Research Spotlight

Malek, A. J., S. V. Stafford, H. T. Papaconstantinou and J. S. Thomas (2021). “Initial Outcomes of a Novel Irrigating Wound Protector for Reducing the Risk of Surgical Site Infection in Elective Colectomies.” J Surg Res 265: 64-70.

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BACKGROUND: Surgical site infection (SSI) rates in elective colorectal surgery remain high due to intraoperative exposure of colonic bacteria at the surgical site. We aimed to evaluate 30-day SSI outcomes of a novel wound retractor that combines barrier protection with continuous wound irrigation in elective colorectal resection. MATERIALS AND METHODS: A retrospective single-center cohort-matched analysis included all patients undergoing elective colorectal resection utilizing the novel irrigating wound protector (IWP) from April 2015 to July 2019. A control cohort of patients who underwent the same procedures with a standard wound protector over the same time period were also identified. Patients from both groups were matched for procedure type, procedure approach, pathology requiring operation, age, sex, race, body mass index, diabetes, smoker status, hypertension, presence of disseminated cancer, current steroid or immunosuppressant use, wound classification, and American Society of Anesthesiologist classification. SSI frequency, SSI subtype (superficial, deep, or organ space), hospital length of stay (LOS) and associated procedure were tabulated through 30 postoperative days. Fisher’s exact test and number needed to treat (NNT) were used to compare SSI rates and estimate cost between both groups. RESULTS: The IWP group had 41 patients. The control group had 82 patients. Control-matched variables were similar for both groups. 30-day SSI rates were significantly lower in the IWP group (P=0.0298). length of stay was significantly shorter in the IWP group (P=0.0150). The NNT for the IWP to prevent one episode of SSI was 8.2 patients. CONCLUSIONS: The novel IWP device shows promise to reducing the risk of SSI in elective colorectal surgery.

Naidu, S. S., S. J. Baron, M. H. Eng, S. K. Sathanandam, D. A. Zidar, D. N. Feldman, F. F. Ing, F. Latif, M. J. Lim, T. D. Henry, S. V. Rao, G. D. Dangas, J. B. Hermiller, R. Daggubati, B. Shah, L. Ang, H. D. Aronow, S. Banerjee, L. C. Box, R. P. Caputo, M. G. Cohen, M. Coylewright, P. L. Duffy, A. M. Goldsweig, D. J. Hagler, B. M. Hawkins, Z. M. Hijazi, S. Jayasuriya, H. Justino, A. J. Klein, C. Kliger, J. Li, E. Mahmud, J. C. Messenger, B. H. Morray, S. A. Parikh, J. Reilly, E. Secemsky, M. H. Shishehbor, M. Szerlip, S. J. Yakubov, C. L. Grines, J. Alvarez-Breckenridge, C. Baird, D. Baker, C. Berry, M. Bhattacharya, S. Bilazarian, R. Bowen, K. Brounstein, C. Cameron, R. Cavalcante, C. Culbertson, P. Diaz, S. Emanuele, E. Evans, R. Fletcher, T. Fortune, P. Gaiha, D. Govender, D. Gutfinger, K. Haggstrom, A. Herzog, D. Hite, B. Kalich, A. Kirkland, T. Kohler, H. Laurisden, K. Livolsi, L. Lombardi, S. Lowe, K. Marhenke, J. Meikle, N. Moat, M. Mueller, R. Patarca, J. Popma, N. Rangwala, C. Simonton, J. Stokes, M. Taber, C. Tieche, J. Venditto, N. E. J. West and L. Zinn (2021). “Hot topics in interventional cardiology: Proceedings from the society for cardiovascular angiography and interventions (SCAI) 2021 think tank.” Catheter Cardiovasc Interv.

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The Society for Cardiovascular Angiography and Interventions (SCAI) Think Tank is a collaborative venture that brings together interventional cardiologists, administrative partners, and select members of the cardiovascular industry community annually for high-level field-wide discussions. The 2021 Think Tank was organized into four parallel sessions reflective of the field of interventional cardiology: (a) coronary intervention, (b) endovascular medicine, (c) structural heart disease, and (d) congenital heart disease. Each session was moderated by a senior content expert and co-moderated by a member of SCAI’s Emerging Leader Mentorship program. This document presents the proceedings to the wider cardiovascular community in order to enhance participation in this discussion, create additional dialog from a broader base, and thereby aid SCAI, the industry community and external stakeholders in developing specific action items to move these areas forward.

Cook, E. E., J. Davis, R. Israni, F. Mu, K. A. Betts, D. Anzalone, L. Yin, H. Szerlip, G. I. Uwaifo, V. Fonseca and E. Q. Wu (2021). “Prevalence of Metabolic Acidosis Among Patients with Chronic Kidney Disease and Hyperkalemia.” Adv Ther Sept 1. [Epub ahead of print].

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INTRODUCTION: Although hyperkalemia and metabolic acidosis often co-occur in patients with chronic kidney disease (CKD), the prevalence of metabolic acidosis among patients with CKD and hyperkalemia is understudied. Therefore, we used medical record data from the Research Action for Health Network to estimate this prevalence. METHODS: Adult patients with CKD stage 3-5, ≥ 1 outpatient potassium value > 5.0 mEq/l, and ≥ 1 outpatient bicarbonate value available were identified. Patients with end stage kidney disease (ESKD) in the prior year were excluded. The prevalence of metabolic acidosis in each calendar year from 2014 to 2017 among patients with CKD and hyperkalemia was estimated using two definitions of hyperkalemia (potassium > 5.0 mEq/l and > 5.5 mEq/l) and metabolic acidosis (bicarbonate < 18 mEq/l and < 22 mEq/l). RESULTS: In the 2017 patient cohort and among patients with CKD and hyperkalemia, patients with metabolic acidosis were younger (69 versus 74 years), more likely to have advanced CKD (35% versus 13%), and use oral sodium bicarbonate (21% versus 4%) than patients without metabolic acidosis. The prevalence of metabolic acidosis (< 22 mEq/l) ranged from 25 to 29% when hyperkalemia was defined by potassium > 5.0 mEq/l and ranged from 33 to 39% when hyperkalemia was defined by potassium > 5.5 mEq/l. CONCLUSION: Results demonstrated that prevalence estimates of metabolic acidosis varied based on the definition of hyperkalemia and metabolic acidosis utilized.

Squiers, J. J., S. Ghamande, T. Qiu, C. Robinson, C. Bertschy, A. C. Arroliga and W. Peters (2021). “Universal preprocedural SARS-CoV-2 testing protocol within a large healthcare system.” Br J Surg Aug 9;znab216. [Epub ahead of print].

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The Baylor Scott & White Health system is comprised of hospitals throughout Central and North Texas, USA. A preprocedural SARS-CoV-2 screening and testing protocol was implemented at 25 hospitals within the system before aerosolizing or potentially aerosolizing procedures, including any requiring endotracheal intubation or conscious sedation. Patients were screened for any symptoms of SARS-CoV-2 infection and, if asymptomatic, tested within 72 h of the scheduled procedure. Testing was performed via nasopharyngeal swabs evaluated with reverse transcriptase–PCR assays (Table S1). All preprocedural tests were designated as such by the ordering provider to distinguish these tests from those ordered for other reasons. Procedures for patients testing positive were delayed unless considered as an emergency.

Squiers, J. J., J. M. Schaffer, J. K. Banwait, W. H. Ryan, M. J. Mack and J. M. DiMaio (2021). “Long-Term Survival After On-Pump and Off-Pump Coronary Artery Bypass Grafting.” Ann Thorac Surg Aug 16;S0003-4975(21)01427-2. [Epub ahead of print].

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BACKGROUND: Off-pump coronary artery bypass grafting (CABG) may be associated with increased hazard for long-term mortality as compared to on-pump CABG. We sought to evaluate risk-adjusted long-term survival after off-pump and on-pump CABG, particularly among high-volume and low-volume CABG surgeons. METHODS: We evaluated 1,235,089 isolated CABGs (off-pump = 209,085; on-pump = 1,026,004) performed in Medicare beneficiaries from 2001-2015. Long-term hazard for mortality after off-pump versus on-pump CABG was compared with Kaplan-Meier and log-rank analysis among all CABG surgeons as well as high-volume and low-volume CABG surgeons, before and after inverse-probability of treatment weighting (IPTW) to adjust for confounding. RESULTS: Among all surgeons, off-pump CABG was associated with a statistically-significant hazard for mortality as compared to on-pump CABG before and after IPTW (median survival: off-pump 9.8 years vs on-pump 10.2 years; difference in median survival -134 days; log-rank p<0.001). Cox regression analysis confirmed an interaction between surgeon volume and long-term mortality. The hazard for mortality associated with off-pump CABG was decreased among high-volume surgeons (difference in median survival: -84 days; log-rank p<0.001) and increased among low-volume surgeons (difference in median survival: -240 days; long-rank p<0.001). CONCLUSIONS: Off-pump CABG was associated with a significant, but clinically modest, increased hazard for mortality as compared to on-pump CABG. The hazard was reduced when off-pump CABG was performed by high-volume CABG surgeons.