| 1. |
- Cao, Yang, Associate Professor, 1972-, et al.
(författare)
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The statistical importance of P-POSSUM scores for predicting mortality after emergency laparotomy in geriatric patients
- 2020
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central. - 1472-6947. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Geriatric patients frequently undergo emergency general surgery and accrue a greater risk of postoperative complications and fatal outcomes than the general population. It is highly relevant to develop the most appropriate care measures and to guide patient-centered decision-making around end-of-life care. Portsmouth - Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) has been used to predict mortality in patients undergoing different types of surgery. In the present study, we aimed to evaluate the relative importance of the P-POSSUM score for predicting 90-day mortality in the elderly subjected to emergency laparotomy from statistical aspects.METHODS: One hundred and fifty-seven geriatric patients aged ≥65 years undergoing emergency laparotomy between January 1st, 2015 and December 31st, 2016 were included in the study. Mortality and 27 other patient characteristics were retrieved from the computerized records of Örebro University Hospital in Örebro, Sweden. Two supervised classification machine methods (logistic regression and random forest) were used to predict the 90-day mortality risk. Three scalers (Standard scaler, Robust scaler and Min-Max scaler) were used for variable engineering. The performance of the models was evaluated using accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Importance of the predictors were evaluated using permutation variable importance and Gini importance.RESULTS: The mean age of the included patients was 75.4 years (standard deviation =7.3 years) and the 90-day mortality rate was 29.3%. The most common indication for surgery was bowel obstruction occurring in 92 (58.6%) patients. Types of post-operative complications ranged between 7.0-36.9% with infection being the most common type. Both the logistic regression and random forest models showed satisfactory performance for predicting 90-day mortality risk in geriatric patients after emergency laparotomy, with AUCs of 0.88 and 0.93, respectively. Both models had an accuracy > 0.8 and a specificity ≥0.9. P-POSSUM had the greatest relative importance for predicting 90-day mortality in the logistic regression model and was the fifth important predictor in the random forest model. No notable change was found in sensitivity analysis using different variable engineering methods with P-POSSUM being among the five most accurate variables for mortality prediction.CONCLUSION: P-POSSUM is important for predicting 90-day mortality after emergency laparotomy in geriatric patients. The logistic regression model and random forest model may have an accuracy of > 0.8 and an AUC around 0.9 for predicting 90-day mortality. Further validation of the variables' importance and the models' robustness is needed by use of larger dataset.
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| 2. |
- Arbeus, Mikael, et al.
(författare)
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Five-year patency for the no-touch saphenous vein and the left internal thoracic artery in on- and off-pump coronary artery bypass grafting
- 2021
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Ingår i: Journal of cardiac surgery. - : Wiley-Blackwell Publishing Inc.. - 0886-0440 .- 1540-8191. ; 36:10, s. 3702-3708
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Randomized trials show high long-term patency for no-touch saphenous vein grafts in coronary artery bypass grafting. The patency rate in off-pump coronary bypass surgery for these grafts has not been investigated. Our center participated in the CORONARY randomized trial, NCT00463294. This is a study aimed to assess the patency of no-touch saphenous veins in on- versus off-pump coronary bypass surgery at five-year follow-up.METHODS: Fifty-six patients were included. Forty of 49 patients, alive at 5 years, participated in this follow-up. There were 21 and 19 patients in the on- and off-pump groups respectively. No-touch saphenous veins were used to bypass all targets and in some cases the left anterior descending artery. Graft patency according to distal anastomosis was evaluated with computed tomography angiography.RESULTS: The five-year patency rate was 123/139 (88.5%). The patency for the no-touch vein grafts was 57/64 (89.1%) in the on-pump versus 37/45 (82.2%) in the off-pump group. All left internal thoracic arteries except for one, 29/30 (96.6%), were patent. All vein grafts used to bypass the left anterior descending and the diagonal arteries were patent 32/32. The lowest patency rate for the saphenous veins was to the right coronary territory, particularly in off-pump surgery (80.0% vs. 62.5% for the on- respective off-pump groups).CONCLUSIONS: Comparable 5-year patency for the no-touch saphenous veins and the left internal thoracic arteries to the left anterior descending territory in both on- and off-pump coronary artery bypass grafting. Graft patency in off-pump CABG is lower to the right coronary artery.
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| 3. |
- Bäck, Anna-Karin, 1971-, et al.
(författare)
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Renography with a semiautomated algorithm for diuretic decision 7 min postradiopharmaceutical administration : a feasibility study
- 2020
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Ingår i: Nuclear medicine communications. - : Lippincott Williams & Wilkins. - 0143-3636 .- 1473-5628. ; 41:10, s. 1018-1025
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The F+10 method for diuretic renography (diuretics given 10 min after the radiopharmaceutical) could be a time-conserving method. This method involves a 30-min dynamic acquisition where diuretics are administered only when necessary by the Nuclear Medicine technologist performing the examination. The purpose of this study was to assess the method's performance and to discover the optimal threshold of residual activity for a diuretic administration 7 min into the F+10 renography by reprocessing raw data from prior performed examinations with 20-min acquisitions without diuretics.METHODS: Retrospectively, raw data from 320 original examinations of adult patients performed from 2013 to 2015 were reprocessed into 7-min series and categorized as requiring diuretic or not. The diuretic decisions made by an expert panel were used as a reference. A receiver-operating characteristic curve was drawn to assess the optimal cutoff value for the residual renal activity. Sensitivity, specificity, positive and negative predictive values, as well as the Youden J index were calculated.RESULT: The experts classified 50% (160 examinations) as in need of diuretics. The receiver-operating characteristic curve demonstrated the theoretical optimal cutoff value at 7 min to be 94% of maximum activity (sensitivity 0.93, specificity 0.81, Youden J index 0.73). A clinically acceptable threshold is suggested to be 85% (sensitivity 0.99, specificity 0.59, Youden J index 0.58).CONCLUSION: Tc-mercaptoacetyltriglycine renography with the F+10 method and the threshold 85% for diuretic decision 7 min into the renography is a feasible and acceptable method in clinical practice.
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| 4. |
- Bäck, Anna-Karin, 1971-, et al.
(författare)
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Timing of diuretics in diuresis renography
- 2022
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Ingår i: Clinical and translational imaging. - : Springer. - 2281-5872 .- 2281-7565. ; 10, s. 37-43
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Forskningsöversikt (refereegranskat)abstract
- Purpose: The aim of this systematic literature review was to obtain an overview of when to administer the diuretics in relation to the radiopharmaceutical during a diuresis renography.Methods: A systematic literature search was performed in three different databases (Embase, PubMed/Medline and Cochrane Library) together with an information specialist. The review question was: when should diuretics be administered in relation to the radiopharmaceutical in a diuresis renography? Studies of adults were included together with guidelines published in collaboration with an organization.Results: Seventeen articles and four guidelines were retrieved in the literature search. The F - 15 method (diuretics administered 15 min before the radiopharmaceutical) was the one that was studied and described most and was compared with other time points for diuretic administration. The retrieved articles and guidelines report of advantages with different time points for diuretics. Both F - 15 and F + 0 are reported to clarify washout in equivocal cases compared to F + 20.Conclusion: No consensus could be found for a preferred time point of diuretics administration during a diuresis renography.
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| 5. |
- Bäck, Anna-Karin, 1971-, et al.
(författare)
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Troubled but in good hands : A qualitative study on patient experiences in diuresis renography examinations
- 2024
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Ingår i: Radiography. - : Elsevier. - 1078-8174 .- 1532-2831.
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Diuresis renography is a nuclear medicine examination that can distinguish between obstructive and non-obstructive uropathy. Renography has been investigated before, but not from a patient perspective. The aim of this study was to gain knowledge and understanding of patient experiences with the diuresis renography process.METHODS: The study had a qualitative descriptive design; data was collected through semi-structured interviews with 17 adult patients that had recently undergone diuresis renography. The transcripts were analysed using inductive qualitative content analysis to identify their manifest and latent content.RESULTS: One main theme was identified: 'Not smooth all the way through, but still in good hands'. The participants understood the necessity of the performed renography and endured the examination despite its worrying elements. They were bothered by diuretic effects, worried about radioactivity and felt isolated during the imaging. The technologists' caring and informative approach eased their experience. The main theme was identified from three subthemes: 'I experienced inconvenience', 'I was worried' and 'I felt safe'.CONCLUSION: The participants experienced worry throughout the renography process but were still satisfied with the examination, mostly because of the technologists being involved. Communication and interaction between patient and technologist are important for creating a good experience. Improved knowledge of patient experiences during renographies could be used to develop patient information and increase technologists' awareness of factors patients may experience as troubling.IMPLICATIONS FOR PRACTICE: This study describes issues that contribute to both negative and positive experiences. Improved professional awareness and knowledge about these issues can contribute to the development of patient information and professional encounters, and may improve patients' compliance and overall experience.
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| 6. |
- Dreifaldt, Mats, 1959-, et al.
(författare)
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Pedicled versus skeletonized internal thoracic artery grafts : a randomized trial
- 2021
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Ingår i: Asian cardiovascular & thoracic annals. - : Medikaru Toribyun. - 1816-5370 .- 0218-4923. ; 29:6, s. 490-497
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Concerns have been raised regarding whether skeletonization of the internal thoracic artery could damage the graft and thereby reduces its patency. The objective of this study was to compare patency rates at mid- and long-term follow-up between pedicled and skeletonized left internal thoracic artery grafts.METHODS: This randomized controlled trial included 109 patients undergoing coronary artery bypass surgery. The patients were assigned to receive either one pedicled or one skeletonized left internal thoracic artery graft to the left anterior descending artery. Follow-up was performed at 3 years with conventional angiography, and at 8 years with computed tomography angiography. Differences between patency rates were analyzed with Fisher's exact test and a generalized linear model.RESULTS: The patency rates for pedicled and skeletonized left internal thoracic artery grafts were 46/48 (95.8%) versus 47/52 (90.4%), p = 0.44 at 3 years, and 40/43 (93.0%) versus 37/41 (90.2%), p = 0.71 at 8 years, respectively. The difference in patency rates for pedicled and skeletonized grafts was 5.4% (95% confidence interval: -4.2-14.5) at 3 years and 2.8% (95% confidence interval: -9.9-14.1) at 8 years. All failed grafts, except for one with a localized stenosis, were anastomosed to native coronary arteries with a stenosis less than 70%. Three patients suffered sternal wound infections (two in the pedicled group, one in the skeletonized group).CONCLUSIONS: The skeletonization technique can be used without jeopardizing the patency of the left internal thoracic artery. The most important factor in graft failure was target artery stenosis below 70%.
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| 7. |
- Dreifaldt, Mats, 1959-, et al.
(författare)
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The no-touch saphenous vein is an excellent alternative conduit to the radial artery 8 years after coronary artery bypass grafting : A randomized trial
- 2021
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Ingår i: Journal of Thoracic and Cardiovascular Surgery. - : Elsevier. - 0022-5223 .- 1097-685X. ; 161:2, s. 624-630
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2004, a prospective randomized trial demonstrated that after 3 years, saphenous veins (SVs) harvested with a no touch (NT) technique had a greater patency than radial grafts for coronary bypass surgery. Here we report the 8-year follow-up data of this trial.Methods: The trial included 108 patients undergoing coronary artery bypass grafting (CABG). Each patient was assigned to receive 1 NT SV and 1 radial artery (RA) graft to either the left or right coronary territory to complement the left internal thoracic artery (LITA). Sequential grafting was common, so overall graft patency as well as the patency of each anastomosis were assessed.Results: Angiography was performed in 84 patients (78%) at mean of 97 months postoperatively. Graft patency were high and similar for both NT and RA: 86% for NT versus 79% for RA (P = .22). The patency of coronary anastomoses was significantly higher with the NT SV grafts (91% vs 81%; P = .046). The NT grafts also had excellent patency in coronary arteries with <90% stenosis (93% patency) and in coronary arteries of small diameter (87% patency) or with mild calcification (88% patency). Patency for the LITA was 92%.Conclusions: NT SV grafts have excellent patency similar to that of RA grafts after 8 years. In addition, NT SV grafts can be used in situations that are not ideal for RA grafts.
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| 8. |
- Edin, Victor, et al.
(författare)
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A Case of Using No-Touch Saphenous Vein Graft in Redo CABG after Multiple Failed Percutaneous Coronary Interventions
- 2022
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Ingår i: Brazilian Journal of Cardiovascular Surgery. - : Brazilian Society for Cardiovascular Surgery. - 0102-7638 .- 1678-9741. ; 37:1, s. 135-138
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Tidskriftsartikel (refereegranskat)abstract
- The modality of repeat revascularization due to late graft failure is a debated topic. The latest available European guidelines recommend redo coronary artery bypass graft (CABG) for cases of extensively diseased and/or occluded grafts and those with diffuse native vessel disease. We present the case of a patient being relieved of recurrent unstable angina pectoris with redo CABG using no-touch saphenous vein grafts after repeated and unsuccessful attempts with percutaneous coronary intervention (PCI). This could be an alternative to PCI in patients with a complex medical history. Teamwork between cardiologists and surgeons is pivotal in deciding the best treatment modality.
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| 9. |
- Ferrari, Gabriele, 1984-, et al.
(författare)
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Long-term results of percutaneous coronary intervention in no-touch vein grafts are significantly better than in conventional vein grafts
- 2024
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Ingår i: Perfusion. - London : Sage Publications. - 0267-6591 .- 1477-111X.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Conventional vein grafts have a high risk of thrombosis and early atherosclerosis. Percutaneous coronary intervention (PCI) in conventional vein grafts is associated with a higher incidence of late adverse cardiac events. The aim of this study was to evaluate the long-term results after PCI in saphenous vein grafts (SVG) harvested with the no-touch technique compared to the conventional technique. Methods: This was a single-center, retrospective, cohort study, based on data from the Swedeheart register. The inclusion criterion was individuals who underwent CABG using different vein graft techniques between January 1992 and July 2020, and who required a PCI in SVGs between January 2006 and July 2020. The primary end point was long-term in-stent restenosis. The secondary endpoints were long-term major adverse cardiac events (MACE) and 1-year re-hospitalization rates. The associations between the graft types and the endpoints were evaluated using the Fine and Gray competing-risk regression analysis. Results: The study included 346 individuals (67 no-touch, 279 conventional). The mean clinical follow-up time was 6.4 years with a standard deviation of 3.7 years. The long-term in-stent restenosis rate for the no-touch grafts was 3.2% compared to 18.7% for the conventional grafts (p <.01), with a subdistribution hazard ratio (SHR) of 0.16 (p =.010). The long-term MACE rate was 27.0% in the no-touch group and 48.3% in the conventional group (p <.01) with a SHR of 0.53 (p =.017). The short-term results were similar in both groups. Conclusions: Percutaneous coronary intervention in a no-touch vein graft was associated with statistically significantly fewer in-stent restenoses and MACE at long-term follow-up compared to a conventional SVG. © The Author(s) 2024.
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| 10. |
- Ferrari, Gabriele, 1984-, et al.
(författare)
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Percutaneous coronary intervention in saphenous vein grafts after coronary artery bypass grafting : a systematic review and meta-analysis
- 2021
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Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 55:4, s. 245-253
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Forskningsöversikt (refereegranskat)abstract
- To investigate the results of percutaneous coronary intervention (PCI) in saphenous vein grafts after coronary artery bypass grafting (CABG). Design. MEDLINE, Embase, and the Cochrane library were searched for relevant articles published between 1 January 2000 and 29 February 2020. The PICO (population, intervention, comparison, outcome) model was applied in constructing the clinical question. Two independent researchers performed the literature search. Thirty-six articles were identified and subjected to a quality assessment. The primary outcomes of the meta-analysis were long-term in-stent restenosis and long-term major adverse cardiac events (MACE). Results. In-stent restenosis was 9.4% (95% CI: 4.2-14.7%) and MACE was 35.3% (95% CI: 27-43.7%) at mean time 2.7 ± 1.0 years. The secondary outcomes were the unsuccessful PCI rate (7.7%; 95% CI: 2.9-12.5%), 30-day MACE (4.3%; 95% CI: 2.5-6.1%), and 1-year MACE (15.5%; 95% CI: 11.7-19.3%). The use of drug-eluting stents resulted in better outcomes at least in term of in-stent restenosis, while the benefit of using embolic protection devices was questionable. Conclusions. PCI of a stenosed or occluded saphenous vein graft is a challenge for interventional cardiologists, and is still associated with relatively high rates of restenosis, MACE, and procedural failure. All efforts to enhance the results are warranted, including improved quality of the venous grafts used during CABG.
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