Publications by authors named "Udo Abah"

16 Publications

  • Page 1 of 1

Development and internal validation of a clinical prediction model for 90-day mortality after lung resection: the RESECT-90 score.

Interact Cardiovasc Thorac Surg 2021 Jul 29. Epub 2021 Jul 29.

Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital NHS Foundation Trust, Manchester, UK.

Objectives: The ability to accurately estimate the risk of peri-operative mortality after lung resection is important. There are concerns about the performance and validity of existing models developed for this purpose, especially when predicting mortality within 90 days of surgery. The aim of this study was therefore to develop a clinical prediction model for mortality within 90 days of undergoing lung resection.

Methods: A retrospective database of patients undergoing lung resection in two UK centres between 2012 and 2018 was used to develop a multivariable logistic risk prediction model, with bootstrap sampling used for internal validation. Apparent and adjusted measures of discrimination (area under receiving operator characteristic curve) and calibration (calibration-in-the-large and calibration slope) were assessed as measures of model performance.

Results: Data were available for 6600 lung resections for model development. Predictors included in the final model were age, sex, performance status, percentage predicted diffusion capacity of the lung for carbon monoxide, anaemia, serum creatinine, pre-operative arrhythmia, right-sided resection, number of resected bronchopulmonary segments, open approach and malignant diagnosis. Good model performance was demonstrated, with adjusted area under receiving operator characteristic curve, calibration-in-the-large and calibration slope values (95% confidence intervals) of 0.741 (0.700, 0.782), 0.006 (-0.143, 0.156) and 0.870 (0.679, 1.060), respectively.

Conclusions: The RESECT-90 model demonstrates good statistical performance for the prediction of 90-day mortality after lung resection. A project to facilitate large-scale external validation of the model to ensure that the model retains accuracy and is transferable to other centres in different geographical locations is currently underway.
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http://dx.doi.org/10.1093/icvts/ivab200DOI Listing
July 2021

Surgical factors associated with new-onset postoperative atrial fibrillation after lung resection: the EPAFT multicentre study.

Postgrad Med J 2020 Dec 11. Epub 2020 Dec 11.

Department of Thoracic Surgery, Castle Hill Hospital, Cottingham, East Riding of Yorkshire, UK.

Purpose Of The Study: Postoperative atrial fibrillation (POAF) is a recognised complication in approximately 10% of major lung resections. In order to best target preoperative treatment, this study aimed at determining the association of incidence of POAF in patients undergoing lung resection to surgical and anatomical factors, such as surgical approach, extent of resection and laterality.

Study Design: Evaluation of Post-operative Atrial Fibrillation in Thoracic surgery (EPAFT): a multicentre, population-based, retrospective, cross-sectional, observational study including 1367 patients undergoing lung resections between April 2016 and March 2017. The primary outcome was the presence of POAF following resection. POAF was defined as at least one episode of symptomatic or asymptomatic AF confirmed by ECG within 7 days from the thoracic procedure or prior to discharge from the hospital.

Results: POAF was observed in 7.4% of patients: 3.1% in minor resection (video-assisted thoracoscopic surgery (VATS): 2.5%; thoracotomy: 3.8%), 9.0% in simple lobectomy (VATS: 7.3%, thoracotomy: 9.9%), 6.0% in complex resection (thoracotomy: 6.3%) and 11.4% in pneumonectomy. POAF was higher in left (4.0%) vs right (2.4%) minor resections, and in left (9.9%) vs right (8.3%) lobectomy, but higher in right (7.5%) complex resections, and the highest in right pneumonectomy (17.6%). No significant variations were observed as per sex, laterality or resected lobes. A positive univariable and multivariable association was observed for increasing age and increasing extent of resection, but not thoracotomy. Median (Q1-Q3) hospital stay was 9 (7-14) days in POAF and 5 (4-7) days in non-AF patients (p<0.001), with an increased cerebrovascular accident burden (p<0.001) and long-term mortality (p<0.001).

Conclusions: Among patients undergoing lung resection, POAF was significantly associated with age, increasing invasiveness of approach and increasing extent of resection. In addition, POAF carried a significant long-term mortality rate and burden of cerebrovascular accident. Appropriate prophylaxis should be targeted at these groups.
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http://dx.doi.org/10.1136/postgradmedj-2020-138904DOI Listing
December 2020

External validation of six existing multivariable clinical prediction models for short-term mortality in patients undergoing lung resection.

Eur J Cardiothorac Surg 2021 05;59(5):1030-1036

Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, UK.

Objectives: National guidelines advocate the use of clinical prediction models to estimate perioperative mortality for patients undergoing lung resection. Several models have been developed that may potentially be useful but contemporary external validation studies are lacking. The aim of this study was to validate existing models in a multicentre patient cohort.

Methods: The Thoracoscore, Modified Thoracoscore, Eurolung, Modified Eurolung, European Society Objective Score and Brunelli models were validated using a database of 6600 patients who underwent lung resection between 2012 and 2018. Models were validated for in-hospital or 30-day mortality (depending on intended outcome of each model) and also for 90-day mortality. Model calibration (calibration intercept, calibration slope, observed to expected ratio and calibration plots) and discrimination (area under receiver operating characteristic curve) were assessed as measures of model performance.

Results: Mean age was 66.8 years (±10.9 years) and 49.7% (n = 3281) of patients were male. In-hospital, 30-day, perioperative (in-hospital or 30-day) and 90-day mortality were 1.5% (n = 99), 1.4% (n = 93), 1.8% (n = 121) and 3.1% (n = 204), respectively. Model area under the receiver operating characteristic curves ranged from 0.67 to 0.73. Calibration was inadequate in five models and mortality was significantly overestimated in five models. No model was able to adequately predict 90-day mortality.

Conclusions: Five of the validated models were poorly calibrated and had inadequate discriminatory ability. The modified Eurolung model demonstrated adequate statistical performance but lacked clinical validity. Development of accurate models that can be used to estimate the contemporary risk of lung resection is required.
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http://dx.doi.org/10.1093/ejcts/ezaa422DOI Listing
May 2021

A review of interventional treatments for colorectal lung metastases: is it time for a change in practice?

Quant Imaging Med Surg 2020 Jun;10(6):1413-1417

Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK.

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http://dx.doi.org/10.21037/qims-2020-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276368PMC
June 2020

Risk Stratification of Postoperative Dyspnoea: Is it Time to Change Practice?

EClinicalMedicine 2019 Oct 17;15:5-6. Epub 2019 Oct 17.

Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, United Kingdom of Great Britain and Northern Ireland.

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http://dx.doi.org/10.1016/j.eclinm.2019.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6833459PMC
October 2019

Digital pathology is a practical alternative to on-site intraoperative frozen section diagnosis in thoracic surgery.

Histopathology 2019 May;74(6):902-907

Thoracic Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.

Aims: Telepathology uses digitised image transfer to allow off-site reporting of histopathology slides. This technology could facilitate the centralisation of pathology services, which may improve their quality and cost-effectiveness. The benefits may be most apparent in frozen section reporting, in which turnaround times (TATs) are vital. We moved from on-site to off-site telepathology reporting of thoracic surgery frozen section specimens in 2016. The aim of this study was to compare TATs before and after this service change.

Methods And Results: All thoracic frozen section specimens analysed 4 months prior and 4 months following the service change were included. Demographics, operation, sample type, time taken from theatre, time received by laboratory, time reported by laboratory, TAT, frozen section diagnosis, final histopathological diagnosis and final TNM staging were recorded. The results were analysed with spss statistical software version 24. In total, there were 65 samples from 59 patients; 34 before the change and 31 after the change. Specimens included 51 lung, six lymph node, three bronchial, three chest wall and two pleural biopsies. Before the change, the median TAT was 25 min [interquartile range (IQR) 20-33 min]. No diagnoses were deferred. No diagnoses were changed on subsequent paraffin analysis. After the change, with the use of digital pathology, the median TAT was 27.5 min (IQR 21.75-38.5 min). This difference was not significant (P = 0.581). Diagnosis was deferred in one case (3.23%). There was one (3.23%) mid-case technical failure resulting in the sample having to be transported by courier, resulting in a TAT of 106 min. No diagnoses were changed on subsequent paraffin analysis.

Conclusions: There was no significant difference in reporting times between digital technology and an on-site service, although one sample was affected by a technical failure requiring physical transportation of the specimen for analysis. Our study was underpowered to detect differences in accuracy.
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http://dx.doi.org/10.1111/his.13804DOI Listing
May 2019

Pathological lymph node involvement is not a predictor of adverse outcomes in patients undergoing thoracoscopic lobectomy for lung cancer†.

Eur J Cardiothorac Surg 2018 02;53(2):342-347

Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.

Objectives: As the practice of video-assisted thoracoscopic surgery (VATS) lobectomy gains widespread acceptance, the complexity of procedures attempted increases and the stage of tumour that may be safely approached remains controversial. We examined the impact of nodal involvement with respect to perioperative outcomes after VATS lobectomy.

Methods: All patients listed for VATS lobectomy for non-small-cell lung cancer at our institution from 2012 to 2016 were analysed. Bronchoplastic or chest wall resections and tumours over 7 cm were considered a contraindication to a thoracoscopic approach.

Results: Of the 489 patients identified, 97 (19.8%) patients had pathological nodal involvement. The overall conversion rate was 6.1%, reoperation rate was 5.3% and readmission rate was 5.9%. Median hospital stay was 5 days, 30-day mortality was 0.6% and 90-day mortality was 1.6%. No significant difference was identified between the nodal-negative or -positive groups in terms of preoperative demographics, hospital stay, postoperative complications, conversion rate, reoperation rate or readmission rate. Univariate logistic regression identified gender, Thoracoscore, dyspnoea score, performance status, chronic obstructive pulmonary disease, previous stroke, preoperative lung function and non-adenocarcinoma as predictors of postoperative complications. A multivariate model including nodal status identified Thoracoscore (odds ratio 1.57, 95% confidence interval 1.16-2.18; P < 0.001) and preoperative transfer factor (odds ratio 0.97, 95% confidence interval 0.96-0.98; P < 0.001) as the only predictors of complications.

Conclusions: In non-small-cell lung cancer patients with pathological hilar or mediastinal lymph node involvement, VATS lobectomy can be safely performed, as there does not appear to be an adverse effect on the incidence of perioperative complications, length of stay or readmissions.
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http://dx.doi.org/10.1093/ejcts/ezx297DOI Listing
February 2018

Spontaneous lung herniation distant to port sites following video-assisted thoracoscopic surgery lobectomy.

Eur J Cardiothorac Surg 2017 11;52(5):1005

Department of Thoracic Surgery, University Hospitals Bristol, Bristol, UK.

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http://dx.doi.org/10.1093/ejcts/ezx184DOI Listing
November 2017

EACTS expert consensus statement for surgical management of pleural empyema.

Eur J Cardiothorac Surg 2015 Nov 7;48(5):642-53. Epub 2015 Aug 7.

Unit of Thoracic Surgery, Az. Osped. S. Camillo Forlanini, Carlo Forlanini Hospital, Rome, Italy.

Pleural infection is a frequent clinical condition. Prompt treatment has been shown to reduce hospital costs, morbidity and mortality. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research. The European Association for Cardio-Thoracic Surgery (EACTS) Thoracic Domain and the EACTS Pleural Diseases Working Group established a team of thoracic surgeons to produce a comprehensive review of available scientific evidence with the aim to cover all aspects of surgical practice related to its treatment, in particular focusing on: surgical treatment of empyema in adults; surgical treatment of empyema in children; and surgical treatment of post-pneumonectomy empyema (PPE). In the management of Stage 1 empyema, prompt pleural space chest tube drainage is required. In patients with Stage 2 or 3 empyema who are fit enough to undergo an operative procedure, there is a demonstrated benefit of surgical debridement or decortication [possibly by video-assisted thoracoscopic surgery (VATS)] over tube thoracostomy alone in terms of treatment success and reduction in hospital stay. In children, a primary operative approach is an effective management strategy, associated with a lower mortality rate and a reduction of tube thoracostomy duration, length of antibiotic therapy, reintervention rate and hospital stay. Intrapleural fibrinolytic therapy is a reasonable alternative to primary operative management. Uncomplicated PPE [without bronchopleural fistula (BPF)] can be effectively managed with minimally invasive techniques, including fenestration, pleural space irrigation and VATS debridement. PPE associated with BPF can be effectively managed with individualized open surgical techniques, including direct repair, myoplastic and thoracoplastic techniques. Intrathoracic vacuum-assisted closure may be considered as an adjunct to the standard treatment. The current literature cements the role of VATS in the management of pleural empyema, even if the choice of surgical approach relies on the individual surgeon's preference.
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http://dx.doi.org/10.1093/ejcts/ezv272DOI Listing
November 2015

Does quality of life improve in octogenarians following cardiac surgery? A systematic review.

BMJ Open 2015 Apr 28;5(4):e006904. Epub 2015 Apr 28.

Papworth Hospital NHS Foundation Trust, Cambridge, UK.

Objectives: Current outcome measures in cardiac surgery are largely described in terms of mortality. Given the changing demographic profiles and increasingly aged populations referred for cardiac surgery this may not be the most appropriate measure. Postoperative quality of life is an outcome of importance to all ages, but perhaps particularly so for those whose absolute life expectancy is limited by virtue of age. We undertook a systematic review of the literature to clarify and summarise the existing evidence regarding postoperative quality of life of older people following cardiac surgery. For the purpose of this review we defined our population as people aged 80 years of age or over.

Methods: A systematic review of MEDLINE, EMBASE, Cochrane Library, trial registers and conference abstracts was undertaken to identify studies addressing quality of life following cardiac surgery in patients 80 or over.

Results: Forty-four studies were identified that addressed this topic, of these nine were prospective therefore overall conclusions are drawn from largely retrospective observational studies. No randomised controlled data were identified.

Conclusions: Overall there appears to be an improvement in quality of life in the majority of elderly patients following cardiac surgery, however there was a minority in whom quality of life declined (8-19%). There is an urgent need to validate these data and if correct to develop a robust prediction tool to identify these patients before surgery. Such a tool could guide informed consent, policy development and resource allocation.
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http://dx.doi.org/10.1136/bmjopen-2014-006904DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420984PMC
April 2015

What is the extent of the advantage of video-assisted thoracoscopic surgical resection over thoracotomy in terms of delivery of adjuvant chemotherapy following non-small-cell lung cancer resection?

Interact Cardiovasc Thorac Surg 2014 Oct 11;19(4):656-60. Epub 2014 Jul 11.

Department of Cardiothoracic Surgery, Oxford Radcliffe Hospitals Trust, Oxford, UK Thoracic Department, John Radcliffe Hospital, Oxford, UK

Objectives: Video-assisted thoracoscopic surgery (VATS) lobectomy for early stage non-small cell lung cancer (NSCLC) is a safe and effective alternative to open lobectomy. Adjuvant chemotherapy is part of the treatment recommended for patients with performance status (PS) 0-1 following resection of NSCLC of stages T1-3 N1-2 M0 and T2-3 N0 M0. If VATS reduces morbidity, does it help delivery of postoperative chemotherapy? We studied our data to compare the delivery and toxicity of chemotherapy in patients following VATS or open lung resections.

Methods: We performed a retrospective study of all patients who had resection of primary NSCLC in a single surgical centre between October 2008 and August 2013. Surgical and chemotherapy databases were reviewed to extract data on patient characteristics, operative details, pathological stage, chemotherapy delivery and toxicity.

Results: Three hundred and twenty-three resections were undertaken for NSCLC; 142 (44%) underwent VATS resection and 181 (56%) open thoracotomy; 16 (11.3%) and 28 (15.5%) of each group received adjuvant chemotherapy, respectively. Patient demographics and tumour stage were as follows: median age (range) was 65.5 (44-77) vs 67.5 (49-76); male: 43.8 vs 50% (P = 1.0); Stage I/II 75 vs 76.9%; Stage III 12.5 vs 30.8%; pre-chemotherapy PS 0 75 vs 78.2% for VATS and thoracotomy groups, respectively. All patients received platinum/vinorelbine therapy. Chemotherapy was initiated significantly earlier in the VATS group (mean 55.7 ± 3.1 vs 68.2 ± 4.3 days, P = 0.046); 68.8% of patients in the VATS group completed four cycles of chemotherapy compared with 60.1% in the open group (P = 0.75). There was a non-significant trend towards reduction in Grade 3/4 haematological toxicity in the VATS group compared with the open group (12.5 vs 39.3%, P = 0.09).

Conclusions: Adjuvant chemotherapy was started significantly earlier in patients following VATS lung resections for NSCLC compared with thoracotomy. There was also a trend towards improved tolerance with more complete courses and reduced haematological toxicity.
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http://dx.doi.org/10.1093/icvts/ivu206DOI Listing
October 2014

Frailty assessment in thoracic surgery.

Interact Cardiovasc Thorac Surg 2014 May 27;18(5):667-70. Epub 2014 Jan 27.

Department of Cardio-thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK.

A best evidence topic in thoracic surgery was performed according to a structured protocol. The question addressed was the role of frailty scores in predicting outcomes of patients undergoing thoracic surgery. Seventy-one papers were found using the reported search, of which three studies and one conference abstract represented the best evidence to answer the clinical question. The authors, journal date, country of publication, patient group, study type, relevant outcomes and results are tabulated. Despite an extensive literature search, few studies were identified which addressed the clinical dilemma posed, all of which were retrospective observational series. A study analysed 971 434 patients across a wide range of surgical specialties, 4648 of which were classified as thoracic. A statistically significant relationship was demonstrated between increasing frailty and higher rates of postoperative complications and mortality (P < 0.0001). Another study reported a similar association between modified frailty index (mFI) scores and postoperative outcomes in patients undergoing lobectomies. Morbidity increased uniformly with mFI and multivariant analysis found an mFI of >0.27 (P = 0.002) to be an independent predictor of mortality. Another paper demonstrated higher rates of major postoperative complications and increased mortality (P < 0.001) in patients with higher preoperative dependency. A study examined geriatric frailty assessment tools for the prediction of postoperative outcomes in patients over 70 undergoing thoracic surgery for neoplasms. The Geriatric Depression Screen, Mini Mental State Examination, Fatigue Inventory, Eastern Co-Operative Oncology Group Performance Scale and Instrumental Activities of Daily Living were used as a means of determining preoperative frailty. Their conclusion supported the conclusions drawn from the larger studies that a single frailty measure alone did not predict an increase in morbidity or mortality, but in combination several measures may have a role in predicting postoperative outcomes. The clinical bottom line is that there is a paucity of evidence to either fully support or fully refute the use of preoperative frailty scoring as a reliable means of predicting morbidity and mortality in thoracic surgery. The evidence presented does however indicate the potentially important clinical role that frailty scores may have in the future.
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http://dx.doi.org/10.1093/icvts/ivt542DOI Listing
May 2014

An unexpected cause of postoperative right heart failure.

Eur J Cardiothorac Surg 2013 Feb 18;43(2):443. Epub 2012 Sep 18.

Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK.

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http://dx.doi.org/10.1093/ejcts/ezs486DOI Listing
February 2013

Stroke prevention in cardiac surgery.

Interact Cardiovasc Thorac Surg 2012 Jul 21;15(1):155-7. Epub 2012 Apr 21.

Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.

This article addresses the main risk factors for stroke in cardiac surgery and discusses the role of carotid artery intervention and peri-operative epi-aortic scanning in the prevention of stroke. In great Britain and Northern Ireland, there were ∼2789 new strokes following the 105,558 cases of cardiac surgery from 2004 to 2008 (an annual stroke rate of 2.6% complicating heart surgery in the UK). We argue that The National Health Service in the UK is set to spend £187,682 preventing each stroke in some 30 cardiac surgical patients while ignoring the remaining 528 strokes that complicate cardiac surgery in the UK each year. Caution must be taken in pricing the prevention of perioperative stroke as we must question our use of finite resources. Aortic atheroma has been demonstrated as the foremost cause of post-coronary artery bypass graft strokes. Epi-aortic scanning is effective in identifying aortic atheroma encouraging measures to reduce perioperative stroke with heart surgery, and it is cheap. Several studies have confirmed epi-aortic scanning at the time of heart surgery to be effective in reducing the incidence of perioperative brain damage. We suggest that it is time to adopt epi-aortic scanning in our routine cardiac surgical practice if only to confirm or refute its cost-effectiveness in brain protection during this surgery.
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http://dx.doi.org/10.1093/icvts/ivs012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380965PMC
July 2012

Is cold or warm blood cardioplegia superior for myocardial protection?

Interact Cardiovasc Thorac Surg 2012 Jun 8;14(6):848-55. Epub 2012 Mar 8.

Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of warm or cold blood cardioplegia has superior myocardial protection. More than 192 papers were found using the reported search, of which 20 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A good breadth of high-level evidence addressing this clinical dilemma is available, including a recent meta-analysis and multiple large randomized clinical trials. Yet despite this level of evidence, no clear significant clinical benefit has been demonstrated by warm or cold blood cardioplegia. This suggests that neither method is significantly superior and that both provide similar efficacy of myocardial protection. The meta-analysis, including 41 randomized control trials (5879 patients in total), concluded that although a lower cardiac enzyme release and improved postoperative cardiac index was demonstrated in the warm cardioplegia group, this benefit was not reflected in clinical outcomes, which were similar in both groups. This theme of benefit in biochemical markers, physiological metrics and non-fatal postoperative events in the warm cardioplegia group ran throughout the literature, in particular the 'Warm Heart investigators' who conducted a randomized trial of 1732 patients, demonstrated a reduction in postoperative low output syndrome (6.1 versus 9.3%, P = 0.01) in the warm cardioplegia group, but no significant drop in 30-day all-cause mortality (1.4 versus 2.5%, P = 0.12). However, their later follow-up indicates non-fatal postoperative events predict reduced late survival, independent of cardioplegia. A minority of studies suggested a benefit of cold cardioplegia over warm in particular patient subgroups: One group conducted a retrospective study of 520 patients who required prolonged aortic cross-clamp times, results demonstrated less myocardial damage and reduced postoperative cardiac mortality and morbidity in the cold group. The clinical bottom line is that warm and cold cardioplegia result in similar short-term mortality. However, large studies have shown that warm cardioplegia reduces adverse post-operative events; the significance of which is unclear.
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http://dx.doi.org/10.1093/icvts/ivs069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3352732PMC
June 2012

Is routine stress ulcer prophylaxis of benefit for patients undergoing cardiac surgery?

Interact Cardiovasc Thorac Surg 2012 May 17;14(5):622-8. Epub 2012 Feb 17.

Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, UK.

A best evidence topic in cardiac surgery was written according to a structured protocol. We address whether routine pharmacological stress ulcer prophylaxis is of benefit for patients undergoing cardiac surgery. One hundred and fifty-six papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and results of these papers were tabulated. The results show that the incidence of stress ulcers following cardiac surgery is low (0.45%), but remains associated with significant morbidity and mortality. Five of the 7 studies demonstrated suppression of acid secretion or decreased incidence of gastric complications in patients given pharmacological stress ulcer prophylaxis, with the remaining two suggesting no clinical benefit. One prospective study of 210 patients, randomized equally between a proton pump inhibitor (PPI), histamine antagonist and teprenone, found that PPIs were the most effective at reducing gastric complications after cardiac surgery, including ulcer formation and upper gastrointestinal bleeding (UGIB). However, a separate retrospective study suggested no difference in the outcomes between the use of a PPI and a histamine antagonist. Of the studies focused on histamine antagonists, one randomized control trial (RCT) showed that cimetidine can reduce surgical stress, augment the immune system and reduce the intubation time after cardiac surgery, although no direct association with UGIB was made. A second prospectively randomized study of histamine antagonists demonstrated superior pH control with famotidine and ranitidine, when compared with cimetidine. Furthermore, haematological and neurological side-effects were noted only with the use of cimetidine. A recent meta-analysis and systematic review of the literature associated gastric acid suppression with an increased risk of pneumonia. Two prospective cohort studies that examined the use of PPI in conjunction with clopidogrel in patients with coronary artery disease concluded that there was no association with an increase in major adverse cardiovascular events with the use of PPIs. We conclude that the current evidence is marginally in favour of the use of prophylactic PPIs. However, this is associated with an increased risk of hospital-acquired pneumonia.
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http://dx.doi.org/10.1093/icvts/ivs019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735850PMC
May 2012
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