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  • SAGE Publications  (2)
  • Conte, John V.  (2)
  • 1
    Online Resource
    Online Resource
    Variation in Platelet Transfusion Practices in Cardiac Surgery
    SAGE Publications ; 2019
    In:  Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery Vol. 14, No. 2 ( 2019-04), p. 134-143
    Details
    In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, SAGE Publications, Vol. 14, No. 2 ( 2019-04), p. 134-143
    Abstract: Although the morbidity associated with red blood cell transfusion in cardiac surgery has been well described, the impacts of platelet transfusion are less clearly understood. Given the conflicting results of prior studies, we sought to investigate the impact of platelet transfusion on outcomes after cardiac surgery across institutions in Maryland. Methods Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative, we retrospectively analyzed data from 10,478 patients undergoing isolated coronary artery bypass across 10 centers. Platelet transfusion practices were compared between institutions. Multivariate logistic regression model was used to analyze the association between platelet transfusion and 30-day mortality and postoperative complications. Results Rates of platelet transfusion varied between institutions from 4.4% to 24.7% ( P 〈 0.001), a difference that remained statistically significant in propensity score–matched cohorts. Among patients on preoperative antiplatelet therapy, transfusion rates varied from 8.5% to 46.4% ( P 〈 0.001). There was no statistically significant relationship between case volume and transfusion rates ( P = 0.815). In multivariate logistic regression, platelet transfusion was associated with increased risk of 30-day mortality (OR 2.43, P = 0.008), postoperative pneumonia (OR 2.21, P = 0.004), prolonged intubation (OR 2.05, P 〈 0.001), and readmission (OR 1.43, P = 0.039). Conclusions Significant variation existed in platelet transfusion rates between institutions, even after controlling for various risk factors. This variation may be associated with increased mortality and length of stay. Further study is warranted to better understand risks associated with platelet transfusion. Standardizing practice may help reduce risk and conserve resources.
    Type of Medium: Online Resource
    ISSN: 1556-9845 , 1559-0879
    URL: Article
    DOI: 10.1177/1556984519836839
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2223439-1
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  • 2
    Online Resource
    Online Resource
    Long-term Follow-up of Continuous Flow Left Ventricular Assist Devices: Complications and Predisposing Risk Factors
    SAGE Publications ; 2017
    In:  The International Journal of Artificial Organs Vol. 40, No. 11 ( 2017-11), p. 622-628
    Details
    In: The International Journal of Artificial Organs, SAGE Publications, Vol. 40, No. 11 ( 2017-11), p. 622-628
    Abstract: To assess LVAD complications and their overall effect on mortality and determine factors associated with development of early and long-term complications. Methods A retrospective cohort study of patients who underwent continuous flow LVAD placement between January 1, 2000 and November 30, 2013 was performed. The incidence of complications (sepsis or bacteremia, driveline infections, gastrointestinal bleeding, pump thrombosis, cerebrovascular accidents and anemia requiring transfusion) was collected and logistic regression and Cox proportional hazards analyses were performed. Results 108 patients met our inclusion criteria. Median length of follow-up was 2.2 years. In univariable logistic regression analysis, higher blood urea nitrogen (BUN), creatinine clearance 〈 60, no prior inotrope use, higher INTERMACS class and lower platelet count were associated with early complications. On multivariable analysis, factors associated with early complications included higher BUN (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.001-1.06 per mg/dL BUN), no prior inotrope use (OR 4.92, 95% CI 1.64- 14.7) and lower platelet count (OR 4.29, 95% CI 1.45-12.7 〈 200 10(3) cu mm); 24% of patients developed early complications and 18.5% developed an early and late complication. Early complications were significantly associated with death (p = 0.017). The presence of 2 or more complications was associated with a 2.7-fold increase in the odds of death (p = 0.016) and odds of death increased by 20% with each subsequent complication (p = 0.004). Conclusions LVADs are associated with significant long-term complications including stroke and sepsis and minimizing time on LVADs may decrease the risk of complications and subsequent morbidity and mortality.
    Type of Medium: Online Resource
    ISSN: 0391-3988 , 1724-6040
    URL: Article
    DOI: 10.5301/ijao.5000628
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 1474999-3
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