Predictors of General Surgical Complications After Heart Transplantation
Bibliographic record
Abstract
BACKGROUND: Several studies have reported the incidence, morbidity, and mortality of general surgical conditions (GSCs) in orthotopic heart transplant (OHT) patients. The following is the largest reported series of such patients and the first study with sufficient patient numbers to formally evaluate peritransplant variables as risk factors for GSC development. STUDY DESIGN: A GSC was defined as a condition for which a general surgeon had been consulted or as a general surgical condition recognized at the time of autopsy. The records of 453 consecutive patients who underwent OHT between 1981 and 1999 were reviewed to identify patients who developed a GSC. Kaplan-Meier actuarial analysis on this cohort, and univariate and multivariate logistic regression models applied to a subpopulation of 324 consecutive OHT patients between 1987 and 1997 were used to determine factors associated with and predictive of GSC after OHT. RESULTS: Of 453 OHT patients, 371 (81.9%) were men, and the average age was 44.5 +/- 15 (standard deviation) years. Median followup was 2,086 days (range 1 to 6,642 days). Ninety-three patients (20.5%) developed 111 GSCs. Of these, 78 were men, and the average age was 49.9+/-10.2 years. There were 83 general surgical interventions. Actuarial analyses revealed that age greater than 50 years, pretransplant diagnosis of ischemic (PTDxI) versus nonischemic heart disease, and previous general surgical history were factors associated (p < 0.05) with a higher GSC incidence. Gender, more urgent transplant priority status, cardiopulmonary bypass time, total graft ischemic time, and intensive care unit length of stay were not associated with GSC. Factors associated with GSC on univariate analysis, with odds ratios (ORs) and 95% confidence intervals (CIs) included: age analyzed as a continuous variable (OR 1.04 per year; CI 1.01, 1.06 per year; p = 0.0021), PTDxI (OR 2.40; CI 1.39, 4.15; p = 0.0016), and pretransplant general surgical history (OR 3.35; CI 1.65, 6.82; p = 0.0008). Multivariate analysis revealed that only pretransplant general surgical history (OR 3.27; CI 1.58, 6.76; p = 0.0004) and PTDxI (OR 2.37; CI 1.35, 4.16; p = 0.0023) were associated with subsequent development of GSC. CONCLUSIONS: A pretransplant diagnosis of ischemic heart disease and previous history of a general surgical procedure are two independent risk factors that predispose OHT patients to development of GSC. Because GSC may arise insidiously in immunosuppressed patients, identification of OHT patients at higher risk for GSC will permit timely intervention decisions, decreasing morbidity and mortality in this challenging group of patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".