Current concepts in reoperative cardiac surgery.

This article summarizes techniques used in reoperative cardiac surgery, outlines a risk-stratified approach to operative planning, and reviews the literature on outcomes after reoperative valvular and coronary surgery.

Choice of hemostatic agent and hospital length of stay in cardiovascular surgery.

Hemostatic agents (HAs) are efficacious in reducing blood loss during surgery, which may affect postoperative length of stay (LOS). The purpose of this study was to compare the expected and actual LOS by HA in cardiac procedures. Hospital claims data between 2003 and 2006 were extracted from a US service-level comparative database. Four cohorts for comparison were FLOSEAL, SURGICEL + thrombin, GELFOAM + thrombin, and other. Expected LOS was derived using 2006 Centers for Medicare and Medicaid LOS by diagnosis-related group, and 2-part regression models were created to assess outcome. A total of 36 950 discharges were included. FLOSEAL was associated with less likelihood of exceeding expected LOS compared with baseline (odds ratio = 0.791; P < .01). Among patients who did exceed expected LOS, FLOSEAL patients did so at a reduced rate (incidence rate ratio = 0.891; P < .01). Further assessment is warranted to distinguish products with favorable outcomes.

An observational, retrospective analysis of retreatment with bortezomib for multiple myeloma.

PURPOSE: The aim of this retrospective chart review of patients with multiple myeloma (MM) was to describe patterns of retreatment with bortezomib-based therapy and responses to retreatment in a community-based setting. PATIENTS AND METHODS: Data were retrospectively extracted from the medical records of patients treated in US Oncology-affiliated community oncology clinics who received 2 separate treatments with bortezomib-based therapy. Eligible patients had > or = 60 days between treatments and > or = 4 bortezomib doses during initial treatment. Responses were determined primarily by laboratory values. Response categories included (1) very good partial response (VGPR), > or = 90% M-protein decrease; (2) partial response (PR), 50%-89% decrease; and (3) less than PR (< PR), < 50% decrease, excluding progressive disease (PD). RESULTS: Retreatment response data were available for 82 patients; 5 (6%) had VGPR, 12 (15%) had PR, 52 (63%) had < PR, 5 (6%) had PD, and 8 (10%) died. Among 62 patients with response assessments for initial treatment and retreatment, VGPR/PR rates to retreatment were 44%, 23%, and 13% among patients with VGPR, PR, and < PR to initial treatment, respectively. Median time between bortezomib treatments was 9.7 months; 29% of patients received non-bortezomib therapy between treatments. The most common treatment pattern (58% of patients) was single-agent bortezomib at initial treatment and retreatment. Toxicity contributed to discontinuation in 38% of patients during initial treatment and 22% during retreatment; rates of neuropathy contributing to discontinuation were 18% and 6%, respectively. CONCLUSION: Retreatment with bortezomib-based therapy is feasible, with predictable toxicities. This observational analysis supports bortezomib alone or in combination as a retreatment option after initial bortezomib treatment in patients with relapsed MM.

Hyperglycemia in the hospital setting: the case for improved control among non-diabetics.

OBJECTIVE: To review studies on the role of hyperglycemia in acutely ill adults, regardless of diabetes diagnosis, and the impact of glucose control on health outcomes. DATA SOURCES: Searches on Ovid MEDLINE, Ovid Evidence-Based Medicine (EBM), and PubMed MEDLINE, limited to articles written in English, trials conducted on adult subjects, and material published between 1994 and April 2004. Search words included the major MeSH term hyperglycemia and title words glucose, hyperglycemia/hyperglycemic, or insulin therapy, with text words admission, hospitalized, in-hospital, or inpatient. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. DATA SYNTHESIS: Hyperglycemia, even in patients without diabetes, has been shown to be detrimental among inpatients in medical and surgical units, as well as in critical care. A review of 25 outcomes studies indicated that the majority of research on this topic used retrospective or prospective cohort designs; only 2 were conducted as randomized controlled studies. In general, the findings demonstrated negative impact on outcomes among various patient populations with hyperglycemia including increased lengths of stay, health complications, utilization of resources, and risk of mortality. CONCLUSIONS: Studies report that hyperglycemia is a common but detrimental condition and that better control in the hospital setting decreases short- and long-term risk of mortality, illness complications, hospital lengths of stay, and healthcare costs. Increased efforts to treat hyperglycemia and screen for diabetes are needed in the hospital setting. Future studies on cost-effective approaches to glucose control are recommended.