. @*Results@#Among a total 453 UTUC patients, 233 (51.4%) had HTN, and 222 (49.0%) had BMI ≥24 kg/m2. The HTN versus no-HTN group had similar perioperative outcomes, except for the rate of diabetes (p<0.001). The high-BMI versus low-BMI group had similar outcomes, except for the prevalence of HTN (p=0.026). During median follow-up of 23 months, 5-year recurrence-free survival rates were 76.2% in the HTN group and 79.9% in the non-HTN group (p=0.002), and 77.3% in the low-BMI group and 79.0% in the high-BMI group (p=0.007). Multivariate analysis showed that BMI (hazard ratio [HR], 0.740; p=0.046), and HTN (HR, 1.687; p=0.005) were significant predictors of cancer recurrence. @*Conclusions@#Among UTUC patients who underwent RNUx, patients with HTN and low-BMI showed worse prognosis regarding cancer recurrence. To validate our results, the mechanisms of association between HTN, BMI, and UTUC should be investigated in further prospective studies.
ABSTRACT
Purpose@#To investigate the impact of preoperative underlying hypertension (HTN) and body mass index (BMI) on oncologic outcomes in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNUx). @*Materials and Methods@#From May 2003 to December 2018, 453 UTUC patients who underwent RNUx at a single institution were enrolled in the study. All patients were divided into 2 groups according to preoperative HTN and BMI (cutoff 24 kg/m2) and perioperative parameters and recurrence outcomes were compared. Multivariate Cox proportional hazard analysis was performed to identify the significance of HTN and BMI regarding UTUC recurrence. @*Results@#Among a total 453 UTUC patients, 233 (51.4%) had HTN, and 222 (49.0%) had BMI ≥24 kg/m2. The HTN versus no-HTN group had similar perioperative outcomes, except for the rate of diabetes (p<0.001). The high-BMI versus low-BMI group had similar outcomes, except for the prevalence of HTN (p=0.026). During median follow-up of 23 months, 5-year recurrence-free survival rates were 76.2% in the HTN group and 79.9% in the non-HTN group (p=0.002), and 77.3% in the low-BMI group and 79.0% in the high-BMI group (p=0.007). Multivariate analysis showed that BMI (hazard ratio [HR], 0.740; p=0.046), and HTN (HR, 1.687; p=0.005) were significant predictors of cancer recurrence. @*Conclusions@#Among UTUC patients who underwent RNUx, patients with HTN and low-BMI showed worse prognosis regarding cancer recurrence. To validate our results, the mechanisms of association between HTN, BMI, and UTUC should be investigated in further prospective studies.