Ninety-day all-cause emergency room use among coronary artery bypass grafting patients associated with near-infrared fluorescence imaging: a retrospective cohort study.

Reducing emergency room (ER) use may indicate the improved quality of patient care at index hospitalization. The aim of this study is to determine whether the use of near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) during coronary artery bypass grafting (CABG) surgery is associated with a lowered 90-day all-cause ER use. Materials and Methods: This retrospective cohort study included adult patients with inpatient hospitalizations between January 2016 and June 2020 for an isolated CABG procedure at a US hospital. Propensity score matching was used to create matched cohorts to address the differences in patient, payer type, hospital, and clinical characteristics. A multivariable regression analysis was conducted to determine the association of NIRF imaging with ICG on ER use within 90 days of discharge after controlling for patient, payer type, hospital, and clinical covariates. Results: In total, 230 506 adult patients underwent an isolated CABG procedure. Less than 1% (n=1965) were assessed with NIRF imaging using ICG. There were differences in patient demographic and hospital characteristics between the treatment group (i.e. NIRF with ICG) and the comparison group (i.e. no NIRF with ICG). After controlling for covariates, a statistically significant lower 90-day all-cause ER use was documented among the treatment group (adjusted odds ratio=0.84, 95% confidence interval=0.73-0.96, P<0.009). Reasons associated with ER use were similar between the two groups. Conclusion: Routine intraoperative graft patency assessment with NIRF imaging using ICG may help to improve a patient's care experience and reduce subsequent resource utilization. Intraoperative graft patency assessment with NIRF imaging using ICG is associated with a 90-day all-cause ER use reduction among CABG patients. Further studies are needed to compare the ER usage among centers that used this technique versus those that did not to determine if associated reductions in ER use are a center or technique-specific phenomenon.

Calcium phosphate cements improve bone density when used in osteoporotic sternums.

PURPOSE: Calcium phosphate cements control bleeding and are safe to use in osteoporotic sternums during open heart surgery. We looked at the clinical and radiographic effects of this agent on bone healing. DESCRIPTION: Since March 2006, 18 patients had calcium phosphate cement inserted in their sternal tables at heart surgery. They were followed-up by office visits and chest computed tomographic (CT) scans. All preoperative and postoperative CT chest scans were evaluated for cement absorption, bone replacement, and bone density. EVALUATION: Five preoperative and 41 postoperative CT chest scans were available for evaluation. Median interval from surgery to CT scan was 531 days (range, 3 to 966 days). At follow-up there were neither clinical dehiscences nor nonunions of the sternums. Calcium phosphate cement appears to reabsorb quickly, but not completely. Five patients with pre-surgical CT chest scans demonstrated an average, improved bone density of 281.66 Hounsfield units at follow-up (p = 0.006). CONCLUSIONS: In each patient, cement was replaced by new bone, and there is evidence that more bone is present as a result of cement use.

Calcium phosphate cements to control bleeding in osteoporotic sternums.

PURPOSE: A new method to control bleeding from fragile, severely osteoporotic sternums in patients undergoing open heart surgery. DESCRIPTION: From January 2006 and January 2007, we used orthopedic calcium phosphate cement in 11 patients to control sternal table bleeding. Each patient had greater than 35% of their sternal table surface missing and had associated bleeding after open heart surgery. The cement was packed into the deficient sternal table surface at the conclusion of surgery, just prior to closure. EVALUATION: All patients had immediate cessation of bleeding from their sternums, despite large superficial sternal deficits, after the cement was applied. All patients made uneventful recoveries and none required exploration for bleeding after surgery. There were no instances of superficial or deep sternal wound infections. At follow-up all sternums were well healed and firm. Seven patients had computed tomographic scans performed at 6 months revealing excellent complete sternal healing. CONCLUSIONS: Calcium phosphate cement can be used safely to control bleeding in patients with osteoporotic sternums and seems to be safe to use in the sternum.