Significant Difference In Mortality Research Articles

Impact of early oral feeding on postoperative outcomes after elective colorectal surgery: a systematic review and meta-analysis

Introduction: This study aimed to evaluate the influence of early oral feeding (EOF), a key component of enhanced recovery after surgery protocols, on postoperative outcomes in patients undergoing elective colorectal surgery. Methods: We searched the Medline, Embase, Cochrane Library, and KoreaMed databases to include randomized clinical trials comparing EOF that started on postoperative day 1 and conventional oral feeding that commenced after first flatus. Two authors independently screened the retrieved records and extracted data. The primary outcome was total complications. Data were pooled, and the overall effect size was calculated. Results: We screened 13 studies, and 1,556 patients were included in the analysis. The EOF group exhibited fewer total complications (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.38 to 0.65). Anastomotic leakage was also reduced in the EOF group (OR 0.40; 95% CI 0.19 to 0.83); however, an increased incidence of vomiting (OR 1.58; 95% CI 1.11 to 2.26) as well as a tendency of higher rate of nasogastric tube reinsertion (OR 1.49; 95% CI 0.96 to 2.31) were observed. The EOF group demonstrated a decreased time to flatus (mean difference [MD] -0.87; 95% CI -1.00 to -0.74) and shortened hospital stay (MD -0.76; 95% CI -0.89 to -0.6). No significant difference in mortality was observed between the two groups (OR 0.54; 95% CI 0.15 to 2.01). Conclusion: EOF proved to be a safe and effective practice for patients undergoing elective colorectal surgery. However, the increased incidence of vomiting necessitates careful consideration.

Comparison of the outcomes between ultrasonic devices and clamping in hepatectomy: a meta-analysis.

Recent advances in ultrasound technology have led to widespread adoption of ultrasonic energy devices in liver resections. While various studies have assessed the comparative advantages of ultrasonic devices and traditional clamp-crushing, their findings vary. Moreover, a specific systematic review on this topic has not yet been conducted. This study aims to present a comprehensive, up-to-date analysis comparing outcomes between ultrasonic devices and conventional clamp-crushing methods in liver resection, based on currently available literature. We conducted a systematic literature search in databases such as PubMed, Embase, Web of Science, and CNKI up to November 2023. Studies that compared the efficacy or safety of ultrasonic devices against traditional clamp-crushing methods in hepatectomy were included. The analysis covered intraoperative outcomes like operating time, blood loss, and transfusion rate, as well as postoperative outcomes such as complication rate, mortality, postoperative bleeding, and bile leakage. Review Manager version 5.3 (Cochrane Collaboration, Oxford, UK) and Stata 17.0 (Stata Corp, College Station, TX, USA) were used for data analysis. Thirteen studies, involving a total of 1,417 patients (630 using ultrasonic devices and 787 using clamp-crushing methods), were included. The clamp-crush method resulted in a shorter operation time. Contrarily, the ultrasonic device group experienced reduced blood loss and lower transfusion rates. Postoperatively, there was no significant difference in mortality or postoperative bleeding between the groups. However, the ultrasonic group had a lower overall complication rate, particularly a reduced incidence of bile leakage. Overall, the ultrasonic devices were associated with improved perioperative outcomes. The findings suggest that ultrasonic devices provide better outcomes in hepatectomy compared to traditional clamp-crushing techniques. Nonetheless, large-scale randomized controlled trials are needed to confirm these results due to potential heterogeneity and biases. The choice of using ultrasonic devices should consider the surgeon's experience and individual patient circumstances.

The perioperative frailty index derived from the Chinese hospital information system: a validation study.

There are various frailty assessment tools in the world, and the application choice of frailty assessment tools for the elderly perioperative population varies. It remains unclear which frailty assessment tool is more suitable for the perioperative population in China. To validate the Perioperative Frailty Index (FI-32) derived from the Chinese Hospital Information System by investigating the impact of preoperative frailty on postoperative outcomes, and ascertain the diagnostic value of FI-32 for predicting postoperative complications through comparing with the FRAIL scale and the modified Frailty Index (mFI-11). A prospective cohort study was conducted in a tertiary hospital. Elderly patients who were 60 years or older and underwent selective operation were included. The FI-32, FRAIL scale, and mFI-11 were assessed. Demographic, surgical variables and outcome variables were extracted from medical records. The data of readmission and mortality within 30 days and 90 days of surgery were ascertained by Telephone follow-up by professionally trained researchers. Multiple logistic regression was used to examine the association between frailty and complications. Receiver operating characteristic curves(ROC) were used to compare FI-32 with mFI-11 and FRAIL, to explore the predictive ability of frailty. 335 patients qualified for the inclusion criteria and were enrolled in the study, and among them, 201 (60.0%) were females, and the Median(P25, P75)age at surgery was 69 (65,74) years. The prevalence of frailty in the study population was 16.4% (assessed by FI-32). After adjusting for concomitant variables including demographic characteristics (such as gender, BMI, smoking, drinking, average monthly income and educational level) and surgical factors (such as surgical approach, surgical site, anesthesia method, operation time, intraoperative bleeding, and intraoperative fluid intake), there was a statistically significant association between frailty and the development of postoperative complication after surgery (OR = 3.051, 95% CI:1.460-6.378, P = 0.003). There were also significant differences in mortality within 30 days of surgery, the length of hospital stay (LOS) and the hospitalization costs. FI-32, FRAIL and mFI-11 showed a moderate predictive ability for postoperative complications, the Area Under Curves (AUCs) were 0.582, 0.566 and 0.531, respectively. With adjusting concomitant variables associated with postoperative complications, the AUCs of FI-32, FRAIL and mFI-11 in the adjusted prediction models were 0.824, 0.827 and 0.820 respectively. The FI-32 has a predictive effect on postoperative adverse outcomes in elderly Chinese patients. Compared to FRAIL and mFI-11, the FI-32 had the same ability to predict postoperative complications, and FI-32 can be extracted directly from HIS, which greatly saves the time for clinical medical staff to evaluate perioperative frailty.

Preventive effects of nitric oxide donors in contrast-induced nephropathy in patients undergoing coronary artery angiography: an updated systematic review and meta-analysis of 13 randomized controlled trials.

Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). We aimed to assess the latest evidence on the preventive effects of nitric oxide (NO) donors in CIN patients undergoing CAG/PCI. We conducted a comprehensive systematic review and meta-analysis of RCTs from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until May 5th, 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3). Our analysis included 13 RCTs encompassing 3,550 patients. NO donors were significantly associated with a decreased incidence of CIN compared to placebo either as an oral administration (RR: 0.33 with 95% CI [0.26, 0.42], P < 0.01) or IV infusions (RR: 0.56 with 95% CI [0.40, 0.78], P < 0.01). Moreover, NO donors were significantly associated with decreased serum creatinine levels compared to placebo either as an oral administration (MD: - 0.07 with 95% CI [- 0.10, - 0.04], P < 0.01) or IV infusions (MD: - 0.07 with 95% CI [- 0.09, - 0.04], P < 0.01). In terms of safety, NO donors were significantly associated with a decreased incidence of major adverse cardiac events (MACE) compared to placebo as an oral administration (RR: 0.64 with 95% CI [0.45, 0.89], P < 0.01). However, there was no significant difference between NO donors as IV infusions and placebo in MACE (RR: 0.68 with 95% CI [0.38, 1.21], P = 0.18). Finally, NO donors were significantly associated with a decreased incidence of all-cause mortality compared to placebo as an oral administration (RR: 0.58 with 95% CI [0.36, 0.94], P = 0.03). Nevertheless, there was no statistically significant difference in all-cause mortality between IV infusions of NO donors and placebo (RR: 1.84 with 95% CI [0.40, 8.52], P = 0.44). NO donors as adjunct therapy are associated with reduced incidence of CIN and decreased serum creatinine levels, either as an oral or IV administration. They were also associated with reduced incidence of MACE, all-cause mortality, and recurrent myocardial infarction as an oral administration, which makes this simple, low-cost intervention an important therapeutic option in patients undergoing CAG/PCI.

Utilization rates and heart transplantation outcomes of donation after circulatory death donors with prior cardiopulmonary resuscitation.

Heart donation after circulatory death (DCD) involves mandatory exposure to warm ischemic injury (WII) due to donor cardiac arrest resulting from withdrawal of life-support (WLS). However, potential DCD donors may also experience a cardiac arrest and undergo cardiopulmonary resuscitation (CPR) and associated WII before WLS. We sought to investigate the effect of previous donor-CPR in DCD heart-transplantation (HT). Between January-2020 and April-2023, we identified 11,415 adult HTs in UNOS of whom 9456 met study criteria and had information on donor-CPR. Follow-up was available till April-2024. Study cohort was divided into four groups based on DCD vs. donation after brain death (DBD) status and donor-CPR i.e., DCD/CPR+ (n = 387), DCD/noCPR (n = 305), DBD/CPR+ (n = 5158) and DBD/noCPR (n = 3606); and compared for HT characteristics and outcomes. With DBD/noCPR HTs as reference cohort, there were no significant differences in mortality in other HT cohorts (DCD/CPR+, DCD/noCPR and DBD/CPR+) upto 1-year of follow up using Kaplan-Meier analysis; and both unadjusted and adjusted Cox hazards-ratio models. Results were similar in propensity-matched cohorts. Duration of donor-CPR (≤20 min vs >20 min) did not influence HT survival; and rates of in-hospital secondary outcomes were similar. The utilization rates of both adult DCD/CPR+ (3.39 % to 9.71 %) and DCD/noCPR donors (4.41 % to 10.34 %) increased significantly (p < 0.01) during study period. The utilization rates of both DCD/CPR+ and DCD/noCPR donors have increased at an equal pace. A significant proportion of DCD HTs were from donors with prior CPR, but this was not associated with worse short-term survival.

HPB SO45 - Level 1 evidence comparing aggressive versus non-aggressive intravenous fluid therapy in acute pancreatitis

Abstract Background Fluid balance in the management of acute pancreatitis (AP) is challenging and has been described as a “double-edged sword” whereby adequate fluids are required to counteract systemic hypovolaemia whilst excessive fluids may exacerbate systemic oedema. Given that data generated from randomised studies are conflicting, the optimal rate and type of fluid resuscitation for AP are yet to be determined. We aimed to perform a comprehensive meta-analysis of all existing randomized controlled trials (RCTs) to evaluate comparative outcomes of aggressive versus non-aggressive intravenous fluid (IVF) therapy in patients with AP. Method A systematic search of electronic data sources and bibliographic reference lists were conducted. All RCTs reporting outcomes of aggressive versus non-aggressive IVF therapy in AP were included and their risk of bias were assessed. Effect sizes were determined for overall mortality, systemic inflammatory response syndrome (SIRS), sepsis, respiratory failure, pancreatic necrosis, severe pancreatitis, clinical improvement, AKI, and length of stay using random-effects modelling. Trial sequential analysis was conducted to determine risk of types 1 or 2 errors. Results Ten RCTs enrolling 993 patients with AP who received aggressive (n = 475) or non-aggressive (n = 518) IVF therapy were included. Aggressive IVF therapy was associated with significantly higher rate of sepsis (OR:2.68, P=0.0005) and longer length of stay (MD:0.94, P&amp;lt;0.00001). There was no statistically significant difference in mortality (RD:0.02, P=0.31), SIRS (OR:0.93, P=0.89), respiratory failure (OR:2.81, P=0.07), pancreatic necrosis (OR:1.98, P = 0.06), clinical improvement (OR:1.12, P=0.83), severe pancreatitis (OR:1.31, P=0.38) or AKI (OR:1.06, P=0.91). Subgroup analysis demonstrated higher morbidity and mortality with aggressive fluids in severe AP. Trial sequential analysis detected risk of type 2 error. Conclusion Aggressive IVF therapy may be associated with higher morbidity in patients with acute pancreatitis compared with the non-aggressive approach, particularly in patients with more severe disease. It may also prolong length of hospital stay. The available evidence is subject to type 2 error indicating the need for adequately powered RCTs.

The effect of interhospital transfer on pediatric burn injury mortality in a resource-limited setting.

The World Health Organization's burn mortality estimate is 180,000 annually. Ninety-five percent of all mortality caused by fire-related burns worldwide occurs in low- and middle-income countries (LMICs). Prior studies have shown that transfer status (direct transfer from an injury scene to a trauma center vs. indirect transfer from another health facility) affects patient outcomes. We evaluated the effect of interhospital transfer on burn mortality. We analyzed a burn database of pediatric patients admitted to the Kamuzu Central Hospital (KCH) burn unit in Lilongwe, Malawi. We performed a bivariate analysis based on their transfer status and mortality and a logistic regression analysis to determine the effect of transfer status on mortality after burn injury. A total of 2301 patients were analyzed, with 1095 (47.6%) being in the transfer cohort from referring hospitals. The median age was 3years (IQR 1-4). The transfer cohort had more patients presenting to the hospital more than 48h after injury. Upon multivariate logistic regression, controlling for pertinent variables, including time to presentation, burn-injured patients in the transfer cohort had increased odds of mortality (OR 2.26, 95% CI 1.22-4.19, and p=0.01) compared to patients who were not transferred. The predictive probabilities of burn mortality by TBSA showed significant differences in mortality based on transfer status at TBSA between 20% and 80%. Ensuring district hospitals and other primary health care centers in resource-limited settings are sufficiently equipped to provide initial burn resuscitation and care may decrease mortality rates associated with transferred patients.

HPB O05 - Changing paradigms in the management of severe acute pancreatitis: Focused multi-disciplinary working between surgeons and intensivists to mitigate organ failure in order to reduce mortality

Abstract Background Mortality was classically bimodal in severe acute pancreatitis and organ failure is the single most important factor in predicting outcome in severe acute pancreatitis. Initial interventions are supportive often requiring critical care. Subsequently treatments are required to manage necrosis and any organ recovery remains under threat. The outcomes and interventions from surgery and critical care are reviewed to determine how to balance organ failure and the need for necrosectomy in a modern multi-disciplinary tertiary care centre Method The Royal Liverpool provides a tertiary service to all patients with pancreatitis across Merseyside and North Wales. All patients that were transferred to critical care from 2018 – 2023 were analysed using the intensive care national audit and research centre database which contains information on organ failure. The patients with severe pancreatitis were then reviewed using electronic clinical notes and radiology images to determine clinical course and management. Results Of 134 patients, 48 (36%) were admitted locally, 85 (64%) transferred in, occurring 35% &amp;lt;2weeks, 29% 2-4weeks, 28% 4-6weeks and 8% &amp;gt;8weeks. 76 (57%) required necrosis intervention, 58 (43%) were conservatively managed. Mortality was 38% with 35% &amp;lt;4weeks, 22% 4-8weeks, 22% 8-12weeks, 22% &amp;gt;12weeks. No significant difference in mortality between conservative or interventional management (15 (45%) vs 18 (55%)) nor median age (58 vs 57.5 yrs). Survival related to number of failing organs (dead vs alive): nil organs: 10 patients vs 27 patients (20%vs32%), One: 11 vs 45 (22%vs45%), Two: 21 vs 9 (42%vs11%), Three: 8 vs 3 (16%vs4%), p&amp;lt;0.005. Conclusion Of patients deemed fit for ITU admission with necrotising pancreatitis, the classic paradigms of biphasic mortality no longer occur. Differences in mortality from intervention and age of patient has been negated by optimal ITU management for organ failure. For the initial phases and the intervention phases of management, ensuring degree of organ failure is key to survival. There is a significant change when two organs fail in mortality and this stresses the importance of holistic management. Our ITU promotes pancreas specific organ preservation measures of early enteral feeding, cessation/tailoring of antibiotics, early extubation/tracheostomy and most importantly multidisciplinary working

EGS SO11 - A Retrospective Review of Perioperative Outcomes after Laparoscopic Cholecystectomy in Older Patients

Abstract Background Laparoscopic cholecystectomy is the definitive treatment for gallstone-related disease. With an increasingly aging population, a growing number of elderly patients are presenting acutely with gallstone pathology. However, rates of perioperative mortality and complications are significantly higher in elderly patients undergoing laparoscopic cholecystectomy (Kamarajah et al). We aim to evaluate peri-operative outcomes in elderly patients presenting with acute gallstone disease who have been clinically evaluated to be appropriate for emergency cholecystectomy, and explore the impact of frailty on these outcomes. Method A retrospective study was performed on patients over the age of 75 presenting acutely with gallstone disease over a 3-year period. Data on perioperative complications, mortality at 1 year, post-operative length of stay (LOS) and 90-day readmissions were collected and analysed. The patient’s pre-operative fitness was categorized using the ASA classification of physical status and the Clinical frailty score (CFS); a 9-point scale quantifying frailty based on function. Statistical significance was assessed to determine differences between the age or frailty score groups. Results 592 patients attended hospital with gallstone-related pathology; 99 patients underwent emergency laparoscopic cholecystectomy, 486 patients were managed conservatively, and 25 patients had cholecystostomies. The post-operative mortality rate was 4%, post-operative complication 19.2% and readmission rate 11.1%. Post-operative LOS was significantly longer in frailer patients (p=0.02299). There were no statistically significant differences in mortality or post-operative complications between the CFS3 or less and CFS4 or more groups, although a general trend towards higher rates of complications and mortality was noted with increasing frailty. Conclusion Patients over 75 years of age should be carefully considered before proceeding with surgical management. Although older and frailer patients exhibited increased rates of complications and mortality post-operatively, these didn't reach statistical significance, reflecting the role of clinical decision-making regarding surgical fitness. Even for a pre-selected patient group, there is statistically significant prolonged post-operative LOS in frailer patients. This suggests a need for comprehensive preoperative assessment in this population, and a combination of CFS and ASA may be key determinants. Further studies assessing frailty and non-operative outcomes are required to substantiate these findings and guide clinical management in this population.

Preclinical safety and efficacy evaluation of the intrathecal transplantation of GMP-grade human umbilical cord mesenchymal stem cells for ischemic stroke

Intrathecal administration of human umbilical cord mesenchymal stem cells may be a promising approach for the treatment of stroke, but its safety, effectiveness, and mechanism remain to be elucidated. In this study, good manufacturing practice–grade human umbilical cord mesenchymal stem cells (5 × 105 and 1 × 106 cells) and saline were administered by cerebellomedullary cistern injection 72 hours after stroke induced by middle cerebral artery occlusion in rats. The results showed (1) no significant difference in mortality or general conditions among the three groups. There was no abnormal differentiation or tumor formation in various organs of rats in any group. (2) Compared with saline-treated animals, those treated with human umbilical cord mesenchymal stem cells showed significant functional recovery and reduced infarct volume, with no significant differences between different human umbilical cord mesenchymal stem cell doses. (3) Human umbilical cord mesenchymal stem cells were found in the ischemic brain after 14 and 28 days of follow-up, and the number of positive cells significantly decreased over time. (4) Neuronal nuclei expression in the human umbilical cord mesenchymal stem cell group was greater than that in the saline group, while glial fibrillary acidic protein and ionized calcium binding adaptor molecule 1 expression levels decreased. (5) Human umbilical cord mesenchymal stem cell treatment increased the number of CD31+ microvessels and doublecortin-positive cells after ischemic stroke. Human umbilical cord mesenchymal stem cells also upregulated the expression of CD31+/Ki67+. (6) At 14 days after intrathecal administration, brain-derived neurotrophic factor expression in the peri-infarct area and the concentrations of brain-derived neurotrophic factor in the cerebrospinal fluid in both human umbilical cord mesenchymal stem cell groups were significantly greater than those in the saline group and persisted until the 28th day. Taken together, these results indicate that the intrathecal administration of human umbilical cord mesenchymal stem cells via cerebellomedullary cistern injection is safe and effective for the treatment of ischemic stroke in rats. The mechanisms may include alleviating the local inflammatory response in the peri-infarct region, promoting neurogenesis and angiogenesis, and enhancing the production of neurotrophic factors.

Abstract 4138225: In-Hospital Outcomes of Percutaneous Coronary Intervention (PCI) in patients primarily admitted with ST-Elevation Myocardial Infarction (STEMI) at PCI centers versus patients transferred from non-PCI centers, a retrospective study involving the National Inpatient Sample (NIS 2016-2021) database.

Background: Timely transfer for PCI is paramount in the management of STEMI. This has been shown to reduce myocardial damage, optimize reperfusion therapy and mitigate the post procedural complications associated with PCI. This study's aim was to describe the in-hospital outcomes associated with acute inter-hospital transfer of patients with STEMI for PCI in comparison with patients directly admitted to a primary PCI center. Methods: The National Inpatient Sample (NIS) was used to identify patients who underwent PCI for STEMI between the years 2016-2021. Based on several transfer indicators, primarily admitted patients and patients with acute inter-hospital transfer were identified. Logistic and linear regression models were used to analyze the primary outcome of in-hospital mortality and secondary outcomes of length of hospital stay, hospital charge, and occurrences of post-procedure complications. Results: Observations were weighted to obtain a national estimate of 748,430 patients with known transfer status who underwent PCI for STEMI. Of these, 625,520 patients were primarily admitted at PCI centers and 122, 910 patients were transferred from non-PCI centers. The mean age of patients with STEMI undergoing PCI was 62 years, and 72 % of the patients were male. There was no significant difference in mortality between patients transferred and patients primarily admitted for PCI due to STEMI. However, patients transferred had longer hospital stay and significantly higher healthcare cost, with a mean difference of 0.72 days (95% CI: 0.65 - 0.81 days, p-value &lt;0.000) and $3,354 (95% CI: $339 - $6371, p-value &lt;0.029), respectively. Patients transferred also had significantly higher odds of post procedure complications, including cardiogenic shock (Odds ratio: 1.49, 95% CI: 1.08 - 2.06, p-value &lt;0.014), cerebrovascular accident (Odds ratio: 3.64 , 95% CI: 1.15 - 11.45, p-value &lt;0.014) and kidney failure (Odds ratio: 2.10 , 95% CI: 1.09 - 4.02, p-value &lt;0.026). Conclusion: Patients with STEMI who were transferred for PCI experienced longer hospital stay and incurred higher healthcare costs. These patients had significantly higher odds of post procedure complications including cardiogenic shock, cerebrovascular accidents and kidney failure.

Abstract 4140149: Differences in Interventional Treatment Outcomes of Peripheral Arterial Disease between African American Females, African American Males, and Caucasian Females

Introduction: Several recent publications demonstrated worse outcomes of interventional treatment of peripheral arterial disease (PAD) in patients of African American (AA) descent compared to Caucasians (C), and in female patients compared to male patients. However, studies addressing sex differences in outcomes, included predominantly white female patients. To our knowledge, there are no published studies specifically addressing outcomes of interventional treatment of PAD in female patients of African American descent. Aims: 1. To determine if the outcomes of interventional treatment of PAD in female patients of African American (FAA) descent differ from male African American patients (MAA), and Caucasian female patients (FC). If such differences exist, to identify factors associated with it. Methods: This study has a cross-sectional design with systematically retrospective data collection by the National Vascular Quality Initiative. Included in this study was data on patients treated with endovascular and open surgical options for symptomatic PAD. Statistical analysis was done using IBM Statistic SPSS V25. Results: 447,263 unique cases containing required data were available in the VQI database. Among them, 171,250 were female patients, of which 32,966 were FAA, 126,519 FC, and 39,461 MAA. This race and gender distribution is not significantly different from the US population structure (US Census Bureau 2023). 1 However, female to male ratio was higher in AA (0.83) compared to C (0.58, p&lt;0.0001). FAA were younger (65.143+/-9.59) compared to FC (69.16+/-10.32, P&lt;0.00001). Comparison of comorbidities, smoking rates, pre-interventional medications and post-interventional outcomes are listed in Table 1. Multivariate analysis confirmed higher amputation rate among FAA compared to FC and to MAA and showed no significant difference in mortality. Conclusions: FAA patients who require interventional treatment for PAD have significantly higher rate of hypertension and diabetes compared to FC and MAA patients and have higher amputation rates. It appears that differences in clinical outcomes of PAD treatment in FAA are related mostly if not entirely to poorly managed comorbidities existed prior to intervention.

Abstract 4124281: Dexmedetomidine for junctional ectopic tachycardia in patients undergoing tetralogy of Fallot repair: a meta-analysis of randomized controlled trials

Background: Junctional ectopic tachycardia (JET) occurs in 2 to 22% of patients after cardiac surgery for congenital heart diseases, including tetralogy of Fallot (TOF) repair. Dexmedetomidine emerged as a potential drug to prevent JET in these patients. This systematic review and meta-analysis aimed to evaluate the efficacy of dexmedetomidine in JET in patients undergoing TOF repair. Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the use of dexmedetomidine in patients undergoing TOF repair. We pooled risk ratios (RR) for binary outcomes, and mean differences (MD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of incidence of JET. We used R version 4.3.2 and TSA version 0.5.9.10 for statistical analyses. Results: Our meta-analysis included 5 RCTs comprising 546 patients, of whom 268 (49%) were randomized to dexmedetomidine. Compared with control, dexmedetomidine significantly reduced the incidence of JET (RR 0.46; 95% CI: 0.30 to 0.71; p&lt;0.05; Figure A). However, there were no significant differences in mortality (RR 0.45; 95% CI: 0.12 to 1.71; p=0.24; Figure B) between groups. In addition, dexmedetomidine also reduced the length of intensive care unit (ICU) stay (MD -7.75 hours; 95% CI: -15.08 to -0.41; p&lt;0.05; Figure C). There were no significant differences in ionotropic score (MD -0.97 ug.min/Kg; 95 % CI: -1.98 to 0.18; p=0.10; Figure D), and ventilation time (MD -2.29 hours; 95% CI: -8.39 to 2.41; p=0.27; Figure E). For the primary endpoint, TSA suggested a low risk of type 1 error; therefore, this result may be conclusive. Conclusion: In patients undergoing TOF repair surgery, dexmedetomidine significantly reduced the incidence of JET and the length of ICU stay.

Abstract 4125493: Is There an Obesity Paradox for Cardiovascular Outcomes in Patients Undergoing Transcatheter Edge-to-Edge Repair? A Pilot Meta-Analysis

Background: The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an 'obesity paradox' exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI. Methodology: We conducted a systematic literature search using major databases to identify studies investigating the association between baseline BMI status and post-procedural outcomes in patients undergoing TEER. Patients were categorized into four BMI groups: underweight (BMI &lt; 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25-29.9 kg/m 2 ), and obese (BMI ≥ 30 kg/m 2 ). The endpoints included were the risk of in-hospital mortality, myocardial infarction, and stroke. Data were pooled using Review Manager with a random-effects model. Risk ratios (RRs) with their 95% confidence intervals (CIs) were used as the effect measure. Statistical significance was set at p&lt;0.05. Results: Our study included a total of six observational studies, encompassing 7,627 obese and 74,820 non-obese patients. The outcome of in-hospital mortality revealed no significant difference between the two groups (RR: 0.85; 95% CI: 0.57, 1.27; p=0.43). Subgroup analysis showed a trend towards higher in-hospital mortality risk for underweight patients compared to overweight (RR: 1.48; 95% CI: 1.11, 1.95; p=0.007) and obese patients (RR: 1.40; 95% CI: 1.02, 1.92; p=0.04). The comparison between underweight and normal-weight patients did not reach statistical significance (RR: 1.18; 95% CI: 0.91, 1.55; p=0.22). Additionally, the risk of myocardial infarction (RR: 1.10; 95% CI: 0.77, 1.58; p=0.59) and stroke (RR: 0.43; 95% CI: 0.13, 1.42; p=0.17) did not differ significantly between obese and non-obese patients. Conclusions: Our study found no significant difference in in-hospital mortality between obese and non-obese patients. However, underweight patients had a higher mortality risk compared to both overweight and obese patients. While myocardial infarction rates were similar across all groups, there was a non-significant trend suggesting a potentially lower risk of stroke in obese patients. These findings warrant further prospective studies to provide robust evidence.

Abstract 4135984: Comparison of Immediate and Staged Complete Revascularization in STEMI Patients with Multivessel Disease: Meta-Analysis of Randomized Controlled Trial

Background: Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) frequently present with multivessel coronary artery disease (CAD) at the time of primary percutaneous coronary intervention (PCI). The optimal timing of complete revascularization (CR) in these cases remains a subject of ongoing debate. Objective: To assess major cardiovascular outcomes and procedural complications in STEMI patients with multivessel CAD undergoing immediate versus staged CR post index procedure. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate to staged CR in STEMI and multivessel CAD. Trials were identified via a systematic search of MEDLINE, Embase, and Cochrane Libraries from database inception to March 6, 2024. The data were analyzed using RevMan software. Results: Among five RCTs (n=1,415) the majority of participants were male, the weighted mean follow-up duration across studies was 15.6 months. Immediate versus staged CR showed no significant differences in MACE (13.3% vs 9.8%; RR: 1.07, 95% CI [0.62, 1.83]), all-cause mortality (3% vs 4.55%; RR: 0.70, 95% CI [0.41, 1.21]), or MI (4.5% vs 2.6%; RR: 1.43, 95% CI [0.58, 3.55]). However, the staged group had higher unplanned revascularization incidence (8.6% vs 4.4%; RR: 1.92, 95% CI [1.21, 3.04]). Conclusion: Staged revascularization in STEMI patients with multivessel CAD demonstrates comparable effectiveness to immediate revascularization but leads to a greater number of unplanned revascularization procedures, likely due to delayed intervention. The early implementation of staged PCI during the initial hospitalization phase may provide equivalent efficacy to immediate complete revascularization. Nonetheless, further research is necessary to corroborate these findings.

Abstract 4127931: Chronic Steroid Use is Associated with Increased Readmission Rates in Patients Admitted with Acute Coronary Syndromes

Introduction: Acute coronary syndrome (ACS) is associated with significant morbidity and mortality. Management of ACS includes percutaneous coronary intervention (PCI) and requires the use of antithrombotic therapy, which increases bleeding risk. Chronic steroid use (CSU) is common for many diseases and is also associated with bleeding risk and impaired wound healing. However, data on outcomes of patients with CSU and AMI are sparse. Methods: Patients admitted for ACS and managed with PCI from 2014 to 2020 with and without CSU were identified using the National Readmissions Database (NRD). In-hospital outcomes include death, arterial thrombosis (composite of ischemic stroke and arterial thromboembolism), and major bleeding (composite of gastrointestinal, intracranial, or post-procedure bleeding or transfusion). Ninety-day readmission outcomes were cardiovascular (CV)-related, bleeding-related and all-cause. Multivariable logistic or Cox proportional hazards were utilized. Results: A total of 1,087,357 patients with ACS were included, of whom, 9,864 (0.9%) had CSU. After multivariable adjustment, there was no significant difference in in-hospital mortality (3.1% vs 3.2%; OR 1.09, 95% CI 0.93-1.26) or risk of arterial thrombosis (3.3% vs 2.8%; OR 0.91, 95% CI 0.81-1.02) between patients with and without CSU. CSU was associated with an increased risk of major bleeding events (8.3% vs 6.0%; OR 1.15, 95% CI 1.06-1.25). CSU was associated with a higher risk of CV-related (10.7% vs 7.5%; HR 1.10, 95% CI 1.02-1.18), bleeding-related (2.3% vs 1.2%; HR 1.28, 95% CI 1.09-1.51), and all-cause 90-day readmissions (23.9% vs 14.9%; HR 1.28, 95% CI, 1.22-1.34). Conclusion: Among patients admitted with ACS who underwent PCI, CSU was associated with increased risk of bleeding during index hospitalization and readmissions for bleeding. Furthermore, CSU was associated with increased risk of 90-day CV and all-cause readmission. Further studies are needed to better characterize this risk.

Abstract 4137869: Ross Procedure for Correction of Congenitally Unicuspid Aortic Valve: A Paradigm Shift?

Case 1: A 54-yr-old man reported exertional dyspnea for 3 months, with a systolic murmur on exam. TTE noted severe aortic stenosis, moderate insufficiency and possible bicuspid valve morphology. Coronary angiogram showed no obstructive disease. CT chest showed a 5-cm ascending aortic aneurysm. CT surgery evaluation was sought, and patient had a Ross procedure with aortic hemiarch repair. Intra-operative TEE confirmed a congenitally unicommissural, unicuspid aortic valve (UAV). A 7-month follow-up TTE showed a normal aortic and pulmonic prosthetic gradient. Case 2: A 46-yr-old lady reported progressive exercise intolerance, with a systolic murmur and faint S2 noted on exam. TTE showed severe aortic stenosis. MR angiogram showed a unicuspid valve and a mildly dilated aortic root. The patient was evaluated by CT surgery and underwent Ross procedure. TTE 4 years later showed a normal aortic and a moderately elevated pulmonic prosthetic gradient. Patient continues to exercise without limitations. Discussion: UAV is a rare entity with an incidence of 0.02%. It has a bimodal distribution, in infants and adults, with the unicommissural type more common in adults. Due to rapid progression of valvular disease, the mean age at diagnosis is 42 years. Concurrent aortic dilatation is present in 48% patients. Management of UAV is a matter of ongoing investigation. Classically, young patients with aortic valve disease underwent mechanical AVR. Ross procedure was under-utilized due to concerns about the surgical complexity and potential need for re-operation of the aortic and pulmonic grafts. However, recent studies show promising results. Patients with UAV have lower reoperation rates after a Ross procedure compared to a repair alone. Furthermore, a Ross procedure confers mortality benefit over mechanical AVR with no significant difference in immediate perioperative complications and mortality, although, this needs further investigation in a UAV cohort. Our cases support the feasibility of a Ross procedure for UAV, in providing a durable solution while avoiding anticoagulation in young patients. As Ross procedure is performed in limited centers, patients with UAV should be referred to such centers for definitive management.

Abstract 4135286: Comparative Efficacy of Intracardiac and Transesophageal Echocardiography in Left Atrial Appendage Occlusion: A Meta-Analysis of Clinical Outcomes

Background: Left atrial appendage occlusion (LAAO) is essential for stroke prevention in patients with non-valvular atrial fibrillation where anticoagulation is contraindicated. Intracardiac Echocardiography (ICE) has been proven effective and safe for LAAO since 2011, yet adoption rates remain low, with only 2.2% of LAAOs guided by ICE between 2015 and 2019. Transesophageal Echocardiography (TEE), the current gold standard, and ICE differ significantly in operational dynamics and patient impacts, influencing procedural outcomes. Objective: This study aims to compare the efficacy and safety of ICE and TEE in facilitating LAAO, offering insights into their comparative clinical use. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Searches were performed in MEDLINE/PubMed, OVID, and Scopus through December 2023, comparing ICE and TEE in LAAO. Inclusion criteria centered on studies reporting technical success, with secondary outcomes including length of stay (LOS), mortality, and adverse outcomes such as stroke, transient ischemic attacks (TIA), pericardial effusion, cardiac tamponade, device thrombosis, device embolization, and peri-device leaks. Data synthesis employed statistical methods utilizing R Studio. Results: Fourteen studies involving 4184 patients were included. The meta-analysis revealed no significant differences in technical success (OR 1.34, 95% CI: [0.76, 2.36]), LOS (OR 1.66, 95% CI: [0.80, 3.42]), or mortality (OR = 1.00, 95% CI: [0.50, 2.00]) between ICE and TEE. Similarly, non-significant differences were noted in stroke, TIA, pericardial effusion, and device leaks, with minimal heterogeneity (I 2 = 0%). Conclusion: ICE and TEE provide comparable clinical outcomes in LAAO, with no significant efficacy or safety differences. These results suggest that the choice between ICE and TEE should be based on procedural convenience, patient anatomy, and resource availability, rather than clinical outcomes alone. The equivalence in performance between these modalities allows for flexibility in clinical practice, ensuring that patient care can be customized to individual needs without compromising safety or effectiveness.

Abstract 4113885: Impact of Sodium-glucose Cotransporter 2 Inhibitor on Recurrence and Cardiovascular Outcomes after Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure

Background: Catheter ablation for Atrial fibrillation (AF) has been proven to improve the prognosis in patients with heart failure (HF), while it remains a high risk for AF recurrence and adverse cardiovascular outcomes. The impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on these outcomes in HF patients after AF ablation is unknown. Method: HF patients with AF undergoing catheter ablation between January 2017 and December 2022 from the China-AF Registry were included. Patients were stratified into 2 groups based on the use of SGLT2i at discharge and were 1:1 matched by propensity score, with SGLT2i using (n=368) and non-SGLT2i using (n=368) in each group. The primary outcome was AF recurrence after a 3-month blanking period. Results: During a total of 1315 person-year follow-ups, AF recurrence occurred in 83 patients (22.6%) in the SGLT2i group and 132 patients (35.8%) in the non-SGLT2i group. SGLT2i was associated with a lower risk of AF recurrence (adjusted HR = 0.56, 95% CI: 0.43-0.74, P&lt;0.001). The composite risk of cardiovascular death, thrombotic events, or cardiovascular hospitalization was significantly lower in the SGLT2i group compared with those without SGLT2i (adjusted HR = 0.58, 95%CI: 0.41-0.80, p = 0.001). Although there was a tendency towards benefits, significant differences in all-cause mortality (adjusted HR = 0.76, 95%CI: 0.35-1.63, p = 0.480), cardiovascular mortality (adjusted HR = 0.62, 95%CI: 0.24-1.57, p = 0.312) and thrombotic events (adjusted HR = 0.40, 95%CI: 0.16-1.03, p = 0.056) were not noted between groups. Conclusion: The use of SGLT2i was associated with a lower risk of AF recurrence and the composite outcome of cardiovascular death, thrombotic events, or cardiovascular hospitalization after catheter ablation for AF in patients with HF.

Preoperative Consultations and Their Effect on Surgical Delays and Mortality in Hip Fracture Surgery.

The impact of preoperative consultations on mortality and morbidity rates, and their association with delays and hospital stays for surgery, remains a topic of discussion. This study aims to elucidate the necessity of consultations for those undergoing femoral neck fracture surgery, examining their influence on delays, hospital durations, and their correlation with mortality rates. The study examined data from 320 emergency department patients with femoral neck fractures undergoing hip arthroplasty surgery at our hospital between 2011 and 2021, using digital medical records. Patients were consulted in relevant departments for risk optimization. They were categorized into two groups based on the time of surgery: Group 1 (operated within 48 h) and Group 2 (delayed surgery). The analysis included days from admission to surgery, total hospital stay, and time from surgery to discharge. Mortality rates, with a minimum 2-year follow-up, were assessed using digital records, patient contact, or a death notification system. Statistical analyses involved Mann-Whitney U, Kruskal-Wallis, post hoc analysis, Pearson's chi-squared, and Fisher-Freeman-Halton tests (α = 0.05). SPSS v25.0 software was used. Patients with consultation requests experience significantly delayed surgery compared to those without (p < 0.001). Statistically significant differences were observed between consulted and nonconsulted groups in time until surgery (p < 0.001), time from surgery to discharge (p < 0.001), and overall length of hospital stay (p < 0.001). However, there is no statistically significant difference in 30-day and 1-year mortality between consulted and nonconsulted patients, both departmentally and overall. This study found that advanced age and high ASA scores were the main factors causing surgical delays in hip fracture patients. While modifiable comorbidities could reduce hospital stays, they did not significantly affect postoperative mortality. Streamlining elective consultations and reducing organizational delays could help prevent delayed surgeries and improve outcomes.