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Objective:To investigate the postoperative complications and in-hospital mortality of reoperative cardiac surgery, and to explore the feasibility and safety of reoperative cardiac surgery.Methods:The baseline data and clinical information of patients undergoing cardiac surgery in Nanjing First Hospital from November 2012 to November 2021 were retrospectively conducted, and they were divided into the reoperative cardiac surgery group and the primary surgery group according to whether they underwent reoperative cardiac surgery using a propensity score analysis. The intraoperative indicators, postoperative complications and in-hospital mortality were compared between the two groups after matching.Results:After propensity score analysis, 146 cases were included in each of the group. In terms of intraoperative indicators, the cardiopulmonary bypass time [(141.48±47.88)min vs.(105.31±33.56)min], aortic occlusion time [87.0(70.5, 113.3)min vs. 71.5(53.0, 92.0)min], ICU stay time[2( 1, 4)days vs. 2(1, 2)days], postoperative drainage volume [750(460, 1300)ml vs. 610(410, 840)ml], postoperative transfusion of red blood cells [0(0, 3.5)U vs. 0(0, 2)U], the reoperative cardiac surgery group increased with statistically significant differences( P<0.05). Postoperative complications, the two groups had postoperative hypoxemia [15(10.3%) vs. 6(4.1%)], acute kidney injury [10(6.8%) vs. 0(0)], postoperative infection [24(16.4%) vs. 4(2.7%)], cerebral complications [7(4.8%) vs. 1(0.7%)] )], the incidence rate in the reoperative cardiac surgery group was higher with statistically significant differences( P<0.05). There was no significant difference in in-hospital mortality[7(4.8%) vs. 4(2.8%)]( P>0.05). Conclusion:The time of reoperative cardiac surgeryis is longer, postoperative recovery is slower, and postoperative complication rate is higher, but does not increase in-hospital mortality.
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The purpose of this paper was to introduce how to combine the propensity score analysis to reasonably carry out multiple linear regression analysis. Firstly， it introduced 3 basic concepts related to the propensity score analysis. Secondly， it presented the core contents of the propensity score analysis， that was， three matching methods. Thirdly， through an epidemiological survey example， it gave the whole process of how to use SAS software for the analysis. The contents were as follows： ① for the original data set， test whether the difference of covariates between the treatment group and the control group was statistically significant； ② directly implement the multiple linear regression analysis for the original data set； ③ the propensity score analysis was used to generate the matched data set； ④ for the matched data set， test whether the difference of covariates between the treatment group and the control group was statistically significant； ⑤ a reasonable multiple linear regression analysis was used for the matched data set.
ABSTRACT
[Objective]To evaluate the effects of sutureless technique in comparison to conventional techniques for repair of total anomalous pulmonary venous connection(TAPVC)with the method of propensity score analysis.[Methods]From October 2007 to December 2013,179 consecutive patients were enrolled in this study. Patients were operated with sutureless technique(n = 81)or Conventional technique(n=98),and followed up at an interval of 1 month,3 months,6 months and then once a year post-operation. During analysis,three type of propensity-score matching methods,including nearest neighbor caliper matching,Mahalanobis metric matching with propensity score ,optimal full matching were used to create balanced groups of patients receiving each treatment. Surgeons’performance difference was assessed with random frailty proportional hazards models with gamma. Composite endpoints was defined by postoperative death or late death or postoperative pulmonary venous obstruction(PVO),which was evaluated with Kaplan-Meier curve and multivariable Cox proportional hazard model,adjusted by Preoperative-PVO,age,gender,weight and TAPVC type.[Results]Nearest neighbor caliper matching method was the best choice during propensity score analysis. After matching ,sutureless group included 73 patients and Conventional group73 patients. In sutureless group,cardiopulmonary bypass(CPB)time(Z=2.18, P=0.030),cross-clamp time(Z=3.63,P<0.001),rate of composite endpoints(HR 95%CI=0.20(0.06~0.61),P=0.005),late death(HR 95%CI=0.03(0.01~0.55),P=0.017)were significantly better than that in Conventional group. In subgroup analysis ,for patients with pre-PVO,decreased composite endpoints was seen in sutureless group.[Conclusion]Comparison using thepropensity score analysis demonstrated that sutureless strategy for primary repair of TAPVC may associate with decreased mortality rate of post-PVO and CPB time and cross-clamp time.