Faculty Bibliography

The STS definition of acute renal failure requires a three-fold rise in creatinine (CR), CR > 4 mg/dL (with at least 0.5mg/dL rise from pre-operative value), or new hemodialysis requirement. This definition does not capture the incidence, clinical impact, and economic burden of lesser degrees of acute renal dysfunction. A retrospective cohort study using discharge data from 650 hospitals was extracted from the Premierâ„¢ administrative database (2010-2014) for index cardiac cases (isolated CABG, isolated valve, and CABG-valve). We documented acute renal dysfunction through ICD 9-CM codes and hospital charges, excluding those patients with pre-existing renal dysfunction. The incidence, length of stay (LOS), and total hospital costs associated with renal dysfunction for each of the index procedures were captured. The results reported are unadjusted for demographic and clinical factors. 200,471procedures were available for analysis in the database. The mean age was 66 years, 68.2% were male and 74% were white. Based on ICD 9-CM codes and hospital charges for these cases, 27,216 (13.6%) patients had some level of renal dysfunction. In addition to increase in LOS, patients who developed renal dysfunction had an associated 57-85% increase in total cost of hospitalization. The incidence of renal dysfunction in this study is higher than reported previously. The STS definition of renal failure captures only severe disease and may miss lesser degrees of dysfunction, which nonetheless have an impact on patient outcome and costs.

Perioperative stroke is one of the most severe and feared complications of cardiac surgery. Based on the timing of onset and detection, perioperative stroke can be classified as intraoperative or postoperative. The pathogenesis of perioperative stroke is multifactorial, which makes prediction and prevention challenging. However, information on its incidence, mechanisms, diagnosis, and treatment can be helpful in minimizing the perioperative neurological risk for individual patients. We herein provide suggestions on preoperative, intraoperative, and postoperative strategies aimed at reducing the risk of perioperative stroke and at improving the outcomes of patients who experience a perioperative stroke.

Desialylation of platelets results in platelet clearance by the Ashwell-Morrell Receptors (AMR) found on hepatocytes. Studies suggest that oseltamivir phosphate inhibits human sialidases, enzymes responsible for desialylation, extending the lifespan of circulating platelets. We thus evaluated, the effects of oseltamivir on platelet count (PC) following treatment. Of the 385 patients evaluated for influenza, 283 (73.5%) were influenza-infected. Of the 283 infected patients, 241 (85.2%) received oseltamivir (I + O+) while 42 patients did not (I + O-). One hundred two non-infected patients received oseltamivir (I-O+). The two groups receiving oseltamivir (I + O+, I-O+), demonstrated a statistically greater increase in the PC (57.53 ± 93.81, p = .013 and 50.79 ± 70.59, p = .023, respectively) relative to the group that did not (18.45 ± 89.33 × 10⁹/L). The observed increase in PC was statistically similar (p = .61) in both groups receiving oseltamivir (I + O+, I-O+), suggesting that this effect is independent of influenza. Comparing clinical characteristics between responders and non-responders to oseltamivir treatment showed that only duration of oseltamivir treatment (AOR = 1.30, 95% CI 1.05-1.61, p = .015) was associated with a positive PC response. Our findings suggest a correlation between oseltamivir treatment and an increase in PCs. Future studies assessing the possible uses of oseltamivir in medical conditions characterized by diminished or defective thrombopoiesis are warranted.