STS 2021, Day 2 — This year’s esteemed J. Maxwell Chamberlain Memorial Papers will compare the risk of complications and higher hospitalization costs in transcatheter versus surgical approaches to aortic stenosis (AS) and coronary artery disease (CAD), analyze the survival benefit of fundoplication for lung transplant recipients, examine the impact of medical center volume on readmissions and mortality following congenital cardiac surgery, and herald failure to rescue as a new STS quality metric for cardiac surgery. These top-scoring abstracts will be presented today during specialty-specific parallel sessions at 11:30 a.m. ET.
Findings Identify Lung Transplant Recipients Who Benefit Most from Fundoplication
Lung transplant recipients who undergo fundoplication exhibit improved long-term survival and a decreased rate of chronic lung allograft dysfunction (CLAD) related to gastroesophageal reflux and aspiration. Chamberlain Paper for General Thoracic Surgery presenting author Miguel M. Leiva-Juarez, MD, a research fellow at Columbia University Medical Center in New York, New York, will discuss findings from a 20-year retrospective study that sought to identify recipient populations who can achieve the most survival benefit from fundoplication.
Fundoplication, both before and after the occurrence of CLAD, was shown to be an independent predictor of survival, said Dr. Leiva-Juarez. When patients received fundoplication before development of CLAD, they tended to experience improved overall survival, while patients receiving fundoplication after developing CLAD had an increase in post-CLAD survival compared with patients who didn’t undergo fundoplication.
The procedure was most beneficial for recipients under the age of 65 years and those with restrictive disorders, and the benefit was independent of the type of transplant. A diagnosis of gastroesophageal reflux by conventional methods was not a significant predictor of survival, Dr. Leiva-Juarez noted.
Errol L. Bush, MD, from Johns Hopkins Medicine in Baltimore, Maryland, will discuss this paper.
Failure to Rescue Emerges as New STS Quality Metric for Cardiac Surgery
In the earliest planning stages of the STS National Database, the founders recognized the importance of risk adjustment—but they also acknowledged that measurement of professional performance isn’t just about mortality rates, said author Paul Kurlansky, MD, from Columbia University Medical Center in New York, New York, who will present the first-ever Chamberlain Paper for Perioperative and Critical Care.
Dr. Kurlansky and colleagues studied failure to rescue as a risk-adjusted metric in 1,128 patients from the STS Adult Cardiac Surgery Database, including patients who underwent isolated CABG, AVR with or without CABG, or mitral valve repair/replacement with or without CABG between January 2015 and June 2019.
This new failure to rescue metric complements existing STS performance measures and specifically assesses institutional effectiveness of postoperative care. This will allow hospitals to develop targeted quality improvement efforts. Incorporation of the metric also may provide valuable information that can be used in patient and family counseling when discussing the likelihood of survival after postoperative complications, Dr. Kurlansky said.
Glenn J.R. Whitman, MD, of The Johns Hopkins Hospital in Baltimore, Maryland, will discuss this Chamberlain paper.
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