Systematic review and meta-analysis to examine the impact of preoperative sleep disturbance on post-cardiovascular surgery outcomes: literature search documentation

This study was registered in PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42017052986Objective: Pre-existing sleep disturbances are common in patients undergoing cardiac surgery. The objective of this study was to investigate whether preoperative sleep disturbance impacts postoperative outcomes following cardiac surgery. Methods: Electronic databases, including MEDLINE, EMBASE, CENTRAL, CINAHL, Science Citation Index Expanded, Scopus, and HTA were searched for studies that evaluated the impact of preoperative sleep disturbance on postoperative outcomes in adult patients undergoing cardiac surgical intervention. Adjusted and unadjusted meta-analyses were performed to compare postoperative outcomes, including: postoperative atrial fibrillation, in-hospital mortality, in-hospital length of stay, intensive care unit length of stay, and intensive care unit mortality among patients with and without preoperative sleep disturbance. Results: A total of 17 studies were included (N=2,886 patients). Preoperative sleep disturbance was incrementally associated with a higher risk of mortality (OR 3.75; 95% CI: 1.1.51-9.30), postoperative atrial fibrillation (POAF) (OR 2.11; 95% CI: 1.62-2.75), increased intensive care unit length of stay (LOS) (MD: 0.31; 95% CI, 0.28-0.33), and increased hospital LOS (MD 1.06; 95% CI, 0.34, 1.79). Preoperative sleep disturbance was not significantly associated with higher rates of intensive care unit readmission (OR 1.61; 95% CI, 0.84-3.08). Conclusions: Sleep disturbance was associated with an increased risk of post-operative mortality, POAF, and prolonged hospital and intensive care unit LOS. Early recognition and effective treatment of sleep disturbances may reduce postoperative mortality, morbidity, and health care costs in patients undergoing cardiac surgery. Actual document is the search documentation supporting the dataset

Managing Common Co-morbidities in Heart Failure

Heart failure increases in prevalence with age and is usually associated with various cardiac and non-cardiac comorbidities.  For common coexisting conditions such as renal dysfunction, anemia and type 2 diabetes mellitus, important pathophysiologic links have been implicated between cardiac dysfunction and the underlying condition.  Indeed, the number and severity of comorbidities in the setting of heart failure is an important driver of prognosis.  By targeting the management of coexisting diseases, it may be possible to improve functional capacity, quality of life and perhaps even overall mortality in heart failure patients.  Recent clinical trial data has provided insights into cardio-renal interactions in acute heart failure, the impact of iron replacement therapy in iron deficient heart failure patients, and the role of pharmacologic therapies to prevent heart failure related events in high risk patients with type 2 diabetes. </jats:p

A Quality Improvement Initiative to Reduce Postoperative Delirium among Cardiac Surgery Patients

Patients following cardiac surgery commonly experience post-operative delirium (POD) during their postoperative hospital stay. A multifaceted, specialty wide, quality improvement (QI) project was undertaken for patients experiencing POD. The goal was to develop a reduction in POD care bundle (rPOD-a structured patient care program) that encompasses efficient preoperative risk factor identification and a postoperative patient-care process to ensure early POD identification and treatment. The following steps were taken to implement the rPOD care bundle including: (a) Developing a quality driven, evidence-based guideline for the perioperative cardiac surgery health care team, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education, and regular project evaluation. Trends of process measures and quality improvement measures were examined. An increasing trend in the rate of postoperative delirium screening during implementation of rPOD intervention was demonstrated. This quality improvement study provides a bases for future postoperative delirium reduction interventions

A Quality Improvement Initiative to Reduce Postoperative Delirium among Cardiac Surgery Patients

Patients following cardiac surgery commonly experience post-operative delirium (POD) during their postoperative hospital stay. A multifaceted, specialty wide, quality improvement (QI) project was undertaken for patients experiencing POD. The goal was to develop a reduction in POD care bundle (rPOD-a structured patient care program) that encompasses efficient preoperative risk factor identification and a postoperative patient-care process to ensure early POD identification and treatment. The following steps were taken to implement the rPOD care bundle including: (a) Developing a quality driven, evidence-based guideline for the perioperative cardiac surgery health care team, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education, and regular project evaluation. Trends of process measures and quality improvement measures were examined. An increasing trend in the rate of postoperative delirium screening during implementation of rPOD intervention was demonstrated. This quality improvement study provides a bases for future postoperative delirium reduction interventions

A Quality Improvement Initiative to Reduce Postoperative Delirium among Cardiac Surgery Patients

Patients following cardiac surgery commonly experience post-operative delirium (POD) during their postoperative hospital stay. A multifaceted, specialty wide, quality improvement (QI) project was undertaken for patients experiencing POD. The goal was to develop a reduction in POD care bundle (rPOD-a structured patient care program) that encompasses efficient preoperative risk factor identification and a postoperative patient-care process to ensure early POD identification and treatment. The following steps were taken to implement the rPOD care bundle including: (a) Developing a quality driven, evidence-based guideline for the perioperative cardiac surgery health care team, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education, and regular project evaluation. Trends of process measures and quality improvement measures were examined. An increasing trend in the rate of postoperative delirium screening during implementation of rPOD intervention was demonstrated. This quality improvement study provides a bases for future postoperative delirium reduction interventions.</jats:p