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1.
Article in English | MEDLINE | ID: mdl-38871047

ABSTRACT

OBJECTIVE(S): To evaluate whether increasing frailty, as measured by the Clinical Frailty Scale (CFS), was associated with an increased risk of hospital mortality for patients undergoing cardiac surgery. METHODS: A retrospective binational cohort study of 46,928 patients who underwent cardiac surgery in Australia and New Zealand was conducted. The primary exposure, frailty, was measured using the CFS. Associations between frailty and the primary outcome, hospital mortality, were evaluated using multivariable, mixed effects logistic regression models. Secondary outcomes including hospital and ICU length of stay, invasive ventilation hours, need for renal replacement therapy and tracheostomy, and non-home discharge were also evaluated. RESULTS: 6.7% (3122/46928) patients were classified as frail (CFS 5-8) and 93.3% (43,806/46,928) were non-frail (CFS 1-4). Raw mortality was 4.2% (132/3122) in the frail group and 1.05% (461/43,806) in the non-frail group. After multivariable adjustment for illness severity, age, elective status, type of surgery, hospital type and country, frailty was significantly associated with increased hospital mortality (OR=2.879, 95% CI 2.284-3.629, p<0.001). Increasing CFS was also significantly associated with a higher risk of secondary outcomes, including length of stay in hospital and the ICU, receipt of renal replacement therapy and tracheostomy and increased duration of mechanical ventilation. CONCLUSION: This study demonstrated that increasing Clinical Frailty Scale was strongly associated with increased hospital mortality, hospital and ICU length of stay, invasive ventilation hours, renal replacement therapy, and tracheostomy insertion, among patients undergoing cardiac surgery in Australia and New Zealand.

2.
J Cardiothorac Vasc Anesth ; 36(12): 4313-4319, 2022 12.
Article in English | MEDLINE | ID: mdl-36207199

ABSTRACT

OBJECTIVE: To determine the effect of intensive care unit (ICU) length of stay (LOS) on hospital mortality and non-home discharge for patients undergoing cardiac surgery over a 16-year period in Australia and New Zealand. DESIGN: A retrospective, multicenter cohort study covering the period January 1, 2004 to December 31, 2019. SETTING: One hundred one hospitals in Australia and New Zealand that submitted data to the Australia New Zealand Intensive Care Society Adult Patient Database. PARTICIPANTS: Adult patients (aged >18) who underwent coronary artery bypass grafting, valve surgery, or combined valve + coronary artery surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The authors analyzed 252,948 cardiac surgical patients from 101 hospitals, with a median age of 68.3 years (IQR 60-75.5), of whom 74.2% (187,632 of 252,948) were male patients. A U-shaped relationship was observed between ICU LOS and hospital mortality, with significantly elevated mortality at short (<20 hours) and long (>5 days) ICU LOS, which persisted after adjustment for illness severity and across clinically important subgroups (odds ratio for mortality with ICU LOS >5 days = 3.21, 95% CI 2.88-3.58, p < 0.001). CONCLUSIONS: Prolonged duration of ICU LOS after cardiac surgery is associated with increased hospital mortality in a U-shaped relationship. An ICU LOS >5 days should be considered a meaningful definition for prolonged ICU stay after cardiac surgery.


Subject(s)
Cardiac Surgical Procedures , Intensive Care Units , Length of Stay , Aged , Female , Humans , Male , Middle Aged , Cardiac Surgical Procedures/mortality , Hospital Mortality , Length of Stay/statistics & numerical data , New Zealand/epidemiology , Retrospective Studies , Treatment Outcome , Australia/epidemiology
3.
Heart Lung Circ ; 29(8): 1234-1240, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32179022

ABSTRACT

BACKGROUND: Ventricular assist devices (VADs) are frequently used as a bridge to heart transplant; however, infections are a common cause of increased morbidity and mortality. The optimal prophylactic antimicrobial regimen has not been effectively evaluated in literature. METHODS: Forty-three (43) patients received a VAD over the 5-year study period (2012-2017) at The Prince Charles Hospital (TPCH), Brisbane Australia. Of these, 41 patients were followed from implantation until transplantation or death. Antimicrobial prophylactic regimens and individual episodes of infection were recorded. The infection profiles, including types and incidence were compared to published literature using definitions from the International Society for Heart and Lung Transplantation (ISHLT) guidelines for consistency. RESULTS: Median duration of VAD insertion was 79 days (IQR: 36-167). Patients received aztreonam, fluconazole and vancomycin (median duration 8 days). Twenty-two (22) (53.6%) patients experienced a VAD-specific and/or a VAD-related infective episode. Incidence of infection in the study cohort was 0.60 infections per 100 patient days. Thirteen (13) patients (31.7%) experienced 16 VAD-specific infections which were all driveline infections. Thirteen (13) patients (31.7%) experienced 14 VAD-related infections. The predominant VAD-related infection type was bacteraemia (36%). Predominant bacterial profiles of VAD-specific as well as VAD related infections were gram positive. Only three episodes had a gram negative as a causative pathogen which occurred much later post VAD insertion. Median time till VAD-specific or VAD-related infection was 46 and 15 days respectively. Obesity was significantly associated with increased risk of infection (HR: 3.2; 95% CI: 1.3-7.4). CONCLUSIONS: Infection is a common complication of VAD implantation. In our study population gram positive bacteria were the predominant causative pathogen. Based on the micro-organism profile there may be scope for a narrowing of the antibiotic regimen. A larger, multicentre study would be able to accurately guide a change. The information gathered in our study offers a strong foundation for such a multicentre study.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Heart Failure/surgery , Heart-Assist Devices/adverse effects , Prosthesis-Related Infections/epidemiology , Adult , Female , Follow-Up Studies , Humans , Incidence , Male , Prognosis , Prosthesis-Related Infections/drug therapy , Prosthesis-Related Infections/etiology , Queensland/epidemiology , Retrospective Studies , Time Factors
4.
BMJ Open ; 9(7): e029293, 2019 07 10.
Article in English | MEDLINE | ID: mdl-31296512

ABSTRACT

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) provides cardiac and/or respiratory support when other therapies fail. Nosocomial infection is reported in up to 64% of patients receiving ECMO and increases morbidity and mortality. These patients are at high risk of infection due, in part, to the multiple invasive devices required in their management, the largest being the cannulae through which ECMO is delivered. Prevalence of nosocomial infection in ECMO patients, including ECMO cannula-related infection, is not well described across Australia and New Zealand. METHODS AND ANALYSIS: This is a prospective, observational point prevalence study of 12 months duration conducted at 11 ECMO centres across Australia and New Zealand. Data will be collected for every patient receiving ECMO during 12 predetermined data collection weeks. The primary outcome is the prevalence of laboratory-confirmed bloodstream infection, and suspected or probable nosocomial infections; and the secondary outcomes include describing ECMO cannula dressing and securement practices, and adherence to local dressing and securement guidelines. Data collection will be finalised by March 2019. ETHICS AND DISSEMINATION: Relevant ethical and governance approvals have been received. Study results will describe the prevalence of suspected and confirmed nosocomial infection in adult, paediatric and neonatal patients receiving ECMO across Australia and New Zealand. It is expected that the results will be hypothesis generating and lead to interventional trials aimed at reducing the high infection rates seen in this cohort. Results will be published in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ANZCTRN12618001109291; Pre-results.


Subject(s)
Cross Infection/epidemiology , Extracorporeal Membrane Oxygenation/adverse effects , Adolescent , Adult , Aged , Australia/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , New Zealand/epidemiology , Prevalence , Prospective Studies , Risk Factors , Young Adult
5.
Cureus ; 10(7): e2957, 2018 Jul 10.
Article in English | MEDLINE | ID: mdl-30214845

ABSTRACT

We discuss a strange case of dissociative identity disorder, also known as multiple personality disorder. This article describes the case of a 55-year-old Caucasian woman with a history of substance use disorder with seven personalities. The patient describes a couple of triggers for her condition. More research is needed to understand these triggers.

6.
J Thorac Dis ; 10(Suppl 17): S1979-S1981, 2018 Jun.
Article in English | MEDLINE | ID: mdl-30023096
7.
Lung India ; 25(2): 82-4, 2008 Apr.
Article in English | MEDLINE | ID: mdl-20165656

ABSTRACT

The growth of some of the adenocarcinomas is virtually identical to that of malignant mesothelioma, also known as pseudomesotheliomatous adenocarcinoma of lung. Their differentiation on the basis of histopathology can pose diagnostic difficulties; hence immunohistochemistry and electron microscopy may be required for further differentiation.

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