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Age-dependent trends in postoperative mortality and preoperative comorbidity in isolated coronary artery bypass surgery: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature277099
Source
Eur J Cardiothorac Surg. 2016 Feb;49(2):391-7
Publication Type
Article
Date
Feb-2016
Author
Kristinn Thorsteinsson
Kirsten Fonager
Charlotte Mérie
Gunnar Gislason
Lars Køber
Christian Torp-Pedersen
Rikke N Mortensen
Jan J Andreasen
Source
Eur J Cardiothorac Surg. 2016 Feb;49(2):391-7
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Comorbidity
Coronary Artery Bypass - mortality
Coronary Artery Disease - mortality - surgery
Denmark - epidemiology
Elective Surgical Procedures - mortality
Emergency Treatment - mortality
Female
Humans
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Postoperative Complications - mortality
Retrospective Studies
Abstract
An increasing number of octogenarians are being subjected to coronary artery bypass grafting (CABG). The purpose of this study was to examine age-dependent trends in postoperative mortality and preoperative comorbidity over time following CABG.
All patients who underwent isolated CABG surgery between January 1996 and December 2012 in Denmark were included. Patients were identified through nationwide administrative registers. Age was categorized into five different groups and time into three periods to see if mortality and preoperative comorbidity had changed over time. Predictors of 30-day mortality were analysed in a multivariable Cox proportional-hazard models and survival at 1 and 5 years was estimated by Kaplan-Meier curves.
A total of 38 830 patients were included; the median age was 65.4 ± 9.5 years, increasing over time to 66.6 ± 9.5 years. Males comprised 80%. The number of octogenarians was 1488 (4%). The median survival was 14.7 years (60-69 years), 10.7 years (70-74 years), 8.9 years (75-79 years) and 7.2 years (=80 years). The 30-day mortality rate was 3%, increasing with age (1% in patients 80 years), respectively. The proportion of patients >75 years increased from 10 to 20% during the study period as well as the proportion of patients undergoing urgent or emergency surgery. The burden of comorbidities increased over time, e.g. congestive heart failure 13-17%, diabetes 12-21%, stroke 9-11%, in all age groups. Age and emergency surgery were the main predictors of 30-day mortality: age >80 years [hazard ratio (HR): 5.75, 95% confidence interval (CI): 4.41-7.50], emergency surgery (HR: 5.23, 95% CI: 4.38-6.25).
Patients are getting older at the time of surgery and have a heavier burden of comorbidities than before. The proportion of patients undergoing urgent or emergency surgery increased with age and over time. Despite this, the 30-day mortality decreased over time and long-term survival increased, except in octogenarians where it was stable. Octogenarians had substantially higher 30-day mortality compared with younger patients but surgery can be performed with acceptable risks and good long-term outcomes.
Notes
Comment In: Eur J Cardiothorac Surg. 2016 Feb;49(2):397-826242898
PubMed ID
25698155 View in PubMed
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Decreased patency rates following endoscopic vein harvest in coronary artery bypass surgery.

https://arctichealth.org/en/permalink/ahliterature273734
Source
Scand Cardiovasc J. 2015;49(5):286-92
Publication Type
Article
Date
2015
Author
Jan J Andreasen
Henrik Vadmann
Lars Oddershede
Hans-Henrik Tilsted
Jens B Frøkjær
Svend E Jensen
Source
Scand Cardiovasc J. 2015;49(5):286-92
Date
2015
Language
English
Publication Type
Article
Keywords
Aged
Angina Pectoris - epidemiology
Coronary Artery Bypass
Denmark - epidemiology
Endoscopy - statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction - mortality
Postoperative Complications - epidemiology
Saphenous Vein - transplantation
Tissue and Organ Harvesting - methods
Vascular Patency
Abstract
Endoscopic vein harvest has gained widespread use in coronary artery bypass surgery. However, potential negative mid- and long-term effects following endoscopic vein harvest have been described. We aimed to compare long-term clinical outcomes following endoscopic and open vein graft harvesting.
This study was a clinical follow-up with additional computed tomographic coronary angiography among 126 first-time bypass patients originally included in a randomized study comparing early leg wound complications and cosmetic results. Deceased patients were retrospectively followed up.
Follow-up was complete, but information on clinical endpoints was not available in all patients. A total of 111 patients were alive at follow-up. Median observation time was 6.3 (range: 0.2–9.1) years including three in-hospital deaths. Vein graft failure was significantly higher in the endoscopic vein harvest (EVH) group (13 of 31; 42%) compared with the open vein harvest (OVH) group (2 of 32, 6%) (P = 0.001). However, this difference was not reflected by differences in recurrence of angina (P = 0.44), myocardial infarction (P = 0.11), and all-cause mortality (P = 0.15).
Using a median follow-up time of 6.3 years significantly more vein graft failures were identified following EVH compared with OVH without any differences in long-term clinical outcomes.
PubMed ID
26053411 View in PubMed
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Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature284232
Source
Interact Cardiovasc Thorac Surg. 2016 Jun;22(6):792-8
Publication Type
Article
Date
Jun-2016
Author
Kristinn Thorsteinsson
Jan J Andreasen
Rikke N Mortensen
Kristian Kragholm
Christian Torp-Pedersen
Gunnar Gislason
Lars Køber
Kirsten Fonager
Source
Interact Cardiovasc Thorac Surg. 2016 Jun;22(6):792-8
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Coronary Artery Bypass - methods
Coronary Artery Disease - mortality - surgery
Denmark - epidemiology
Female
Humans
Kaplan-Meier Estimate
Longevity
Male
Middle Aged
Nursing Homes - statistics & numerical data
Proportional Hazards Models
Survival Rate - trends
Time Factors
Abstract
Data on nursing home admission in patient's =80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort.
All patients who underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan-Meier estimates were used for survival analysis. Subanalysis on home care usage was performed in the period 2008-2012.
A total of 38 487 patients were included. The median age was 65.4 ± 9.5 years (1455 > 80 years) and 80% were males. The 30-day mortality rate was 2.8%, increasing with age (1.2% in patients
Notes
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PubMed ID
26969738 View in PubMed
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Statin initiation and acute kidney injury following elective cardiovascular surgery: a population cohort study in Denmark†.

https://arctichealth.org/en/permalink/ahliterature277511
Source
Eur J Cardiothorac Surg. 2016 Mar;49(3):995-1000
Publication Type
Article
Date
Mar-2016
Author
James Bradley Layton
Malene K Hansen
Carl-Johan Jakobsen
Abhijit V Kshirsagar
Jan J Andreasen
Vibeke E Hjortdal
Bodil S Rasmussen
Ross J Simpson
Maurice Alan Brookhart
Christian F Christiansen
Source
Eur J Cardiothorac Surg. 2016 Mar;49(3):995-1000
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Acute Kidney Injury - epidemiology
Aged
Aged, 80 and over
Cardiovascular Surgical Procedures - adverse effects - statistics & numerical data
Cohort Studies
Denmark - epidemiology
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage - therapeutic use
Male
Perioperative Period
Risk
Abstract
Acute kidney injury (AKI) is a serious complication of cardiac surgery. Statins may prevent post-surgical AKI, yet methodological concerns about existing studies raise questions about the magnitude of a protective effect. We sought to determine the effect of initiating a statin prior to elective cardiac surgery on post-surgical AKI in a regional Danish surgical cohort.
We identified adults who underwent cardiac surgery during 2006-11 using the Western Denmark Heart Registry. Presurgical medication use, pre- and post-surgical serum creatinine (sCr) measures, and other patient characteristics were obtained from Danish population-based registries. Post-surgical AKI was assessed using sCr measures within 5 days of surgery. The adjusted risk ratio (RR) of AKI and 95% confidence interval (CI) were estimated for patients who initiated a statin within 100 days prior to surgery compared with patients without prior statin use; long-term statin users were excluded to reduce healthy-user bias. Subanalyses were stratified by surgery type: coronary artery bypass grafting (CABG) and non-CABG surgeries.
We identified 1929 CABG and 1775 non-CABG patients. AKI occurred in 25% of CABG and 28% of non-CABG surgeries, and in 29% of the non-users and 21% of the statin initiators. Half of CABG patients and 9% of non-CABG patients initiated a statin prior to surgery. The adjusted RRs for the effect of statin initiation on AKI were as follows: all surgeries combined, RR = 0.86 (95% CI: 0.74, 0.98); CABG, RR = 0.88 (0.74, 1.05); non-CABG RR = 0.87 (0.68, 1.11).
Presurgical statin initiation is associated with a reduction in AKI risk after cardiac surgery.
Notes
Comment In: Eur J Cardiothorac Surg. 2016 Mar;49(3):1001-326320126
PubMed ID
26188012 View in PubMed
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Transfusion practice in coronary artery bypass surgery in Denmark: a multicenter audit.

https://arctichealth.org/en/permalink/ahliterature162138
Source
Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):623-7
Publication Type
Article
Date
Oct-2007
Author
Jan J Andreasen
Mikkel Westen
Peter A Pallesen
Søren Jensen
Anders Gorst-Rasmussen
Søren P Johnsen
Author Affiliation
Department of Cardiothoracic Surgery, Aalborg Hospital, Hobrovej, Postboks 365, DK-9100 Aalborg, Denmark. jan.jesper.andreasen@stofanet.dk
Source
Interact Cardiovasc Thorac Surg. 2007 Oct;6(5):623-7
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Aged
Anastomosis, Surgical - statistics & numerical data
Antifibrinolytic Agents - therapeutic use
Blood Component Transfusion - standards - statistics & numerical data
Blood Loss, Surgical - prevention & control - statistics & numerical data
Cardiopulmonary Bypass - statistics & numerical data
Coronary Artery Bypass - standards - statistics & numerical data
Coronary Artery Disease - blood - epidemiology - surgery
Denmark - epidemiology
Female
Hemoglobins - metabolism
Humans
Male
Medical Audit - statistics & numerical data
Middle Aged
Odds Ratio
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic
Quality of Health Care - standards - statistics & numerical data
Retrospective Studies
Risk assessment
Time Factors
Abstract
Transfusion rates in coronary artery bypass grafting (CABG) continue to vary substantially, although guidelines for allogeneic transfusion have been developed. In order to evaluate ongoing transfusion practices, we performed a multicenter audit in four Danish hospitals regarding the use of allogeneic blood products among patients undergoing first-time CABG. Data on patient characteristics, peri- and postoperative factors were retrieved from 600 patient records (150 records per hospital). Substantial differences were seen regarding preoperative intake of antiplatelet drugs, perioperative use of antifibrinolytic drugs, use of cardiopulmonary bypass (CPB), cross-clamp time, time on CPB, lowest hemoglobin during CPB, and number of distal anastomoses. The percentage of patients transfused with allogeneic red blood cells ranged from 30.0% to 64.2%. Several patients (12.1-42.7%) transfused with red blood cells were discharged with a hemoglobin concentration >7 mmol/l, indicating inappropriate transfusions. The relative risk of receiving an allogeneic blood transfusion was 2.1 (95% CI: 1.6-2.7) in the hospital with the highest transfusion rate, after adjustment for patient-, drug-, and procedure-related factors. Interesting differences in transfusion rates exists in Danish hospitals and these differences may reflect true variations in transfusion practices. Audits create a basis for educational efforts among surgeons and anesthesiologists to standardize transfusion practices.
PubMed ID
17670734 View in PubMed
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