12 research outputs found
Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study
Objectives
The role of the underlying etiology in isolated tricuspid valve surgery has not been investigated extensively in current literature. Aim of this study was to analyse outcomes of patients undergoing surgery due to endocarditis compared to other pathologies.
Methods
The SURTRI study is a multicenter study enrolling adult patients who underwent isolated tricuspid valve surgery (n = 406, 55 ± 16 y.o.; 56% female) at 13 international sites. Propensity weighted analysis was performed to compare groups (IE group n = 107 vs Not-IE group n = 299).
Results
No difference was found regarding the 30-day mortality (Group IE: 2.8% vs Group Not-IE = 6.8%; OR = 0.45) and major adverse events. Weighted cumulative incidence of cardiac death was significantly higher for patients with endocarditis (p = 0.01). The composite endpoint of cardiac death and reoperation at 6 years was reduced in the Group IE (63.2 ± 6.8% vs 78.9 ± 3.1%; p = 0.022). Repair strategy resulted in an increased late survival even in IE cases.
Conclusions
Data from SURTRI study report acceptable 30-day results but significantly reduced late survival in the setting of endocarditis of the tricuspid valve. Multi-disciplinary approach, repair strategy and earlier treatment may improve outcomes.
© 2022 The Author
Differences in access to coronary care unit among patients with acute myocardial infarction in Rome: old, ill, and poor people hold the burden of inefficiency
BACKGROUND: Direct admission to Coronary Care Unit (CCU) on hospital arrival can be considered as a good proxy for adequate management in patients with acute myocardial infarction (AMI), as it has been associated with better prognosis. We analyzed a cohort of patients with AMI hospitalized in Rome (Italy) in 1997–2000 to assess the proportion directly admitted to CCU and to investigate the effect of patient characteristics such as gender, age, illness severity on admission, and socio-economic status (SES) on CCU admission practices. METHODS: Using discharge data, we analyzed a cohort of 9127 AMI patients. Illness severity on admission was determined using the Deyo's adaptation of the Charlson's comorbidity index, and each patient was assigned to one to four SES groups (level I referring to the highest SES) defined by a socioeconomic index, derived by the characteristics of the census tract of residence. The effect of gender, age, illness severity and SES, on risk of non-admission to CCU was investigated using a logistic regression model (OR, CI 95%). RESULTS: Only 53.9% of patients were directly admitted to CCU, and access to optimal care was more frequently offered to younger patients (OR = 0.35; 95%CI = 0.25–0.48 when comparing 85+ to >=50 years), those with less severe illness (OR = 0.48; 95%CI = 0.37–0.61 when comparing Charlson index 3+ to 0) and the socially advantaged (OR = 0.81; 95%CI = 0.66–0.99 when comparing low to high SES). CONCLUSION: In Rome, Italy, standard optimal coronary care is underprovided. It seems to be granted preferentially to the better off, even after controversial clinical criteria, such as age and severity of illness, are taken into account
Stime del bisogno e dei costi assistenziali a fini allocativi: l’esperienza della regione Friuli-Venezia Giulia
La ricerca si colloca nel contesto della definizione di criteri allocativi validi in sanità pubblica e si inserisce in una ricerca più ampia condotta insieme all’Agenzia Regionale della Sanità della regione Friuli-Venezia Giulia. In questa sede viene presentata solo la parte dello studio
svolta per la determinazione di un criterio per l’allocazione delle risorse tra le Aziende sanitarie per
i servizi territoriali (Ass), senza considerare il finanziamento alle strutture ospedaliere. FinalitĂ di
base dello studio è la stima del bisogno assistenziale delle popolazioni residenti nei comuni della
regione. L’identificazione del bisogno consente, infatti, la determinazione delle risorse erogabili alle Ass. Lo studio prende in considerazione i costi individuali medi comunali in assistenza sanitaria, sia in prestazioni tariffate sia non soggette a tariffazione, per l’anno 2004. A livello sia comunale sia distrettuale sono state raccolte variabili che connotano la struttura demografica, le condizioni sociali ed economiche, la mortalità e morbilità delle popolazioni residenti. L’approccio proposto
per la stima del bisogno assistenziale parte dalla considerazione dei costi assistenziali medi individuali sostenuti dai residenti in ciascun comune. Tali costi osservati vengono corretti in base alle caratteristiche demografiche, epidemiologiche e socioeconomiche delle popolazioni stesse, arrivando, quindi, alla determinazione di costi teorici medi individuali, assimilabili ai costi attesi indotti dal bisogno assistenziale delle popolazioni. Per la stima dei costi teorici si sono considerati
sia modelli lineari semplici sia modelli lineari misti. La numerosità delle variabili demografiche e socioeconomiche è stata ridotta attraverso l’identificazione, mediante metodi di analisi multivariata, di fattori latenti. L’approccio adottato ha consentito di derivare i costi teorici medi individuali, ovvero quei costi che in media i soggetti residenti nei comuni della regione dovrebbero sostenere
in considerazione delle loro caratteristiche socioeconomiche e di salute, e della relativa struttura
demografica delle popolazioni
Progetto di Ricerca LARS (Laboratorio di Ricerca Infermieristica Agenzia Regionale alla SanitĂ , Friuli Venezia Giulia). Studio osservazionale sugli esiti dei modelli organizzativi assistenziali delle medicine, su infermieri, su pazienti ed organizzazione.
No large scale studies have been conducted in
Italy to assess factors that influence hospital nurses’
satisfaction.
Aims. To explore the relationship between participative
organizative models and outcomes on
nurses (work satisfaction, burnout, intention to
stay), patients (satisfaction with quality of care)
and organization (nurses turnover).
Materials and methods. This multicentre regional
study involves 20 acute medical wards and more
than 500 nurses. Data on the organizative model
adopted in the ward will be collected with an
ad hoc questionnaire with scores from 7 (scarcelimited
involvement of nurses in decision making)
to 35 (nurses take decisions on the management
of the ward). Nurses satisfaction with their
work is measured with the Nursing Work Index
Revised; burnout with the Maslack Burnout Inventory;
patients satisfaction with the Experiences
of Nursing Care Scale Newcastle Satisfaction
with Nursing Scale. The outcomes considered
for the organization will be turnover, absences
from work, injuries.
Resultats. The study is ongoing. The association
of each outcome to the organizzative model
will be explored. Multivariate regression model
will be adjusted for casemix index of the previuos
year. T test and chi square tests will be
used and a p value of 0.05 will be considered
significant
Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study
Objectives: The role of the underlying etiology in isolated tricuspid valve surgery has not been investigated extensively in current literature. Aim of this study was to analyse outcomes of patients undergoing surgery due to endocarditis compared to other pathologies. Methods: The SURTRI study is a multicenter study enrolling adult patients who underwent isolated tricuspid valve surgery (n = 406, 55 ± 16 y.o.; 56% female) at 13 international sites. Propensity weighted analysis was performed to compare groups (IE group n = 107 vs Not-IE group n = 299). Results: No difference was found regarding the 30-day mortality (Group IE: 2.8% vs Group Not-IE = 6.8%; OR = 0.45) and major adverse events. Weighted cumulative incidence of cardiac death was significantly higher for patients with endocarditis (p = 0.01). The composite endpoint of cardiac death and reoperation at 6 years was reduced in the Group IE (63.2 ± 6.8% vs 78.9 ± 3.1%; p = 0.022). Repair strategy resulted in an increased late survival even in IE cases. Conclusions: Data from SURTRI study report acceptable 30-day results but significantly reduced late survival in the setting of endocarditis of the tricuspid valve. Multi-disciplinary approach, repair strategy and earlier treatment may improve outcomes
Outcome of patients undergoing isolated tricuspid repair or replacement surgery
OBJECTIVES: The interest in isolated tricuspid valve disease has rapidly increased recently. However, clinical trials and registry data are rare in the surgical literature. This study aimed to describe the early and long-term outcomes of a real-world experience in isolated tricuspid procedures comparing repair and replacement strategies.METHODS: The Surgical-Tricuspid study is a multicentre retrospective study that enrolled adult patients who had undergone isolated tricuspid valve surgery at 13 international sites. Propensity score-matched analysis was used to compare repair versus replacement.RESULTS: A cohort of 426 patients was enrolled [mean age: 55 (16) years; 56% female]. After matching, 175 comparable pairs were analysed. Preoperative left ventricular ejection fraction was 55(9) vs 56(9) (P = 0.8) while moderate-severe tricuspid regurgitation was present in 95% of cases. The 30-day mortality rate was 4.0% vs 8.0% in the repair and replacement groups, respectively (P = 0.115). The rates of reexploration for bleeding (6.9% vs 13.1% P = 0.050), permanent pacemaker implantation (5.1% vs 12.0%; P = 0.022) and blood transfusion (46% vs 62%; P = 0.002) were higher in the replacement group. Cumulative survival rates at 3, 5 and 7 years in the repair group were 84 (3)%, 75 (4)% and 56 (9)% vs 71 (4)%, 66 (5)% and 58 (5)% in the replacement group (P= 0.001) while cumulative incidence for reoperation at 10 years did not differ between groups [repair 10 (1)% vs replacement 9 (1 )%; P = 0.469].CONCLUSIONS: The data from the Surgical-Tricuspid study reported a high risk for patients undergoing tricuspid surgery. Isolated valve repair offered reduced early and late mortality with no difference regarding reoperation rate when compared with replacement
Outcome of patients undergoing isolated tricuspid repair or replacement surgery
OBJECTIVES: The interest in isolated tricuspid valve disease has rapidly increased recently. However, clinical trials and registry data are rare in the surgical literature. This study aimed to describe the early and long-term outcomes of a real-world experience in isolated tricuspid procedures comparing repair and replacement strategies.METHODS: The Surgical-Tricuspid study is a multicentre retrospective study that enrolled adult patients who had undergone isolated tricuspid valve surgery at 13 international sites. Propensity score-matched analysis was used to compare repair versus replacement.RESULTS: A cohort of 426 patients was enrolled [mean age: 55 (16) years; 56% female]. After matching, 175 comparable pairs were analysed. Preoperative left ventricular ejection fraction was 55(9) vs 56(9) (P = 0.8) while moderate-severe tricuspid regurgitation was present in 95% of cases. The 30-day mortality rate was 4.0% vs 8.0% in the repair and replacement groups, respectively (P = 0.115). The rates of reexploration for bleeding (6.9% vs 13.1% P = 0.050), permanent pacemaker implantation (5.1% vs 12.0%; P = 0.022) and blood transfusion (46% vs 62%; P = 0.002) were higher in the replacement group. Cumulative survival rates at 3, 5 and 7 years in the repair group were 84 (3)%, 75 (4)% and 56 (9)% vs 71 (4)%, 66 (5)% and 58 (5)% in the replacement group (P= 0.001) while cumulative incidence for reoperation at 10 years did not differ between groups [repair 10 (1)% vs replacement 9 (1 )%; P = 0.469].CONCLUSIONS: The data from the Surgical-Tricuspid study reported a high risk for patients undergoing tricuspid surgery. Isolated valve repair offered reduced early and late mortality with no difference regarding reoperation rate when compared with replacement
Outcome of patients undergoing isolated tricuspid repair or replacement surgery
OBJECTIVES: The interest in isolated tricuspid valve disease has rapidly increased recently. However, clinical trials and registry data are rare in the surgical literature. This study aimed to describe the early and long-term outcomes of a real-world experience in isolated tricuspid procedures comparing repair and replacement strategies. METHODS: The Surgical-Tricuspid study is a multicentre retrospective study that enrolled adult patients who had undergone isolated tricuspid valve surgery at 13 international sites. Propensity score-matched analysis was used to compare repair versus replacement. RESULTS: A cohort of 426 patients was enrolled [mean age: 55 (16) years; 56% female]. After matching, 175 comparable pairs were analysed. Preoperative left ventricular ejection fraction was 55(9) vs 56(9) (P = 0.8) while moderate-severe tricuspid regurgitation was present in 95% of cases. The 30-day mortality rate was 4.0% vs 8.0% in the repair and replacement groups, respectively (P = 0.115). The rates of re-exploration for bleeding (6.9% vs 13.1% P = 0.050), permanent pacemaker implantation (5.1% vs 12.0%; P = 0.022) and blood transfusion (46% vs 62%; P = 0.002) were higher in the replacement group. Cumulative survival rates at 3, 5 and 7 years in the repair group were 84 (3)%, 75 (4)% and 56 (9)% vs 71 (4)%, 66 (5)% and 58 (5)% in the replacement group (P = 0.001) while cumulative incidence for reoperation at 10 years did not differ between groups [repair 10 (1)% vs replacement 9 (1)%; P = 0.469]. CONCLUSIONS: The data from the Surgical-Tricuspid study reported a high risk for patients undergoing tricuspid surgery. Isolated valve repair offered reduced early and late mortality with no difference regarding reoperation rate when compared with replacement