Browsing by Author "Beckman, Daniel J."

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    Outcomes of surgical coronary revascularization performed pre-solid abdominal organ transplant
    (Elsevier, 2020) Matthews, Caleb R.; Millward, James B.; Faiza, Zainab; Namburi, Niharika; Timsina, Lava; Hess, Philip J.; Corvera, Joel S.; Everett, Jeffrey E.; Beckman, Daniel J.; Lee, Lawrence S.; Surgery, School of Medicine
    Background Cardiac risk stratification and coronary angiography are routinely performed as part of kidney and liver transplant candidacy evaluation. There are limited data on the outcomes of surgical coronary revascularization in this patient population. We investigated outcomes in patients with end stage renal or hepatic disease undergoing coronary artery bypass grafting (CABG) to attain kidney or liver transplant candidacy. Methods Retrospective analysis of all patients who underwent isolated CABG at our institution between 2010 and 2016. Patients were divided into two cohorts: Pre-transplant (those undergoing surgery to attain renal or hepatic transplant candidacy) and Non-transplant (all others). Baseline characteristics and postoperative outcomes were compared between groups. Results A total of 1801 patients were included: 28 in Pre-transplant (n=22 kidney, n=7 liver) and 1773 in Non-transplant. Major adverse postoperative outcomes were significantly greater in Pre-transplant compared to Non-transplant: 30-day mortality (14.3% vs. 2.8%, p=0.009), neurologic events (17.9% vs. 4.8%, p=0.011), re-intubation (21.4% vs. 5.8%, p=0.005) and total postoperative ventilation (5.2 vs. 5.0 hours, p=0.0124). One- and five-year mortality in Pre-transplant was 17.9% and 53.6%, respectively. Of the Pre-transplant cohort, three patients (10.7%) underwent organ transplantation (all kidneys) at a mean 436 days after CABG. No patients received liver transplantation. Conclusions Outcomes following CABG in the pre-kidney and pre-liver transplant population are poor. Despite surgical revascularization, the vast majority of patients do not ultimately undergo transplantation. Revascularization strategies and optimal management in this high-risk population warrants further study.
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    The Presence of a Dedicated Cardiac Surgical Intensive Care Service Impacts Clinical Outcomes in Adult Cardiac Surgery Patients
    (Wiley, 2020-04) Lee, Lawrence S.; Clark, Aaron J.; Namburi, Niharika; Naum, Christopher; Timsina, Lava R.; Corvera, Joel S.; Beckman, Daniel J.; Everett, Jeffrey E.; Hess, Philip J.; Medicine, School of Medicine
    Background Postoperative critical care management is an integral part of cardiac surgery that contributes directly to clinical outcomes. In the United States there remains considerable variability in the critical care infrastructure for cardiac surgical programs. There is little published data investigating the impact of a dedicated cardiac surgical intensive care service. Methods A retrospective study examining postoperative outcomes in cardiac surgical patients before and after the implementation of a dedicated cardiac surgical intensive care service at a single academic institution. An institutional Society of Thoracic Surgeons database was queried for study variables. Primary endpoints were the postoperative length of stay, intensive care unit length of stay, and mechanical ventilation time. Secondary endpoints included mortality, readmission rates, and postoperative complications. The effect on outcomes based on procedure type was also analyzed. Results A total of 1703 patients were included in this study—914 in the control group (before dedicated intensive care service) and 789 in the study group (after dedicated intensive care service). Baseline demographics were similar between groups. Length of stay, mechanical ventilation hours, and renal failure rate were significantly reduced in the study group. Coronary artery bypass grafting patients observed the greatest improvement in outcomes. Conclusions Implementation of a dedicated cardiac surgical intensive care service leads to significant improvements in clinical outcomes. The greatest benefit is seen in patients undergoing coronary artery bypass, the most common cardiac surgical operation in the United States. Thus, developing a cardiac surgical intensive care service may be a worthwhile initiative for any cardiac surgical program.