Stuck between a rock and a hard place: The clinical conundrum of managing cardiac surgical patients during the SARS‐CoV‐2 pandemic

Stuck Between a Rock and a Hard Place: The Clinical Conundrum of Managing Cardiac Surgical Patients During the SARS-CoV-2 Pandemic

10.22541/au.163456335.58011308/v1 ◽

2021 ◽

Author(s):

Nitish Dhingra ◽

Subodh Verma ◽

Terrence Yau ◽

Bobby Yanagawa ◽

Makoto Hibino

Keyword(s):

Cardiac Surgery ◽

Patient Outcomes ◽

Policy Development ◽

Surgical Patients ◽

Clear Understanding ◽

Italian Population ◽

Surgery Outcomes ◽

Cardiac Surgeons ◽

Cardiac Surgery Outcomes ◽

Hard Place

Deferring non-emergent cardiac surgery became the strategy of choice for several international healthcare systems afflicted by high case burdens of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) in order to both conserve valuable healthcare resources and protect patients from possible exposure. Missing from the available dataset to help guide policy development has been a clear understanding of the extent to which COVID-19 infection modulates cardiac surgery outcomes. In their investigation, Bonalumi and colleagues uncovered an inpatient COVID-19 positivity rate of almost 10 times higher than that of the general Italian population, as well as a mortality rate over 20 times higher amongst cardiac surgery patients with perioperative COVID-19 infection compared to those COVID-negative. While the summation of available evidence points to the serious consideration cardiac surgeons must give to delaying surgeries during the COVID-19 pandemic, recognition must be given to the risks that postponing cardiac surgery may have on patient outcomes. Emerging data is beginning to demonstrate the efficacy of vaccination in preventing postoperative COVID-19 infection and morbidity.

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Long-Term Follow-Up of Surgical Patients Extolled

Skin & Allergy News ◽

10.1016/s0037-6337(06)71614-x ◽

2006 ◽

Vol 37 (10) ◽

pp. 52

Author(s):

KAREN DENTE

Keyword(s):

Surgical Patients ◽

Long Term Follow Up

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Abstract #1226: E-Glycemic Management System Safely Maintains Glycemic Targets with a Low Incidence of Hypoglycemia for Nondiabetic Cv Surgical Patients in the Inpatient Setting

Endocrine Practice ◽

10.1016/s1530-891x(20)42455-3 ◽

2015 ◽

Vol 21 ◽

pp. 287-288

Author(s):

Joseph Aloi ◽

Paul Chidester ◽

Jagdeesh Ullal ◽

Amy Henderson ◽

Robby Booth ◽

...

Keyword(s):

Management System ◽

Surgical Patients ◽

Inpatient Setting ◽

Low Incidence ◽

Glycemic Targets ◽

Glycemic Management

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Quality management in the prophylaxis of venous thrombembolism - Results of a survey including 464 medical and surgical patients

VASA ◽

10.1024/0301-1526/a000082 ◽

2011 ◽

Vol 40 (2) ◽

pp. 123-130

Author(s):

Klein-Weigel ◽

Richter ◽

Arendt ◽

Gerdsen ◽

Härtwig ◽

...

Keyword(s):

Renal Function ◽

High Risk ◽

Quality Management ◽

High Risk Group ◽

Surgical Patients ◽

Medical Patients ◽

Risk Status ◽

Vte Prophylaxis ◽

Safety Concerns

Background: We surveyed the quality of risk stratification politics and monitored the rate of entries to our company-wide protocol for venous thrombembolism (VTE) prophylaxis in order to identify safety concerns. Patients and methods: Audit in 464 medical and surgical patients to evaluate quality of VTE prophylaxis. Results: Patients were classified as low 146 (31 %), medium 101 (22 %), and high risk cases 217 (47 %). Of these 262 (56.5 %) were treated according to their risk status and in accordance with our protocol, while 9 more patients were treated according to their risk status but off-protocol. Overtreatment was identified in 73 (15.7 %), undertreatment in 120 (25,9 %) of all patients. The rate of incorrect prophylaxis was significantly different between the risk categories, with more patients of the high-risk group receiving inadequate medical prophylaxis (data not shown; p = 0.038). Renal function was analyzed in 392 (84.5 %) patients. In those patients with known renal function 26 (6.6 %) received improper medical prophylaxis. If cases were added in whom prophylaxis was started without previous creatinine control, renal function was not correctly taken into account in 49 (10.6 %) of all patients. Moreover, deterioration of renal function was not excluded within one week in 78 patients (16.8 %) and blood count was not re-checked in 45 (9.7 %) of all patients after one week. There were more overtreatments in surgical (n = 53/278) and more undertreatments in medical patients (n = 54/186) (p = 0.04). Surgeons neglected renal function and blood controls significantly more often than medical doctors (p-values for both < 0.05). Conclusions: We found a low adherence with our protocol and substantial over- and undertreatment in VTE prophylaxis. Besides, we identified disregarding of renal function and safety laboratory examinations as additional safety concerns. To identify safety problems associated with medical VTE prophylaxis and hot spots quality management-audits proved to be valuable instruments.

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