The Effect of Birth Month on the Risk of Deep Sternal Wound Infections in Patients After Coronary Artery Bypass Grafting and Heart Defect Surgery.

BACKGROUND: Cardiovascular diseases remain one of the leading causes of morbidity and mortality worldwide, however its surgical treatment remains risky with possible complications. There is increasing evidence that the month of birth (MOB) has been related to different health problems during life. The aim of this study was to identify the effect of MOB on the risk of deep sternal wound infections (DSWI) in patients after open-heart surgery. METHODS: The follow-up retrospective research was performed at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. We analyzed the MOB of 201 patients, who underwent open-heart surgery between January 2017 and December 2018. The case group consisted of 46 patients, who suffered from DSWI. Multivariate logistic regression for the association between MOB and risk of DSWI was used. RESULTS: The results showed that the risk of DSWI was by four times higher for patients born in June-September months. The risk of developing DSWI in the case group was even higher for women, patients aged 70 years and younger, those overweight or obese, and patients who underwent only CABG surgery. CONCLUSION: Due to the growing evidence that the month of birth affects the onset of diseases, it is important to assess MOB as the potential risk factor for developing DSWI.

Risk Factors Associated with an Increased Risk of Deep Sternal Wound Infections in Patients After Coronary Artery Bypass Grafting and Heart Defect Surgery.

BACKGROUND: Despite improvements over time with regard to morbidity, mortality, and long-term survival, deep sternal wound infection (DSWI) continues to be a major complication after open-heart surgery. This is why it is important to identify possible risk factors for postoperative development of DSWI in patients undergoing coronary artery bypass grafting and valve replacement. The aim of this study was to identify the risk factors for postoperative development of deep sternal wound infection in patients after coronary artery bypass grafting and heart defect surgery at the Department of Thoracic, Cardiac, and Vascular Surgery of the Hospital of Lithuanian University of Health Sciences. METHODS: This retrospective study analyzed 201 patients, who underwent coronary artery bypass grafting and heart defect surgery between January 2017 and December 2018. The case group contained 45 patients, who had to be reoperated because of deep sternal wound infection, and the control group consisted of 156 randomly selected patients. For descriptive statistics, we used means, median values, ranges, standard deviations, and 95% confidence intervals, where appropriate. Categorical data were analyzed using the chi-square or Fisher's exact test. Student T-test and Mann-Whitney used to compare numerical variables. Logistic regression model adjusting for age and gender was used to compare the risk of infection. A P-value of < 0.05 was considered to be statistically significant. SPSS 26.0 was used for calculations. RESULTS: Logistic regression analysis revealed that independent risk factors for sternal wound infection were high BMI (odds ratio [OR] 1.15, CI 1.06-1.24), preoperative CRP (OR 1.08, CI 1.01-1.16), long duration of cardiopulmonary bypass (OR 1.02, CI 1.01-1.03), intraoperative anemia (OR 0.97, CI 0.95-0.99), and postoperative CRP concentration (OR 1.10; CI 1.05-1.16). CONCLUSIONS: Preoperative assessment to identify obese individuals as being at risk and techniques to minimize the duration of surgery and intraoperative blood loss may help reduce postoperative deep sternal wound infections.

Effects of Combined and General Anesthesia on Cognitive Functions for Patients Undergoing Cardiac Surgery Under CPB.

BACKGROUND: Patients may experience a variety of neurological complications after heart surgery. The most common complication observed in clinical practice is delayed neurocognitive recovery (dNCR). The role of the anesthesiologist is very important, as the risk of dNCR may be reduced, depending on the anesthesia tactic chosen. Although the possibility that neuropsychological complications are less common in patients undergoing combined anesthesia (general + epidural) than in patients undergoing general anesthesia is not yet confirmed, the results are being discussed. The aim of this study was to determine impact of combined anesthesia (general + epidural) on cognitive functions of patients after cardiac surgery. METHODS: The prospective, case-controlled study included 80 patients undergoing cardiac surgery from 2015 to 2017 at the Department of Cardiothoracic and Vascular Surgery in the Hospital of Lithuanian University of Health Sciences Kauno Klinikos. After approval from the local bioethics center, informed consent was obtained from all study participants. Inclusion criteria were age 51 to 80 years, elective cardiac surgery, left ventricular ejection fraction > 35%, anamnesis of not using agents affecting the central nervous system, absence of neuropathology, and sufficient renal function. Exclusion criteria were patients suffering from diseases causing cognitive function or using agents affecting the central nervous system, emergency or re-surgery, carotid artery atherosclerosis with artery diameter 50 or more percent reduction, and a patient's disagreement. MMSE test and 6-CIT test were used for a cognitive function assessment, Trail making test and WAIS Digital Symbol Substitution test were used for psychomotor function assessment. All tests were used a day before surgery and seven days after surgery. According to the planned anesthesia, patients were assigned into two groups: 1 - combined general + epidural anesthesia and 2 - general anesthesia. Standardized protocol of anesthesia was followed for all patients. Preoperative patients and surgery factors, preoperative and postoperative neuropsychological test results were recorded. RESULTS: Eighty patients were enrolled in the study. Both groups did not differ in demographic, perioperative values, and baseline (preoperative) test results. Postoperative (7th day) WAIS (P = .042) and 6-item cognitive impairment (P = .016) test results were statistically different when comparing the GA and CA groups. Comparing preoperative and postoperative test results, there was a significant decline in the WAIS test score in the GA group (P = .013).

Cognitive Impairment Prevalence and Impact on Quality of Life for Patients after Cardiac Surgery.

Cognitive impairment is a common complication after cardiac surgery. It complicates not only the patient's recovery and return to normal life, but also has a negative impact on quality of life. OBJECTIVE: The aim of this study was to investigate the prevalence of cognitive impairment and its impact of quality of life for patients after cardiac surgery. RESULTS: Before cardiac surgery, mild cognitive impairment was determined to be 20.8 percent and moderate cognitive impairment was 3.3 percent. After surgery, mild cognitive impairment almost doubled to 46.1 percent and moderate cognitive impairment increased to 4.9 percent. Older age, lower education, smoking, and prolonged hospitalization before surgery impacts cognitive impairment. Postoperative cognitive impairment is influenced by older age, prolonged hospitalization before surgery, prolonged operation, mechanical ventilation, and duration of cardiopulmonary bypass. For patients without cognitive impairment before cardiac surgery, general health assessment improved the most without reduced vitality/viability. For patients whose cognitive impairment significantly improved physical activity, pain sensation, and general health assessment improved slightly. CONCLUSIONS: Preoperative cognitive impairment was determined in 1/4 of our patients. Mild cognitive impairment after surgery was slightly increased. Older age, lower education, and prolonged hospitalization before surgery have an impact on cognitive impairment before and after surgery.

[The burnout syndrome among nurses working in Lithuanian cardiac surgery centers]. / 'Perdegimo" sindromas tarp Lietuvos kardiochirurgijos centruose dirbanciu slaugytoju

UNLABELLED: The burnout syndrome may be defined as a complex phenomenon which is characterized by three components: emotional burnout (physical and psychical exhaustion, incapability to carry on requirements), depersonalization (cynical attitude towards performed work, duties, cold or negative reaction to the patients), and lowered efficiency (reflected by the sense of incompetence, the lack of efficiency and achievements). This process is progressing slowly for a long time and is characterized individually by various psychical and physical symptoms of different intensity. The aim of this study was to examine the manifestation of burnout syndrome and to estimate the influence of the syndrome on the behavior and practice of the nurses in cardiac surgery units of Lithuania (to evaluate physiological and psychological symptoms of the burnout). METHODS: The study was performed using a questionnaire. A total of 180 questionnaires completed by nurses in Lithuanian cardiac surgical centers (Vilnius, Kaunas, and Klaipeda) were analyzed. RESULTS: The study revealed that 72.8% of nurses had an excess of workload (exceeding full-time job). Most of the respondents (84.4%) pointed out the emotional stress, unevaluated work and underpayment. Three-fourths of the nurses (75%) indicated that they felt physical fatigue after their work. More than half of nurses (67.2%) felt general fatigue, 63.3% reported the leg pains after the work, and 32.2% feel splitting headaches. Psychological fatigue was stressed by 86.1% of specialists. The main causes of psychological stress are as follows: the communication with the doctors in 57% of the cases, communication with the patient's relatives in 52% of cases, communication with the nursing administration in 49% of cases, and communication with the patients in 40% of cases. CONCLUSIONS: The majority of the nurses working in the centers of cardiac surgery experience physical and psychological fatigue, emotional stress. All this determinates the dissatisfaction in the work, conflicts rising between the nurse and job environment. Above-mentioned symptoms show the progression of the burnout syndrome.

[Magnesium sulfate usage for patients during cardiopulmonary bypass]. / Magnio sulfato naudojimas anestezijai operuojant isemine sirdies liga sergancius ligonius.

OBJECTIVE: Our study was performed in order to assess the effects of magnesium sulfate during coronary artery bypass surgery to evaluate whether perioperative intravenous infusion of magnesium, as an adjuvant agent for perioperative analgesia, affects a quality of anesthesia, reduces amounts of anesthetic and muscle relaxing drugs needed, affects adrenaline usage and nitroglycerine during anesthesia. METHODS: We investigated two patient groups, undergoing a coronary artery bypass surgery. Thirty patients (control group) have not received intravenous infusion of magnesium, 31 patients (magnesium group) have received 40 mg/kg of intravenous magnesium sulfate initially and a continuous 500 mg/h infusion during anesthesia. RESULTS: Patients in the magnesium group have received 1.01+/-0.07 mg of phentanyl, 9.33+/-0.72 mg of pipecuronium, 468+/-69 mg of tiopenthal, and 10.87+/-1.23 mg of midasolam; patients in the control group have received 1.02+/-0.07 mg of phentanyl, 10.4+/-1.2 mg of pipecuronium, 332+/-58 mg of tiopenthal and 10.4+/-1.2 mg of midasolam. Frequency of adrenaline usage in magnesium group was 6.67%, of nitroglycerine - 13.33% and nitropruside sodium - 6.67%, in control group patients have not received nitropruside sodium, frequency of adrenaline usage was 26.67% and nitroglycerine - 33.33%. CONCLUSIONS: Perioperative intravenous infusion of magnesium, as an adjuvant agent for anesthetics, does not reduce amounts of anesthetic and relaxant drugs needed, but it stabilized blood pressure fluctuations outside the critical range, without causing the pressure fall to a level that might risk undesirable side effects during surgery.