scholarly journals Acute Care Resource Use After Elective Surgery in the United States: Implications During the COVID-19 Pandemic

2021 ◽  
pp. e1-e5
Author(s):  
Vijay Krishnamoorthy ◽  
Tetsu Ohnuma ◽  
Raquel Bartz ◽  
Matthew Fuller ◽  
Nita Khandelwal ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Care ◽  
Elective Surgery ◽  
Artery Bypass ◽  
The United States ◽  
Bypass Grafting ◽  
Red Blood Cell Transfusions ◽  
Postoperative Mechanical Ventilation

Background The COVID-19 pandemic created pressure to delay inpatient elective surgery to increase US health care capacity. This study examined the extent to which common inpatient elective operations consume acute care resources. Methods This cross-sectional study used the Premier Healthcare Database to examine the distribution of inpatient elective operations in the United States from the fourth quarter of 2015 through the second quarter of 2018. Primary outcomes were measures of acute care use after 4 common elective operations: joint replacement, spinal fusion, bariatric surgery, and coronary artery bypass grafting. A framework for matching changing demand with changes in supply was created by overlaying acute care data with publicly available outbreak capacity data. Results Elective coronary artery bypass grafting (n = 117 423) had the highest acute care use: 92.8% of patients used intensive care unit beds, 89.1% required postoperative mechanical ventilation, 41.0% required red blood cell transfusions, and 13.3% were readmitted within 90 days of surgery. Acute care use was also substantial after spinal fusion (n = 203 789): 8.3% of patients used intensive care unit beds, 2.2% required postoperative mechanical ventilation, 9.2% required red blood cell transfusions, and 9.3% were readmitted within 90 days of surgery. An example of a framework for matching hospital demand with elective surgery supply is provided. Conclusions Acute care needs after elective surgery in the United States are consistent and predictable. When these data are overlaid with national hospital capacity models, rational decisions regarding matching supply to demand can be achieved to meet changing needs.

scholarly journals First Database Comparison Between the United States and Japan: Coronary Artery Bypass Grafting

2020 ◽  
Vol 109 (4) ◽  
pp. 1159-1164 ◽  
Author(s):  
Kan Nawata ◽  
Richard S. D’Agostino ◽  
Robert H. Habib ◽  
Hiraku Kumamaru ◽  
Norimichi Hirahara ◽  
...  
Keyword(s):  
United States ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
The United States ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Database Comparison

Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis

Perfusion ◽  
2020 ◽  
pp. 026765912096031
Author(s):  
Pengbin Zhang ◽  
Liping Wang ◽  
Kerong Zhai ◽  
Jian Huang ◽  
Weifan Wang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Transfusion Rate ◽  
Bypass Grafting ◽  
Off Pump ◽  
Operative Complications ◽  
Hospital Stays

Background: Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG. Methods: Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays. Results: The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = −8.21 h, 95% CI = −11.74 to −4.68, p < 0.00001; MD = −0.77 d, 95% CI = −0.81 to −0.73, p < 0.00001; MD = −2.24 d, 95% CI = −3.17 to −1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization. Conclusion: In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.

scholarly journals Characteristics of Adults Aged 18–49 Years Without Underlying Conditions Hospitalized With Laboratory-Confirmed Coronavirus Disease 2019 in the United States: COVID-NET—March–August 2020

2020 ◽  
Author(s):  
Daniel Owusu ◽  
Lindsay Kim ◽  
Alissa O’Halloran ◽  
Michael Whitaker ◽  
Alexandra M Piasecki ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
The United States ◽  
Medical Conditions ◽  
Younger Adults

Abstract Among 513 adults aged 18–49 years without underlying medical conditions hospitalized with coronavirus disease 2019 (COVID-19) during March 2020–August 2020, 22% were admitted to an intensive care unit, 10% required mechanical ventilation, and 3 patients died (0.6%). These data demonstrate that healthy younger adults can develop severe COVID-19.

scholarly journals Factors associated to the length of time on mechanical ventilation in the postoperative period of cardiac surgery

2014 ◽  
Vol 35 (2) ◽  
pp. 67-72 ◽  
Author(s):  
Laura Fonseca ◽  
Fernando Nataniel Vieira ◽  
Karina De Oliveira Azzolin
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Medical Records ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Factors Associated ◽  
Continuous Sedation ◽  
The Mean

Our objective was to identify factors associated with the duration of mechanical ventilation (MV) postoperative to cardiac surgery and assess the association between duration of endotracheal intubation, length of stay in the Intensive Care Unit (ICU) and hospital. Longitudinal, retrospective study of medical records of 116 adults undergoing cardiac surgery from March 2012 to May 2013. The mean age was 57±14 years, predominantly male and coronary artery bypass grafting surgery (52.6%). The MV time was 15.25(7.66 to 23.68) hours. Associated with longer MV was the age (r=0.5,p<0.001), comorbidities (r=0.344,p<0.001), cardiopulmonary bypass time (r=0.244,p=0.008), duration of continuous sedation (r=0.607,p<0.001), sedative doses (r=0.4, p<0.001), time of vasoconstrictors and vasodilators (r=0.711, p< 0.001, r=0.368, p<0.001), drainage of the 1st time (r=0.201, p<0.031), presence of drains (r=0.445, p<0.001), postoperative complications (r=0.524, p< 0.001) and hospital stay. Our data confirms that both preoperative, transoperative and postoperative variables prolong the VM and therefore the hospital stay.

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