Validation of Open-Heart Intraoperative Risk score to predict a prolonged intensive care unit stay for adult patients undergoing cardiac surgery with cardiopulmonary bypass.

BACKGROUND: A prolonged stay in an intensive care unit (ICU) after cardiac surgery with cardiopulmonary bypass (CPB) increases the cost of care as well as morbidity and mortality. Several predictive models aim at identifying patients at risk of prolonged ICU stay after cardiac surgery with CPB, but almost all of them involve a preoperative assessment for proper resource management, while one - the Open-Heart Intraoperative Risk (OHIR) score - focuses on intra-operative manipulatable risk factors for improving anesthetic care and patient outcome. OBJECTIVE: We aimed to revalidate the OHIR score in a different context. MATERIALS AND METHODS: The ability of the OHIR score to predict a prolonged ICU stay was assessed in 123 adults undergoing cardiac surgery (both coronary bypass graft and valvular surgery) with CPB at two tertiary university hospitals between January 2013 and December 2014. The criteria for a prolonged ICU stay matched a previous study (ie, a stay longer than the median). RESULTS: The area under the receiver operating characteristic curve of the OHIR score to predict a prolonged ICU stay was 0.95 (95% confidence interval 0.90-1.00). The respective sensitivity, specificity, positive predictive value, and accuracy of an OHIR score of ≥3 to discriminate a prolonged ICU stay was 93.10%, 98.46%, 98.18%, and 95.9%. CONCLUSION: The OHIR score is highly predictive of a prolonged ICU stay among intraopera-tive patients undergoing cardiac surgery with CPB. The OHIR comprises of six risk factors, five of which are manipulatable intraoperatively. The OHIR can be used to identify patients at risk as well as to improve the outcome of those patients.

Surgical outcomes for congenital lung malformations: 10 years experience at a single center.

OBJECTIVE: To study the surgical outcome of congenital lung malformation and natural history of the disease at Srinagarind Hospital. MATERIAL AND METHOD: Retrospectively review the medical records of 25 patients diagnosed with congenital lung malformation who underwent surgical treatment between January 2001 and December 2011. RESULTS: Twenty-five patients diagnosed with congenital lung malformation underwent surgery: 16 males (64%), 9 females (36%), median age seven months, median body weight 6 kg. Twelve (48%) had congenital cystic adenomatoid malformation congenital cystic adenomatoidmaflormation (CCAM), seven (28%) pulmonary sequestration, four (16%) congenital lobar emphysema, and one a bronchogenic cyst (4%). The most common presenting symptoms were respiratory tract infection (14, 56%), respiratory distress (7, 28%), lung abscess (1, 4%), hemoptysis (1, 40%), and asymptomatic (2, 8%). Post-operative mortality over 30 days was 0. Complications included lung infection, atelectasis, post-operative bleeding, and wound infection. Post-operative follow-up (lasting between 1-8 years) revealed normal tolerance to daily activity without any respiratory problems. CONCLUSION: Surgical treatment for congenital lung malformations had a good result with few complications.

The posterior pericardiotomy. Does it reduce the incidence of postoperative atrial fibrillation after coronary artery bypass grafting?

Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass graft surgery (CABG). Posterior pericardiotomy (PP) has been reported toreduce pericardial effusion, AF triggel; and reduce the length of hospital stay and hospital costs without significant complications. A total of 20 patients, diagnosed with coronary artery diseases to be treated by an elective or urgent CABG between August and December 2013, were randomly divided into two groups; 10 patients received PP (PP group) and 10 patients did not receive PP (control group). The incidence ofAF was equal (40% in both groups). Early pericardial effusion was slightly higher in the PP group (PP 70%, control 60%; p = 1.00). The incidence of left pleural effusion and pneumonia were higher in the PP group than in the control. Moreover, one patient in the PP group developed perioperative myocardial infarction (MI) that required intensive care with medication. The duration of ICU stay of the PP group was significantly longer than that of the control group. In conclusion, PP did not reduce the incidence of postoperative AF nor did early pericardial effusion. Rather, PP increased post-operative complications such asperioperative MI, left pleural effusion, and pneumonia resulting in the prolonged ICU stay.