The Baird Institute

Brieger DB, Ng ACC, Chow V, D’Souza M, Hyun K, Bannon PG, Kritharides L

Open Heart 2019;6(1):e000959

PMID: 31168375

Abstract

Objectives: To describe changes in mortality among patients undergoing coronary artery bypass grafting (CABG) in New South Wales (NSW) Australia from 2000 to 2013.

Methods: Patients undergoing CABG were identified from the NSW Admission Patient Data Collection (APDC) registry, linked to the NSW state-wide death registry database. Changes in all-cause mortality over time were observed following stratification of the study cohort into two year groups.

Results: We identified 54 767 patients undergoing CABG during the study period. The risk profile of patients increased over time with significant increases in age, comorbidities and concomitant valve surgery (all p < 0.0001). During a median follow-up period of 6 years, a total 12 161 (22.2%) of patients had died. Survival curves and adjusted analyses showed a steady fall in mortality rate: those operated on during 2012-2013 had 40 % lower mortality than those operated on during 2000-2001 (HR 0.61; 95% CI 0.53 to 0.69). This was contributed to both by a fall in mortality both in hospital (HR 0.48, 95% CI 0.37 to 0.62) and postdischarge (HR 0.73; 95% CI 0.61 to 0.86).

Conclusions: We report a consistent reduction in medium-term mortality among a large unselected cohort of NSW patients undergoing CABG between 2000 and 2013. This fall is attributable both to an improvement in outcomes in hospital and in the postdischarge period.

McBride KE, Solomon MJ, Steffens D, Bannon PG, Glozier N

ANZ J Surg 2019 06;89(6):630-631

PMID: 31179630

Abstract

Cao C, Huang J

J. Thorac. Cardiovasc. Surg. 2019 Apr;

PMID: 31043314

Abstract

Cao C, Cerfolio RJ, Louie BE, Melfi F, Veronesi G, Razzak R, Romano G, Novellis P, Shah S, Ranganath N, Park BJ

Ann. Thorac. Surg. 2019 Jun;

PMID: 31255610

Abstract

BACKGROUND: Intraoperative catastrophes during robotic anatomical pulmonary resections are potentially devastating events. The present study aimed to assess the incidence, management, and outcomes of these intraoperative catastrophes for patients with primary lung cancers.

METHODS: This was a retrospective, multi-institutional study that evaluated patients who underwent robotic anatomical pulmonary resections. Intraoperative catastrophes were defined as events necessitating emergency thoracotomy or requiring an additional unplanned major surgical procedure. Standardized data forms were collected from each institution, with questions on intraoperative management strategies of catastrophic events.

RESULTS: Overall, 1,810 patients underwent robotic anatomical pulmonary resections, including 1,566 (86.5%) lobectomies. Thirty-five patients (1.9%) experienced an intraoperative catastrophe. These patients were found to have significantly higher clinical TNM stage (p=0.031) and lower FEV1 (81% vs 90%, p=0.004). A higher proportion of patients who had a catastrophic event underwent preoperative radiotherapy (8.6% vs 2.3%, p=0.048), and the surgical procedures performed differed significantly compared to non-catastrophic patients. Patients in the catastrophic group had higher perioperative mortality (5.7% vs 0.5%, p=0.018), longer operative duration (195 min vs 170 min, p = 0.020), and higher estimated blood loss (225 ml vs 50 ml, p<0.001). The most common catastrophic event was intraoperative hemorrhage from the pulmonary artery, followed by injury to the airway, pulmonary vein, and the liver. Detailed management strategies were discussed.

CONCLUSIONS: The incidence of catastrophic events during robotic anatomical pulmonary resections was low, and the most common complication was pulmonary arterial injury. Awareness of potential intraoperative catastrophes and their management strategies are critical to improving clinical outcomes.

Edelman JJ, Kitahara H, Thourani VH

J. Thorac. Cardiovasc. Surg. 2019 Jul;

PMID: 31277811

Abstract

McBride KE, Steffens D, Solomon MJ, Anderson T, Young J, Leslie S, Thanigasalam R, Bannon PG

Aust Health Rev 2019 Jul;

PMID: 31306613

Abstract

Within Australia, robotic-assisted surgery (RAS) has largely been undertaken within the private sector, and predominately based within urology. This is rapidly developing, with RAS becoming increasingly prevalent across surgical specialties and within public hospitals. At this point in time there is a need to consider how this generation of the technology can be appropriately and safely introduced into the public health system given its prohibitive costs and lack of high-level long-term evidence.This paper describes a unique approach used to govern the establishment of a new RAS program within a large public tertiary referral hospital in Australia. This included the creation of a comprehensive governance framework that covered research, training and operational components, with research being the ultimate gatekeeper to accessing the technology.Taking this novel approach, both benefits and challenges were encountered. Although initially there was a trade-off of activity to enable time for the research program to be developed, it was found the model strengthened patient safety in introducing the technology, fostered a breadth of surgical speciality involvement, ensured uniformity of data collection and, in the longer term, will enable a significant contribution to be made to the evidence regarding the appropriateness of RAS being used across several surgical specialties.There is potential for this comprehensive governance framework to be transferred to other public hospitals commencing or with existing RAS programs and to be applied to the introduction of other new and expensive surgical technology.RAS is rapidly evolving and becoming increasingly prevalent across surgical specialities in major public hospitals. Consequently, it is important that this new technology is safely and appropriately implemented into the public health system.This article describes the benefits and implementation challenges of a novel RAS approach, including a comprehensive governance framework that covered research, training and operational components, with research being the ultimate gatekeeper to accessing the technology.This comprehensive governance framework can be transferred to other public hospitals introducing, or already using, new and expensive surgical technology.