Aortic Center: specialized care improves outcomes and decreases mortality
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| Formato: | Artículo científico |
| Lenguaje: | en |
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Sociedade Brasileira de Cirurgia Cardiovascular
2014
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| _version_ | 1876445365385822208 |
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| author | Marcela da Cunha Sales |
| author_facet | Marcela da Cunha Sales |
| contents | Aortic Center: specialized care improves outcomes and decreases mortality Marcela da Cunha Sales José Dario Frota Filho Cristiane Aguzzoli Leonardo Dornelles Souza Álvaro Machado Rösler Eraldo Azevedo Lucio Paulo Ernesto Leães Mauro Ricardo Nunes Pontes Fernando Antônio Lucchese Medicina Aortic surgery Aortic surgery Aortic surgery Aortic surgery Aortic surgery Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA). Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%); and January/2008 to December/2010 (CTA, n=175, 52.7%). Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008), which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046), major complications (20.6 vs. 33.1%, P=0.007), stroke (4.6 vs. 10.9%, P=0.045) and sepsis (1.7 vs. 9.6%, P=0.001), as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007). CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99, P=0.049) and by procedure (hybrid, OR=0.07, CI 95% 0.007 – 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904, P=0.037). Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008), urgent surgery (OR=5.0 [1.5-16.7], P=0.008) and thoracoabdominal aneurysm (OR=24.6 [3.1-194.1], P=0.002). Conclusions: Thoracic aorta surgery in specialized center was associated with lower incidence of complications and all-cause mortality as compared to usual care. 2014 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398941895005 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.4 Vol.29 |
| format | Artículo científico |
| id | redalyc_398941895005 |
| institution | Redalyc |
| language | en |
| publishDate | 2014 |
| publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
| spellingShingle | Aortic Center: specialized care improves outcomes and decreases mortality Marcela da Cunha Sales Medicina Aortic surgery Aortic surgery Aortic surgery Aortic surgery Aortic surgery Aortic Center: specialized care improves outcomes and decreases mortality Marcela da Cunha Sales José Dario Frota Filho Cristiane Aguzzoli Leonardo Dornelles Souza Álvaro Machado Rösler Eraldo Azevedo Lucio Paulo Ernesto Leães Mauro Ricardo Nunes Pontes Fernando Antônio Lucchese Medicina Aortic surgery Aortic surgery Aortic surgery Aortic surgery Aortic surgery Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA). Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%); and January/2008 to December/2010 (CTA, n=175, 52.7%). Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008), which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046), major complications (20.6 vs. 33.1%, P=0.007), stroke (4.6 vs. 10.9%, P=0.045) and sepsis (1.7 vs. 9.6%, P=0.001), as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007). CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99, P=0.049) and by procedure (hybrid, OR=0.07, CI 95% 0.007 – 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904, P=0.037). Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008), urgent surgery (OR=5.0 [1.5-16.7], P=0.008) and thoracoabdominal aneurysm (OR=24.6 [3.1-194.1], P=0.002). Conclusions: Thoracic aorta surgery in specialized center was associated with lower incidence of complications and all-cause mortality as compared to usual care. 2014 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398941895005 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.4 Vol.29 |
| title | Aortic Center: specialized care improves outcomes and decreases mortality |
| topic | Medicina Aortic surgery Aortic surgery Aortic surgery Aortic surgery Aortic surgery |
| url | https://www.redalyc.org/articulo.oa?id=398941895005 |