63 research outputs found
B-type natriuretic peptide following thoracic surgery: a predictor of postoperative cardiopulmonary complications
No full textB-type natriuretic peptides (BNPs) are secreted by the human heart in response to ventricular wall stretch or myocardial ischaemia, and predict adverse cardiovascular events and death in the general population. Following non-cardiac surgical procedures, there is growing evidence supporting BNP measurement as a powerful independent predictor of death and perioperative complications. However, the clinical implication of elevated BNP measurements after pulmonary resection has not been completely defined. This study aimed to evaluate the role of BNP in predicting adverse cardiopulmonary events after thoracic surgery.
A prospective, short-term, observational cohort study was conducted in a tertiary care hospital, including consecutive patients undergoing scheduled pulmonary resection between April 2012 and October 2013. Baseline clinical details were obtained; serum BNP levels were measured at baseline and on postoperative days 1 and 4.
We enrolled 294 consecutive patients, median age 66 [interquartile range (IQR): 57-73], 67% male. There were 2 perioperative deaths, and 52 patients experienced one or more cardiopulmonary complications. The baseline median BNP value was normal (29.5 pg/ml, IQR: 16-57.2), and showed significant postoperative increase, peaking on day 1. Patients who developed postoperative complications had a significantly greater BNP increase (P < 0.0001) when compared with those without complications. A postoperative day 1 BNP measurement of a parts per thousand yen118.5 [receiver operating characteristic area: 0.654; 95% confidence interval (CI): 0.57-0.74; P = 0.001] was associated with a 3-fold risk of developing postoperative cardiopulmonary complications [odds ratio (OR): 2.94; 95% CI: 1.32-6.57; P = 0.008]. Logistic regression analysis showed major pulmonary resections (lobectomies or pneumonectomies), BNP a parts per thousand yen 118.5 and age a parts per thousand yen 65 to be the only independent predictive variables. In the subset of patients undergoing lobectomy or pneumonectomy (n = 226), BNP was the strongest independent predictor of complications (OR: 3.49; 95% CI: 1.51-8.04).
Our results show that BNP elevation, measured in the first days after thoracic surgery, is independently associated with postoperative adverse events. In patients undergoing major pulmonary resections, a postoperative BNP elevation is the strongest independent predictor of cardiopulmonary complications
Reply: Summarizing randomized evidence with clinically relevant outcomes performed in the perioperative period
No full textHow value perspectives influence decision-making in the South African private healthcare sector: A cross-sectional comparative study.
No full textBackgroundEvery healthcare clinical event aims to create value at a certain cost. This value has been defined as the outcome achieved (the degree to which a care event achieved a clinical goal) divided by the cost incurred (determined by the combined price charged by the care provides) to generate the outcome. Subsequently, patient experience has been included as a third factor contributing to value of care, but its value and relationship relative to clinical outcome and event cost is not well understood. This cross-sectional comparative study explored the relative importance of 1) clinical outcome, 2) event cost, and 3) patient experience as they relate to the value of care in the South African private healthcare context.Materials and methodsUsing a value perspectives survey, healthcare consumers (n = 662) and healthcare providers (n = 318) distributed 100 points between the three factors according to how they perceived their value. They were then asked to assess the value of the three factors across six clinical scenarios progressing in clinical severity.ResultsFor all scenarios, all participants valued patient experience above event cost, but lower than clinical outcome. However, there were significant differences between consumers and providers in the relative value assigned to each of the three factors. These values changed as the severity of the surgical and medical scenarios changed. Patient experience was consistently assigned a higher value than event cost, thereby making a strong argument for its inclusion into the healthcare value equation.ConclusionBoth South African healthcare consumers and providers assigned significant value to patient experience across a range of clinical scenarios. These findings suggest that patient experience should be included as a factor in the Value Care Index (VCI) where VCI = (Outcome ÷ Cost) x Patient Experience
Preoperative predictors of thrombocytopenia in Caesarean delivery: is routine platelet count testing necessary?
No full textProphylactic Phenylephrine Infusions to Reduce Severe Spinal Anesthesia Hypotension During Cesarean Delivery in a Resource-Constrained Environment
No full textPreoperative predictors of thrombocytopenia in Caesarean delivery: is routine platelet count testing necessary?
No full textBackground: Peri-partum thrombocytopenia significantly impacts anaesthetic technique and increases the risk of perioperative bleeding. However, as less than 5% of normal pregnancies have significant thrombocytopenia, routine platelet testing incurs great cost for a relatively low yield. Determining whether clinical predictors, in particular HIV status, are associated with thrombocytopenia may assist clinicians in rationalising preoperative testing.Methods: This was a prospective, observational, single-centre study at a South African regional hospital. We evaluated five variables as candidate predictors for mild preoperative thrombocytopenia (< 150 000/μl) in patients scheduled for both elective and emergency Caesarean delivery: HIV status, pre-eclampsia, urgency of surgery, renal impairment and liver failure. As a subanalysis we compared the incidence of moderate thrombocytopenia (< 100 000/μl) in HIV-positive patients, with HIV-negative patients.Results: We recruited 1 015 patients to this study. The incidence of mild thrombocytopenia was 10.3% (105/1 015). Only preeclampsia was predictive of mild thrombocytopenia (odds ratio 3.51; p < 0.01; 95% confidence interval 2.12–5.82). The incidence of moderate thrombocytopenia was not influenced by HIV status (occurring in 1.5% of HIV-positive patients versus 1.8% in HIVnegative patients; p = 0.716).Conclusions: In this study of predominantly asymptomatic patients scheduled for Caesarean delivery, only pre-eclampsia was predictive of mild thrombocytopenia. In sub-analysis HIV status was not independently associated with moderate thrombocytopenia. All asymptomatic patients, including those who were HIV positive, had platelet counts > 70 000/μl.Keywords: Caesarean delivery, HIV, obstetrics, pregnancy, thrombocytopeni
Readmission and inhospital death 1 year after COVID-19 hospitalization in South Africa
No full textBACKGROUND : Acute SARS-COVID-19 infection may increase readmission risk compared to other respiratory infections. We assessed the 1-year readmission and inhospital death rates of hospitalized SARS-COVID-19 patients compared to patients hospitalized with other types of pneumonia.
METHODS : We determined the 1-year readmission and inhospital death rate of adult patients initially hospitalized with a positive SARS-COVID-19 result, and subsequently discharged, between March 2020 and August 2021, at a Netcare private hospital in South Africa, and compared this to all hospitalized adult pneumonia patients in the 3 years prior to the COVID-19 pandemic (2017–2019).
RESULTS : The 1-year readmission rate in COVID-19 patients was 6.6% (328/50,067) versus 8.5% in pneumonia patients (4699/55,439; p < 0.001), with an inhospital mortality rate of 7.7% (n = 251) and 9.7% (n = 454; p = 0.002) for COVID-19 and pneumonia patients, respectively.https://onlinelibrary.wiley.com/journal/13652796hj2024Gordon Institute of Business Science (GIBS)SDG-03:Good heatlh and well-bein
Ventricular septal defect following blunt chest trauma
No full textWe present a 32-year-old male with ventricular septal defect (VSD) following blunt chest trauma. Traumatic VSD is a rare but potentially life-threatening injury, the severity, course and presentation of which are variable. While the diagnosis of myocardial injury may be challenging, cardiac troponins are useful as a screening and diagnostic test. The proposed pathophysiological mechanisms in the development of traumatic VSD are early mechanical rupture and delayed inflammatory rupture. We conducted a literature review to investigate the pathogenesis, distribution of patterns of presentation, and the associated prognoses in patients with VSD following blunt chest trauma. We found that traumatic VSDs diagnosed within 48 hours were more likely to be severe, require emergency surgery and were associated with a higher mortality. Children with traumatic VSDs had an increased mortality risk. Smaller lesions may be managed conservatively but should be followed up to detect late complications. In both groups elective repair was associated with a good outcome
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