Non-cardiac surgery after transcatheter aortic valve implantation
Notice bibliographique
Résumé
AIMS: There is a lack of data on perioperative outcomes for patients undergoing non-cardiac surgery (NCS) after transcatheter aortic valve implantation (TAVI). Hence, we aimed to determine the incidence, type of surgery, timing, and perioperative outcomes of individuals undergoing elective NCS after discharge for TAVI. METHODS AND RESULTS: Hospitalisations for TAVI were identified from the US National Readmission Database between 2012 and 2021, and patients who received NCS within 6 months were included for analysis. Incidence, type, and timing of planned readmissions for NCS were evaluated according to the surgical risk as low, intermediate, and high. The primary outcome was the occurrence of in-hospital major adverse events (MAE), defined as the composite of death, cardiac complications, and stroke/transient ischaemic attack. Multivariable regression models were constructed to identify independent factors associated with MAE. Out of 502 775 TAVI procedures, 2390 (0.48%) patients were electively admitted to undergo NCS within 6 months after discharge for TAVI. Surgeries were classified as low- (n = 321, 13.4%), intermediate- (n = 1522, 63.7%), and high-risk (n = 547, 22.9%). The median age of the study population was 78 years (IQR 73-84), with 59% of participants being male. Overall surgeries occurred at a median of 83 days (IQR 48-120) after discharge for TAVI, a time-period which was significantly shorter for those who underwent high-risk surgeries (median 67, IQR 41-109 days, P < 0.001). The overall rate of post-operative MAE was 7.6% (n = 181), and these rates did not differ between surgical risk groups (P = 0.46). The primary outcome was driven primarily by cardiac complications (3.6%), while rates of death were low (1.3%) and almost identical between surgical risk groups (P = 0.99). Factors independently associated with the primary outcome were congestive heart failure (aOR: 1.62, CI: 1.23-2.12, P < 0.001), liver disease (aOR: 2.17, CI: 1.37-3.45, P = 0.001), diabetes mellitus (aOR: 1.44, CI: 1.13-1.82, P = 0.003), cancer (aOR: 1.18, CI: 0.92-1.50, P < 0.001), anaemia (aOR: 0.76, CI: 0.58-0.99, P = 0.046), and time to readmission (aOR: 1.00, CI: 0.99-1.00, P = 0.004). CONCLUSION: Elective NCS occurred infrequently post-TAVI and was associated with low rates of mortality. While diabetes mellitus, congestive heart failure, liver disease, cancer, anaemia, and time to readmission were associated with post-procedural adverse events, the surgical risk was not. The risk of NCS after TAVI should be balanced against the risk of delaying an operation.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».