33 results on '"Pettit, Shirley"'
Search Results
2. Examination of psychological risk factors for chronic pain following cardiac surgery: protocol for a prospective observational study.
- Author
-
McGillion, Michael H, Henry, Shaunattonie, Busse, Jason W, Ouellette, Carley, Katz, Joel, Choinière, Manon, Lamy, Andre, Whitlock, Richard, Pettit, Shirley, Hare, Jacqueline, Gregus, Krysten, Brady, Katheryn, Dvirnik, Nazari, Yang, Stephen Su, Parlow, Joel, Dumerton-Shore, Deborah, Gilron, Ian, Buckley, D Norman, Shanthanna, Harsha, Carroll, Sandra L, Coyte, Peter C, Ebrahim, Shanil, Isaranuwatchai, Wanrudee, Guerriere, Denise N, Hoch, Jeffrey, Khan, James, MacDermid, Joy, Martorella, Geraldine, Victor, J Charles, Watt-Watson, Judy, Howard-Quijano, Kimberly, Mahajan, Aman, Chan, Matthew TV, Clarke, Hance, and Devereaux, PJ more...
- Subjects
cardiac surgery ,health economics ,pain management ,Clinical Sciences ,Public Health and Health Services ,Other Medical and Health Sciences - Abstract
INTRODUCTION:Approximately 400 000 Americans and 36 000 Canadians undergo cardiac surgery annually, and up to 56% will develop chronic postsurgical pain (CPSP). The primary aim of this study is to explore the association of pain-related beliefs and gender-based pain expectations on the development of CPSP. Secondary goals are to: (A) explore risk factors for poor functional status and patient-level cost of illness from a societal perspective up to 12 months following cardiac surgery; and (B) determine the impact of CPSP on quality-adjusted life years (QALYs) borne by cardiac surgery, in addition to the incremental cost for one additional QALY gained, among those who develop CPSP compared with those who do not. METHODS AND ANALYSES:In this prospective cohort study, 1250 adults undergoing cardiac surgery, including coronary artery bypass grafting and open-heart procedures, will be recruited over a 3-year period. Putative risk factors for CPSP will be captured prior to surgery, at postoperative day 3 (in hospital) and day 30 (at home). Outcome data will be collected via telephone interview at 6-month and 12-month follow-up. We will employ generalised estimating equations to model the primary (CPSP) and secondary outcomes (function and cost) while adjusting for prespecified model covariates. QALYs will be estimated by converting data from the Short Form-12 (version 2) to a utility score. ETHICS AND DISSEMINATION:This protocol has been approved by the responsible bodies at each of the hospital sites, and study enrolment began May 2015. We will disseminate our results through CardiacPain.Net, a web-based knowledge dissemination platform, presentation at international conferences and publications in scientific journals. TRIAL REGISTRATION NUMBER:NCT01842568. more...
- Published
- 2019
No additional results were found in
Catalog
3. Determinants of tobacco smoking abstinence one year after major noncardiac surgery: a secondary analysis of the VISION study
- Author
-
Ofori, Sandra N., Marcucci, Maura, Mbuagbaw, Lawrence, Conen, David, Borges, Flavia K., Chow, Clara K., Sessler, Daniel I., Chan, Matthew T.V., Hillis, Graham S., Pettit, Shirley, Heels-Ansdell, Diane, and Devereaux, Philip J. more...
- Published
- 2022
- Full Text
- View/download PDF
4. Association of Preoperative Growth Differentiation Factor-15 Concentrations and Postoperative Cardiovascular Events after Major Noncardiac Surgery
- Author
-
Duceppe, Emmanuelle, Borges, Flavia K., Conen, David, Tiboni, Maria, Chan, Matthew T. V., Patel, Ameen, Sessler, Daniel I., Kavsak, Peter A., Ofori, Sandra, Srinathan, Sadeesh, Pearse, Rupert, Jaffe, Allan S., Heels-Ansdell, Diane, Garg, Amit X., Pettit, Shirley, Sapsford, Robert, and Devereaux, P. J. more...
- Published
- 2023
- Full Text
- View/download PDF
5. Technology-Enabled Remote Monitoring and Self-Management — Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol
- Author
-
Mcgillion, Michael H, Devereaux, P J, Yost, Jennifer, Turner, Andy, Bender, Duane, Scott, Ted, Carroll, Sandra L, Ritvo, Paul, Peter, Elizabeth, Lamy, Andre, Furze, Gill, Krull, Kirsten, Dunlop, Valerie, Good, Amber, Bedini, Debbie, Naus, Frank, Pettit, Shirley, Henry, Shaunattonie, Probst, Christine, Mills, Joseph, Gossage, Elaine, Travale, Irene, Duquette, Janine, Taberner, Christy, Bhavnani, Sanjeev, Khan, James, Cowan, David, Romeril, Eric, Lee, John, Collela, T, Choiniere, Manon, Busse, Jason W, Katz, Joel, Victor, J. Charles, Hoch, Jeffrey S, Isranauwatchai, W, Kaasalainen, Sharon, Ladak, Salima SJ, O'Keefe-McCarthy, Sheila, Parry, Monica, Sessler, Daniel, Stacey, Michael, Stevens, Bonnie, Stremler, Robyn, Thabane, Lehana, Watt-Watson, Judy, Whitlock, Richard, Macdermid, Joy C, Leegaard, Marit, McKelvie, Robert, Hillmer, Michael, Cooper, L, Arthur, Gavin, Sider, Krista, Oliver, Susan, Boyajian, Karen, Farrow, Mark, Lawton, Chris, Gamble, Darryl, Welch, Jake, S LeFort S, Field M, Clyne, Wendy, Ricuppero, Maria, Poole, Laurie, Russell-Wood, Karsten, Weber, Michael, McNeil, Jolene, Alpert, Robyn, Sharpe, Sarah, Bhella, Sue, Mohajer, David, Ponnambalam, Sem, Lakhani, Naeem, Khan, Rabia, and Liu, Peter more...
- Subjects
Technology-Enabled ,Remote ,Monitoring ,Self-Management ,Vision ,Patient ,Empowerment ,Following ,Cardiac ,Vascular ,Surgery ,Testing ,Randomized ,Controlled ,Trial ,Protocol - Published
- 2016
6. Preoperative levels of natriuretic peptides and the incidence of postoperative atrial fibrillation after noncardiac surgery: a prospective cohort study
- Author
-
Szczeklik, Wojciech, LeManach, Yannick, Fronczek, Jakub, Polok, Kamil, Conen, David, McAlister, Finlay A., Srinathan, Sadeesh, Alonso-Coello, Pablo, Biccard, Bruce, Duceppe, Emmanuelle, Heels-Ansdell, Diane, Gorka, Jacek, Pettit, Shirley, Roshanov, Pavel S., and Devereaux, P.J. more...
- Subjects
Atrial fibrillation -- Risk factors ,Postoperative complications -- Risk factors ,Natriuretic peptides -- Health aspects ,Health - Abstract
BACKGROUND: Postoperative atrial fibrillation (POAF) is associated with clinically significant short- and long-term complications after noncardiac surgery. Our aim was to describe the incidence of clinically important POAF after noncardiac surgery and establish the prognostic value of N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in this context. METHODS: The Vascular events In noncardiac Surgery patients cOhort evaluatioN (VISION) Study was a prospective cohort study involving patients aged 45 years and older who had inpatient noncardiac surgery that was performed between August 2007 and November 2013. We determined 30-day incidence of clinically important POAF (i.e., resulting in angina, congestive heart failure, symptomatic hypotension or requiring treatment) using logistic regression models to analyze the association between preoperative NT-proBNP and POAF. RESULTS: In 37664 patients with no history of atrial fibrillation, we found that the incidence of POAF was 1.0% (95% confidence interval [CI] 0.9%-1.1%; 369 events); 3.2% (95% CI 2.3%-4.4%) in patients undergoing major thoracic surgery, 1.3% (95% CI 1.2%-1.5%) in patients undergoing major nonthoracic surgery and 0.2% (95% CI 0.1%0.3%) in patients undergoing low-risk surgery. In a subgroup of 9789 patients with preoperative NT-proBNP measurements, the biomarker improved the prediction of POAF risk over conventional prognostic factors (likelihood ratio test p < 0.001; fraction of new information from NT-proBNP was 16%). Compared with a reference NT-proBNP measurement set at 100 ng/L, adjusted odds ratios for the occurrence of POAF were 1.31 (95% CI 1.15-1.49) at 200 ng/L, 2.07 (95% CI 1.27-3.36) at 1500 ng/L and 2.39 (95% CI 1.26-4.51) at 3000 ng/L. INTERPRETATION: We determined that the incidence of clinically important POAF after noncardiac surgery was 1.0%. We also found that preoperative NT-proBNP levels were associated with POAF independent of established prognostic factors. Trial registration: ClinicalTrials.gov, no. NCT00512109, Postoperative atrial fibrillation (POAF) is the most common arrhythmia that occurs after noncardiac surgery (1) and is associated with prolonged hospital stays and an increased risk of stroke and death, [...] more...
- Published
- 2020
- Full Text
- View/download PDF
7. Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study
- Author
-
Khan, James S., Sessler, Daniel I., Chan, Matthew T. V., Wang, C. Y., Garutti, Ignacio, Szczeklik, Wojciech, Turan, Alparslan, Busse, Jason W., Buckley, D. Norman, Paul, James, McGillion, Michael, Fernández-Riveira, Carmen, Srinathan, Sadeesh K., Shanthanna, Harsha, Gilron, Ian, Jacka, Michael, Jackson, Paul, Hankinson, James, Paniagua, Pilar, Pettit, Shirley, and Devereaux, P. J. more...
- Published
- 2021
- Full Text
- View/download PDF
8. One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery
- Author
-
Sessler, Daniel I., Conen, David, Leslie, Kate, Yusuf, Salim, Popova, Ekaterina, Graham, Michelle, Kurz, Andrea, Villar, Juan Carlos, Mrkobrada, Marko, Sigamani, Alben, Biccard, Bruce M., Meyhoff, Christian S., Parlow, Joel L., Guyatt, Gordon, Xavier, Denis, Chan, Matthew T. V., Kumar, Priya A., Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Torres, David, Wang, C. Y., Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Landoni, Giovanni, Manach, Yannick Le, Whitlock, Richard, Lamy, André, Balasubramanian, Kumar, Gilron, Ian, Turan, Alparslan, Pettit, Shirley, and Devereaux, P. J. more...
- Published
- 2020
- Full Text
- View/download PDF
9. Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery :An International Randomized Controlled Trial.
- Author
-
Marcucci, Maura, Painter, Thomas TW, Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I, Chan, Matthew T V, Borges, Flavia K, Leslie, Kate, Duceppe, Emmanuelle, Martínez-Zapata, María José, Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N, Wang, Michael Ke, Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo YV, Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X, Short, Timothy TG, Wittmann, Maria, Meyhoff, Christian Sylvest, Amir, Mohammed, Torres, David, Patel, Ameen, Ruetzler, Kurt, Parlow, Joel JL, Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carísi Anne, Lamy, Andre, Jayaram, Raja, Astrakov, Sergey SV, Wu, William Ka Kei, Cheong, Chao Chia, Ayad, Sabry, Kirov, Mikhail M.Y., de Nadal, Miriam, Likhvantsev, Valery VV, Paniagua, Pilar, Aguado, Hector HJ, Maheshwari, Kamal, Whitlock, Richard RP, McGillion, Michael MH, Vincent, Jessica, Copland, Ingrid, Balasubramanian, Kumar, Biccard, Bruce BM, Srinathan, Sadeesh, Ismoilov, Samandar, Pettit, Shirley, Stillo, David, Kurz, Andrea, Belley-Côté, Emilie EP, Spence, Jessica, McIntyre, William WF, Bangdiwala, Shrikant SI, Guyatt, Gordon, Yusuf, Salim, Devereaux, P J, POISE-3 Trial Investigators and Study Groups, Marcucci, Maura, Painter, Thomas TW, Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I, Chan, Matthew T V, Borges, Flavia K, Leslie, Kate, Duceppe, Emmanuelle, Martínez-Zapata, María José, Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N, Wang, Michael Ke, Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo YV, Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X, Short, Timothy TG, Wittmann, Maria, Meyhoff, Christian Sylvest, Amir, Mohammed, Torres, David, Patel, Ameen, Ruetzler, Kurt, Parlow, Joel JL, Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carísi Anne, Lamy, Andre, Jayaram, Raja, Astrakov, Sergey SV, Wu, William Ka Kei, Cheong, Chao Chia, Ayad, Sabry, Kirov, Mikhail M.Y., de Nadal, Miriam, Likhvantsev, Valery VV, Paniagua, Pilar, Aguado, Hector HJ, Maheshwari, Kamal, Whitlock, Richard RP, McGillion, Michael MH, Vincent, Jessica, Copland, Ingrid, Balasubramanian, Kumar, Biccard, Bruce BM, Srinathan, Sadeesh, Ismoilov, Samandar, Pettit, Shirley, Stillo, David, Kurz, Andrea, Belley-Côté, Emilie EP, Spence, Jessica, McIntyre, William WF, Bangdiwala, Shrikant SI, Guyatt, Gordon, Yusuf, Salim, Devereaux, P J, and POISE-3 Trial Investigators and Study Groups more...
- Abstract
Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively., SCOPUS: ar.j, info:eu-repo/semantics/published more...
- Published
- 2023
10. High-sensitivity Troponin I Predicts Major Cardiovascular Events after Non-Cardiac Surgery: A Vascular Events in Non-Cardiac Surgery Patients Cohort Evaluation (VISION) Substudy.
- Author
-
Borges, Flavia K., Duceppe, Emmanuelle, Heels-Ansdell, Diane, Patel, Ameen, Sessler, Daniel I., Tandon, Vikas, Chan, Matthew, Pearse, Rupert, Srinathan, Sadeesh, Garg, Amit X., Sapsford, Robert J., Ofori, Sandra N., Marcucci, Maura, Kavsak, Peter A., Pettit, Shirley, Spence, Jessica, Belley-Cote, Emilie, McGillion, Michael, Whitlock, Richard, and Lamy, Andre more...
- Published
- 2023
- Full Text
- View/download PDF
11. Accelerated Surgery Versus Standard Care in Hip Fracture (HIP ATTACK-1): A Kidney Substudy of a Randomized Clinical Trial.
- Author
-
UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, UCL - (SLuc) Service de médecine interne générale, Borges, Flavia K, Devereaux, P J, Cuerden, Meaghan, Sontrop, Jessica M, Bhandari, Mohit, Guerra-Farfán, Ernesto, Patel, Ameen, Sigamani, Alben, Umer, Masood, Neary, John, Tiboni, Maria, Tandon, Vikas, Ramokgopa, Mmampapatla Thomas, Sancheti, Parag, Lawendy, Abdel-Rahman, Balaguer-Castro, Mariano, Jenkinson, Richard, Ślęczka, Paweł, Nur, Aamer Nabi, Wood, Gavin C A, Feibel, Robert J, McMahon, John Stephen, Biccard, Bruce M, Ortalda, Alessandro, Szczeklik, Wojciech, Wang, Chew Yin, Tomás-Hernández, Jordi, Vincent, Jessica, Harvey, Valerie, Pettit, Shirley, Balasubramanian, Kumar, Slobogean, Gerard, Garg, Amit X, HIP ATTACK-1 Investigators, Veevaete, Laurent, Le Polain de Waroux, Bernard, Lavand'homme, Patricia, Cornu, Olivier, Tribak, Karim, Yombi, Jean Cyr, Touil, Nassim, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, UCL - (SLuc) Service de médecine interne générale, Borges, Flavia K, Devereaux, P J, Cuerden, Meaghan, Sontrop, Jessica M, Bhandari, Mohit, Guerra-Farfán, Ernesto, Patel, Ameen, Sigamani, Alben, Umer, Masood, Neary, John, Tiboni, Maria, Tandon, Vikas, Ramokgopa, Mmampapatla Thomas, Sancheti, Parag, Lawendy, Abdel-Rahman, Balaguer-Castro, Mariano, Jenkinson, Richard, Ślęczka, Paweł, Nur, Aamer Nabi, Wood, Gavin C A, Feibel, Robert J, McMahon, John Stephen, Biccard, Bruce M, Ortalda, Alessandro, Szczeklik, Wojciech, Wang, Chew Yin, Tomás-Hernández, Jordi, Vincent, Jessica, Harvey, Valerie, Pettit, Shirley, Balasubramanian, Kumar, Slobogean, Gerard, Garg, Amit X, HIP ATTACK-1 Investigators, Veevaete, Laurent, Le Polain de Waroux, Bernard, Lavand'homme, Patricia, Cornu, Olivier, Tribak, Karim, Yombi, Jean Cyr, and Touil, Nassim more...
- Abstract
To the Editor: Acute kidney injury (AKI) is a lesser-known complication of hip fracture that may come about owing to decreased kidney perfusion and heightened inflammation from trauma, pain, bleeding, and fasting. Approximately 15%-20% of patients undergoing surgery for a hip fracture develop AKI, with 0.5%-1.8% receiving dialysis. [...] more...
- Published
- 2022
12. Intraoperative Inspiratory Oxygen Fraction and Myocardial Injury After Noncardiac Surgery:Results From an International Observational Study in Relation to Recent Controlled Trials
- Author
-
Pedersen, Sofie S., Holse, Cecilie, Mathar, Clara E., Chan, Matthew T.V., Sessler, Daniel I., Liu, Yingzhi, Zhang, Lin, Kurz, Andrea, Jacka, Mike, Torborg, Alexandra, Biyase, Thuli, Montes, Felix R., Wang, Chew Yin, Pettit, Shirley, Devereaux, P. J., Meyhoff, Christian S., Pedersen, Sofie S., Holse, Cecilie, Mathar, Clara E., Chan, Matthew T.V., Sessler, Daniel I., Liu, Yingzhi, Zhang, Lin, Kurz, Andrea, Jacka, Mike, Torborg, Alexandra, Biyase, Thuli, Montes, Felix R., Wang, Chew Yin, Pettit, Shirley, Devereaux, P. J., and Meyhoff, Christian S. more...
- Abstract
BACKGROUND: Two trials reported that a high inspiratory oxygen fraction (F io2 ) does not promote myocardial infarction or death. Observational studies can provide larger statistical strength, but associations can be due to unobserved confounding. Therefore, we evaluated the association between intraoperative F io2 and cardiovascular complications in a large international cohort study to see if spurious associations were observed. METHODS: We included patients from the Vascular events In noncardiac Surgery patIents cOhort evaluatioN (VISION) study, who were ≥45 years of age, scheduled for overnight hospital admission, and had intraoperative F io2 recorded. The primary outcome was myocardial injury after noncardiac surgery (MINS), and secondary outcomes included mortality and pneumonia, all within 30 postoperative days. Data were analyzed with logistic regression, adjusted for many baseline cardiovascular risk factors, and illustrated in relation to findings from 2 recent controlled trials. RESULTS: We included 6588 patients with mean age of 62 years of whom 49% had hypertension. The median intraoperative F io2 was 0.46 (5%-95% range, 0.32-0.94). There were 808 patients (12%) with MINS. Each 0.10 increase in median F io2 was associated with a confounder-adjusted increase in odds for MINS: odds ratio (OR), 1.17 (95% confidence interval [CI], 1.12-1.23; P < .0001). MINS occurred in contrast with similar frequencies and no significant difference in controlled trials (2240 patients, 194 events), in which patients were given 80% vs 30% oxygen. Mortality was 2.4% and was not significantly associated with a median F io2 (OR, 1.07; 95% CI, 0.97-1.19 per 0.10 increase; P = .18), and 2.9% of patients had pneumonia (OR, 1.05; 95% CI, 0.95-1.15 per 0.10 increase; P = .34). CONCLUSIONS: We observed an association between intraoperative F io2 and risk of myocardial injury within 30 days after noncardiac surgery, which contrasts with recent controlled clinical trials. F io2 w more...
- Published
- 2022
13. Intraoperative Inspiratory Oxygen Fraction and Myocardial Injury After Noncardiac Surgery: Results From an International Observational Study in Relation to Recent Controlled Trials
- Author
-
Pedersen, Sofie S., primary, Holse, Cecilie, additional, Mathar, Clara E., additional, Chan, Matthew T. V., additional, Sessler, Daniel I., additional, Liu, Yingzhi, additional, Zhang, Lin, additional, Kurz, Andrea, additional, Jacka, Mike, additional, Torborg, Alexandra, additional, Biyase, Thuli, additional, Montes, Felix R., additional, Wang, Chew Yin, additional, Pettit, Shirley, additional, Devereaux, P. J., additional, and Meyhoff, Christian S., additional more...
- Published
- 2022
- Full Text
- View/download PDF
14. Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM): protocol for a randomized controlled trial
- Author
-
McGillion, Michael H., primary, Parlow, Joel, additional, Borges, Flavia K., additional, Marcucci, Maura, additional, Jacka, Michael, additional, Adili, Anthony, additional, Lalu, Manoj M., additional, Yang, Homer, additional, Patel, Ameen, additional, O’Leary, Susan, additional, Tandon, Vikas, additional, Hamilton, Gavin M., additional, Mrkobrada, Marko, additional, Ouellette, Carley, additional, Bird, Marissa, additional, Ofori, Sandra, additional, Conen, David, additional, Roshanov, Pavel S., additional, Harvey, Valerie, additional, Guyatt, Gordon H., additional, Le Manach, Yannick, additional, Bangdiwala, Shrikant I., additional, Arellano, Ramiro, additional, Scott, Ted, additional, Lounsbury, Jennifer, additional, Taylor, Dylan A., additional, Nenshi, Rahima, additional, Forster, Alan J., additional, Nagappa, Mahesh, additional, Lamy, Andre, additional, Peter, Elizabeth, additional, Levesque, Kelsea, additional, Marosi, Kristen, additional, Chaudhry, Sultan, additional, Haider, Shariq, additional, Deuchar, Lesly, additional, LeBlanc, Brandi, additional, McCartney, Colin J.L., additional, Schemitsch, Emil H., additional, Vincent, Jessica, additional, Pettit, Shirley M., additional, Paul, James, additional, DuMerton, Deborah, additional, Paulin, Angela Djuric, additional, Simunovic, Marko, additional, Williams, David C., additional, Halman, Samantha, additional, Schlachta, Christopher M., additional, Shelley, Jessica, additional, Harlock, John, additional, Meyer, Ralph M., additional, Graham, Michelle, additional, Shanthanna, Harsha, additional, Parry, Neil, additional, Pichora, David R., additional, Yousef, Haroon, additional, Moloo, Husein, additional, Sehmbi, Herman, additional, Waggott, Melissa, additional, Belley-Cote, Emilie P., additional, Whitlock, Richard, additional, and Devereaux, P.J., additional more...
- Published
- 2021
- Full Text
- View/download PDF
15. ASSOCIATION BETWEEN HIGH-SENSITIVITY TROPONIN I AND MAJOR CARDIOVASCULAR EVENTS AFTER NON-CARDIAC SURGERY
- Author
-
Duceppe, Emmanuelle, primary, Borges, Flavia K., additional, Tiboni, Maria, additional, Pearse, Rupert, additional, Chan, Matthew T.V., additional, Srinathan, Sadeesh, additional, Kavsak, Peter, additional, Szalay, David, additional, Garg, Amit, additional, Sessler, Daniel, additional, Sapsford, Robert, additional, Pettit, Shirley, additional, Vasquez, Javiera, additional, and Devereaux, P.J., additional more...
- Published
- 2020
- Full Text
- View/download PDF
16. Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture: a substudy protocol of the hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) international randomised controlled trial
- Author
-
Borges, Flavia K, primary, Devereaux, P J, additional, Cuerden, Meaghan, additional, Bhandari, Mohit, additional, Guerra-Farfán, Ernesto, additional, Patel, Ameen, additional, Sigamani, Alben, additional, Umer, Masood, additional, Neary, John, additional, Tiboni, Maria, additional, Tandon, Vikas, additional, Ramokgopa, Mmampapatla Thomas, additional, Sancheti, Parag, additional, John, Bobby, additional, Lawendy, AbdelRahman, additional, Balaguer-Castro, Mariano, additional, Jenkinson, Richard, additional, Ślęczka, Paweł, additional, Nabi Nur, Aamer, additional, Wood, Gavin C A, additional, Feibel, Robert, additional, McMahon, John Stephen, additional, Sigamani, Alen, additional, Biccard, Bruce M, additional, Landoni, Giovanni, additional, Szczeklik, Wojciech, additional, Wang, Chew Yin, additional, Tomas-Hernandez, Jordi, additional, Abraham, Valsa, additional, Vincent, Jessica, additional, Harvey, Valerie, additional, Pettit, Shirley, additional, Sontrop, Jessica, additional, and Garg, Amit X, additional more...
- Published
- 2019
- Full Text
- View/download PDF
17. Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients
- Author
-
Borges, Flavia K, primary, Bhandari, Mohit, additional, Patel, Ameen, additional, Avram, Victoria, additional, Guerra-Farfán, Ernesto, additional, Sigamani, Alben, additional, Umer, Masood, additional, Tiboni, Maria, additional, Adili, Anthony, additional, Neary, John, additional, Tandon, Vikas, additional, Sancheti, Parag K, additional, Lawendy, AbdelRahman, additional, Jenkinson, Richard, additional, Ramokgopa, Mmampapatla, additional, Biccard, Bruce M, additional, Szczeklik, Wojciech, additional, Wang, Chew Yin, additional, Landoni, Giovanni, additional, Forget, Patrice, additional, Popova, Ekaterine, additional, Wood, Gavin, additional, Nabi Nur, Aamer, additional, John, Bobby, additional, Ślęczka, Paweł, additional, Feibel, Robert J, additional, Balaguer-Castro, Mariano, additional, Deheshi, Benjamin, additional, Winemaker, Mitchell, additional, de Beer, Justin, additional, Kolesar, Richard, additional, Teixidor-Serra, Jordi, additional, Tomas-Hernandez, Jordi, additional, McGillion, Michael, additional, Shanthanna, Harsha, additional, Moppett, Iain, additional, Vincent, Jessica, additional, Pettit, Shirley, additional, Harvey, Valerie, additional, Gauthier, Leslie, additional, Alvarado, Kim, additional, and Devereaux, P J, additional more...
- Published
- 2019
- Full Text
- View/download PDF
18. Rationale and design for the detection and neurological impact of cerebrovascular events in non-cardiac surgery patients cohort evaluation (NeuroVISION) study: a prospective international cohort study
- Author
-
Mrkobrada, Marko, primary, Chan, Matthew T V, additional, Cowan, David, additional, Spence, Jessica, additional, Campbell, Douglas, additional, Wang, Chew Yin, additional, Torres, David, additional, Malaga, German, additional, Sanders, Robert D, additional, Brown, Carl, additional, Sigamani, Alben, additional, Szczeklik, Wojciech, additional, Dmytriw, Adam Andrew, additional, Agid, Ronit, additional, Smith, Eric E, additional, Hill, Michael D, additional, Sharma, Manas, additional, Sharma, Mukul, additional, Tsai, Scott, additional, Mensinkai, Arun, additional, Sahlas, Demetrios J, additional, Guyatt, Gordon, additional, Pettit, Shirley, additional, Copland, Ingrid, additional, Wu, William K K, additional, Yu, Simon C H, additional, Gin, Tony, additional, Loh, Pui San, additional, Ramli, Norlisah, additional, Siow, Yee Lein, additional, Short, Timothy G, additional, Waymouth, Ellen, additional, Kumar, Jonathan, additional, Dasgupta, Monidipa, additional, Murkin, John M, additional, Fuentes, Maite, additional, Ortiz-Soriano, Victor, additional, Lindroth, Heidi, additional, Simpson, Sara, additional, Sessler, Daniel, additional, and Devereaux, P J, additional more...
- Published
- 2018
- Full Text
- View/download PDF
19. Design of a Randomized Placebo-Controlled Trial to Assess Dabigatran and Omeprazole in Patients with Myocardial Injury after Noncardiac Surgery (MANAGE)
- Author
-
Duceppe, Emmanuelle, Yusuf, Salim, Tandon, Vikas, Rodseth, Reitze, Biccard, Bruce M, Xavier, Denis, Szczeklik, Wojciech, Meyhoff, Christian S, Franzosi, Maria Grazia, Vincent, Jessica, Srinathan, Sadeesh K, Parlow, Joel, Magloire, Patrick, Neary, John, Rao, Mangala, Chaudhry, Navneet K, Mayosi, Bongani, de Nadal, Miriam, Popova, Ekaterine, Villar, Juan Carlos, Botto, Fernando, Berwanger, Otavio, Guyatt, Gordon, Eikelboom, John W, Sessler, Daniel I, Kearon, Clive, Pettit, Shirley, Connolly, Stuart J, Sharma, Mukul, Bangdiwala, Shrikant I, Devereaux, P J, Duceppe, Emmanuelle, Yusuf, Salim, Tandon, Vikas, Rodseth, Reitze, Biccard, Bruce M, Xavier, Denis, Szczeklik, Wojciech, Meyhoff, Christian S, Franzosi, Maria Grazia, Vincent, Jessica, Srinathan, Sadeesh K, Parlow, Joel, Magloire, Patrick, Neary, John, Rao, Mangala, Chaudhry, Navneet K, Mayosi, Bongani, de Nadal, Miriam, Popova, Ekaterine, Villar, Juan Carlos, Botto, Fernando, Berwanger, Otavio, Guyatt, Gordon, Eikelboom, John W, Sessler, Daniel I, Kearon, Clive, Pettit, Shirley, Connolly, Stuart J, Sharma, Mukul, Bangdiwala, Shrikant I, and Devereaux, P J more...
- Abstract
BACKGROUND: Worldwide approximately 200 million adults undergo major surgery annually, of whom 8 million are estimated to suffer a myocardial injury after noncardiac surgery (MINS). There is currently no trial data informing the management of MINS. Antithrombotic agents such as direct oral anticoagulants might prevent major vascular complications in patients with MINS.METHODS: The Management of Myocardial Injury After Noncardiac Surgery (MANAGE) trial is a large international blinded randomized controlled trial of dabigatran vs placebo in patients who suffered MINS. We used a partial factorial design to also determine the effect of omeprazole vs placebo in reducing upper gastrointestinal bleeding and complications. Both study drugs were initiated in eligible patients within 35 days of suffering MINS and continued for a maximum of 2 years. The primary outcome is a composite of major vascular complications for the dabigatran trial and a composite of upper gastrointestinal complications for the omeprazole trial. We present the rationale and design of the trial and baseline characteristics of enrolled patients.RESULTS: The trial randomized 1754 patients between January 2013 and July 2017. Patients' mean age was 69.9 years, 51.1% were male, 14.3% had a history of peripheral artery disease, 6.6% had a history of stroke or transient ischemic attack, 12.9% had a previous myocardial infarction, and 26.0% had diabetes. The diagnosis of MINS was on the basis of an isolated ischemic troponin elevation in 80.4% of participants.CONCLUSION: MANAGE is the first randomized controlled trial to evaluate a potential treatment of patients who suffered MINS. more...
- Published
- 2018
20. Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE):an international, randomised, placebo-controlled trial
- Author
-
Devereaux, P J, Duceppe, Emmanuelle, Guyatt, Gordon, Tandon, Vikas, Rodseth, Reitze, Biccard, Bruce M, Xavier, Denis, Szczeklik, Wojciech, Meyhoff, Christian S, Vincent, Jessica, Franzosi, Maria Grazia, Srinathan, Sadeesh K, Erb, Jason, Magloire, Patrick, Neary, John, Rao, Mangala, Rahate, Prashant V, Chaudhry, Navneet K, Mayosi, Bongani, de Nadal, Miriam, Iglesias, Pilar Paniagua, Berwanger, Otavio, Villar, Juan Carlos, Botto, Fernando, Eikelboom, John W, Sessler, Daniel I, Kearon, Clive, Pettit, Shirley, Sharma, Mukul, Connolly, Stuart J, Bangdiwala, Shrikant I, Rao-Melacini, Purnima, Hoeft, Andreas, Yusuf, Salim, Devereaux, P J, Duceppe, Emmanuelle, Guyatt, Gordon, Tandon, Vikas, Rodseth, Reitze, Biccard, Bruce M, Xavier, Denis, Szczeklik, Wojciech, Meyhoff, Christian S, Vincent, Jessica, Franzosi, Maria Grazia, Srinathan, Sadeesh K, Erb, Jason, Magloire, Patrick, Neary, John, Rao, Mangala, Rahate, Prashant V, Chaudhry, Navneet K, Mayosi, Bongani, de Nadal, Miriam, Iglesias, Pilar Paniagua, Berwanger, Otavio, Villar, Juan Carlos, Botto, Fernando, Eikelboom, John W, Sessler, Daniel I, Kearon, Clive, Pettit, Shirley, Sharma, Mukul, Connolly, Stuart J, Bangdiwala, Shrikant I, Rao-Melacini, Purnima, Hoeft, Andreas, and Yusuf, Salim more...
- Abstract
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients.METHODS: In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries. Eligible patients were aged at least 45 years, had undergone non-cardiac surgery, and were within 35 days of MINS. Patients were randomly assigned (1:1) to receive dabigatran 110 mg orally twice daily or matched placebo for a maximum of 2 years or until termination of the trial and, using a partial 2-by-2 factorial design, patients not taking a proton-pump inhibitor were also randomly assigned (1:1) to omeprazole 20 mg once daily, for which results will be reported elsewhere, or matched placebo to measure its effect on major upper gastrointestinal complications. Research personnel randomised patients through a central 24 h computerised randomisation system using block randomisation, stratified by centre. Patients, health-care providers, data collectors, and outcome adjudicators were masked to treatment allocation. The primary efficacy outcome was the occurrence of a major vascular complication, a composite of vascular mortality and non-fatal myocardial infarction, non-haemorrhagic stroke, peripheral arterial thrombosis, amputation, and symptomatic venous thromboembolism. The primary safety outcome was a composite of life-threatening, major, and critical organ bleeding. Analyses were done according to the intention-to-treat principle. This trial is registered with ClinicalTrials.gov, number NCT01661101.FINDINGS: Between Jan 10, 2013, and July 17, 2017, we randomly assigned 1754 patients t more...
- Published
- 2018
21. Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting
- Author
-
Lamy, André, Devereaux, PJ, Prabhakaran, Dorairaj, Taggart, David P, Hu, Shengshou, Straka, Zbynek, Piegas, Leopoldo S, Avezum, Alvaro, Akar, Ahmet R, Lanas Zanetti, Fernando, Jain, Anil R, Noiseux, Nicolas, Padmanabhan, Chandrasekar, Bahamondes, Juan-Carlos, Novick, Richard J, Tao, Liang, Olavegogeascoechea, Pablo A, Airan, Balram, Sulling, Toomas-Andres, Whitlock, Richard P, Ou, Yongning, Gao, Peggy, Pettit, Shirley, Yusuf, Salim, and CORONARY Investigators more...
- Abstract
BACKGROUND: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial). METHODS: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years. RESULTS: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29). The secondary outcome for the overall period of the trial - the mean cost in U.S. dollars per patient - also did not differ significantly between the off-pump group and the on-pump group ($15,107 and $14,992, respectively; between-group difference, $115; 95% CI, -$697 to $927). There were no significant between-group differences in quality-of-life measures. CONCLUSIONS: In our trial, the rate of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years of follow-up was similar among patients who underwent off-pump CABG and those who underwent on-pump CABG. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294 .). more...
- Published
- 2016
22. Colchicine for Prevention of Perioperative Atrial Fibrillation in patients undergoing lung resection surgery: a pilot randomized controlled study
- Author
-
Bessissow, Amal, primary, Agzarian, John, additional, Shargall, Yaron, additional, Srinathan, Sadeesh, additional, Neary, John, additional, Tandon, Vikas, additional, Finley, Christian, additional, Healey, Jeff S, additional, Conen, David, additional, Rodseth, Reitze, additional, Pettit, Shirley, additional, Dechert, William, additional, Regalado, Otto, additional, Ramasundarahettige, Chinthanie, additional, Alshalash, Saleh, additional, and Devereaux, P J, additional more...
- Published
- 2017
- Full Text
- View/download PDF
23. Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery.
- Author
-
Devereaux, P J, Biccard, Bruce M, Sigamani, Alben, Xavier, Denis, Chan, Matthew T V, Srinathan, Sadeesh K, Walsh, Michael, Abraham, Valsa, Pearse, Rupert, Wang, C Y, Sessler, Daniel I, Kurz, Andrea, Szczeklik, Wojciech, Berwanger, Otavio, Villar, Juan Carlos, Malaga, German, Garg, Amit X, Chow, Clara K, Ackland, Gareth, Patel, Ameen, Borges, Flavia Kessler, Belley-Cote, Emilie P, Duceppe, Emmanuelle, Spence, Jessica, Tandon, Vikas, Williams, Colin, Sapsford, Robert J, Polanczyk, Carisi A, Tiboni, Maria, Alonso-Coello, Pablo, Faruqui, Atiya, Heels-Ansdell, Diane, Lamy, Andre, Whitlock, Richard, LeManach, Yannick, Roshanov, Pavel S, McGillion, Michael, Kavsak, Peter, McQueen, Matthew J, Thabane, Lehana, Rodseth, Reitze N, Buse, Giovanna A Lurati, Bhandari, Mohit, Garutti, Ignacia, Jacka, Michael J, Schünemann, Holger J, Cortes, Olga Lucía, Coriat, Pierre, Dvirnik, Nazari, Botto, Fernando, Pettit, Shirley, Jaffe, Allan S, Guyatt, Gordon H, Devereaux, P J, Biccard, Bruce M, Sigamani, Alben, Xavier, Denis, Chan, Matthew T V, Srinathan, Sadeesh K, Walsh, Michael, Abraham, Valsa, Pearse, Rupert, Wang, C Y, Sessler, Daniel I, Kurz, Andrea, Szczeklik, Wojciech, Berwanger, Otavio, Villar, Juan Carlos, Malaga, German, Garg, Amit X, Chow, Clara K, Ackland, Gareth, Patel, Ameen, Borges, Flavia Kessler, Belley-Cote, Emilie P, Duceppe, Emmanuelle, Spence, Jessica, Tandon, Vikas, Williams, Colin, Sapsford, Robert J, Polanczyk, Carisi A, Tiboni, Maria, Alonso-Coello, Pablo, Faruqui, Atiya, Heels-Ansdell, Diane, Lamy, Andre, Whitlock, Richard, LeManach, Yannick, Roshanov, Pavel S, McGillion, Michael, Kavsak, Peter, McQueen, Matthew J, Thabane, Lehana, Rodseth, Reitze N, Buse, Giovanna A Lurati, Bhandari, Mohit, Garutti, Ignacia, Jacka, Michael J, Schünemann, Holger J, Cortes, Olga Lucía, Coriat, Pierre, Dvirnik, Nazari, Botto, Fernando, Pettit, Shirley, Jaffe, Allan S, and Guyatt, Gordon H more...
- Abstract
Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality. Among 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2%; 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to less than 65 ng/L, 65 to less than 1000 ng/L, and 1000 ng/L or higher had 30-day mortality rates of 3.0% (123/4049; 95% CI, 2.6%-3.6%), 9.1% (102/1118; 95% CI, 7.6%-11.0%), and 29.6% (16/54; 95% CI, 19.1%-42.8%), with corresponding adjusted HRs of 23.63 (95% CI, 10.32-54.09), 70.34 (95% CI, 30.60-161.71), and 227.01 (95% CI, 87.35-589.92), respectively. An absolute hsTnT change of 5 ng/L or higher was associated wi more...
- Published
- 2017
24. Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery
- Author
-
Devereaux, P.J., Biccard, Bruce M., Sigamani, Alben, Xavier, Denis, Chan, Matthew T. V., Srinathan, Sadeesh K., Walsh, Michael, Abraham, Valsa, Pearse, Rupert, Wang, Y., Sessler, Daniel I., Kurz, Andrea, Szczeklik, Wojciech, Berwanger, Otavio, Villar, Juan Carlos, Malaga, German, Garg, Amit X., Chow, Clara K., Ackland, Gareth, Patel, Ameen, Kessler Borges, Flavia, Belley-Cote, Emilie P., Duceppe, Emmanuelle, Spence, Jessica, Tandon, Vikas, Williams, Colin, Sapsford, Robert J., Polanczyk, Carisi A., Tiboni, Maria, Alonso-Coello, Pablo, Faruqui, Atiya, Heels-Ansdell, Diane, Lamy, Andre, Whitlock, Richard, LeManach, Yannick, Roshanov, Pavel S., McGillion, Michael, Kavsak, Peter, McQueen, Matthew J., Thabane, Lehana, Rodseth, Reitze N., Lurati Buse, Giovanna A., Bhandari, Mohit, Garutti, Ignacia, Jacka, Michael J., Schunemann, Holger J., Cortes, Olga Lucia, Coriat, Pierre, Dvirnik, Nazari, Botto, Fernando, Pettit, Shirley, Jaffe, Allan S., Guyatt, Gordon H., and VISION Study Investigators more...
- Subjects
Male ,Myocardial Ischemia/mortality ,Myocardial Infarction ,Myocardial Ischemia ,030204 cardiovascular system & hematology ,Risk Assessment ,Preoperative care ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Troponin T ,030202 anesthesiology ,medicine ,Humans ,Prospective Studies ,Postoperative Period ,Myocardial infarction ,Prospective cohort study ,Myocardial Infarction/mortality ,Aged ,Troponin T/blood ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,General Medicine ,Perioperative ,Middle Aged ,medicine.disease ,purl.org/pe-repo/ocde/ford#3.02.00 [https] ,Editorial ,Anesthesia ,Female ,Risk assessment ,business ,Electrocardiography - Abstract
IMPORTANCE Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). OBJECTIVE To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries; follow-up finished in December 2013. EXPOSURES Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days; 40.4% had a preoperative hsTnT measurement. MAIN OUTCOMES AND MEASURES A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality. RESULTS Among 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2%; 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT = 5 ng/L or hsTnT >= 65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20; 95% CI, 2.37-4.32). Among the 3904 patients (17.9%; 95% CI, 17.4%-18.4%) with MINS, 3633 (93.1%; 95% CI, 92.2%-93.8%) did not experience an ischemic symptom. CONCLUSIONS AND RELEVANCE Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality. more...
- Published
- 2017
- Full Text
- View/download PDF
25. Technology-Enabled Remote Monitoring and Self-Management — Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol
- Author
-
McGillion, Michael, primary, Yost, Jennifer, additional, Turner, Andrew, additional, Bender, Duane, additional, Scott, Ted, additional, Carroll, Sandra, additional, Ritvo, Paul, additional, Peter, Elizabeth, additional, Lamy, Andre, additional, Furze, Gill, additional, Krull, Kirsten, additional, Dunlop, Valerie, additional, Good, Amber, additional, Dvirnik, Nazari, additional, Bedini, Debbie, additional, Naus, Frank, additional, Pettit, Shirley, additional, Henry, Shaunattonie, additional, Probst, Christine, additional, Mills, Joseph, additional, Gossage, Elaine, additional, Travale, Irene, additional, Duquette, Janine, additional, Taberner, Christy, additional, Bhavnani, Sanjeev, additional, Khan, James S, additional, Cowan, David, additional, Romeril, Eric, additional, Lee, John, additional, Colella, Tracey, additional, Choinière, Manon, additional, Busse, Jason, additional, Katz, Joel, additional, Victor, J Charles, additional, Hoch, Jeffrey, additional, Isaranuwatchai, Wanrudee, additional, Kaasalainen, Sharon, additional, Ladak, Salima, additional, O'Keefe-McCarthy, Sheila, additional, Parry, Monica, additional, Sessler, Daniel I, additional, Stacey, Michael, additional, Stevens, Bonnie, additional, Stremler, Robyn, additional, Thabane, Lehana, additional, Watt-Watson, Judy, additional, Whitlock, Richard, additional, MacDermid, Joy C, additional, Leegaard, Marit, additional, McKelvie, Robert, additional, Hillmer, Michael, additional, Cooper, Lynn, additional, Arthur, Gavin, additional, Sider, Krista, additional, Oliver, Susan, additional, Boyajian, Karen, additional, Farrow, Mark, additional, Lawton, Chris, additional, Gamble, Darryl, additional, Walsh, Jake, additional, Field, Mark, additional, LeFort, Sandra, additional, Clyne, Wendy, additional, Ricupero, Maria, additional, Poole, Laurie, additional, Russell-Wood, Karsten, additional, Weber, Michael, additional, McNeil, Jolene, additional, Alpert, Robyn, additional, Sharpe, Sarah, additional, Bhella, Sue, additional, Mohajer, David, additional, Ponnambalam, Sem, additional, Lakhani, Naeem, additional, Khan, Rabia, additional, Liu, Peter, additional, and Devereaux, PJ, additional more...
- Published
- 2016
- Full Text
- View/download PDF
26. Myocardial Injury after Noncardiac Surgery : a Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes
- Author
-
Surgery Patients Cohort Evaluation, Vascular Events In Noncardiac, Botto, Fernando, Alonso-Coello, Pablo, Chan, Matthew T. V., Villar, Juan Carlos, Xavier, Denis, Srinathan, Sadeesh, Guyatt, Gordon H., Cruz, Patricia, Graham, Michelle, Berwanger, Otavio, Pearse, Rupert M., Biccard, Bruce M., Abraham, Valsa, Malaga, German, Hillis, Graham S., Rodseth, Reitze N., Cook, Deborah, Polanczyk, Carisi A., Szczeklik, Wojciech, Sessler, Daniel I., Sheth, Tej, Ackland, Gareth L., Leuwer, Martin, Garg, Amit X., LeManach, Yannick, Pettit, Shirley, Heels-Ansdell, Diane, LuratiBuse, Giovanna, Walsh, Michael, Sapsford, Robert, Schunemann, Holger J., Kurz, Andrea, Thomas, Sabu, Mrkobrada, Marko, Thabane, Lehana, Gerstein, Hertzel, Paniagua, Pilar, Nagele, Peter, Raina, Parminder, Yusuf, Salim, and Devereaux, P.-J. more...
- Published
- 2014
27. Colchicine for Prevention of Perioperative Atrial Fibrillation in patients undergoing lung resection surgery: a pilot randomized controlled study.
- Author
-
Bessissow, Amal, Agzarian, John, Shargall, Yaron, Srinathan, Sadeesh, Neary, John, Tandon, Vikas, Finley, Christian, Healey, Jeff S., Conen, David, Rodseth, Reitze, Pettit, Shirley, Decherti, William, Regalado, Otto, Ramasundarahettige, Chinthanie, Alshalash, Saleh, and Devereaux, P. J. more...
- Subjects
ATRIAL fibrillation ,COLCHICINE ,LUNG surgery ,THORACIC surgery ,PLACEBOS ,PATIENTS ,THERAPEUTICS - Abstract
OBJECTIVES: We carried out a pilot randomized controlled study to determine the feasibility of a large trial evaluating the impact of colchicine versus placebo on postoperative atrial fibrillation or atrial flutter (POAF) among patients undergoing lung resection surgery. METHODS: Patients >55 years of age undergoing lung resection surgery were randomly assigned to receive colchicine 0.6mg or placebo starting a few hours before surgery. Postoperatively, patients received colchicine 0.6mg or placebo twice daily for an additional 9 days. Our feasibility outcomes included the period of time required to recruit 100 patients, the completeness of follow-up and compliance with the study drug. The primary efficacy outcome was POAF within 30 days of randomization. RESULTS: One hundred patients were randomized (49 to colchicine and 51 to placebo) over a period of 12 months at 2 centres in Canada. All patients completed the 30-day follow-up. The mean staff time required to recruit and to follow-up each patient was 165 min. In all, 71% of patients completed the study drug course without interruption. Patient refusal to continuing taking the study drug was the main reason for permanent drug discontinuation. New POAF occurred in 5 (10.2%) patients in the colchicine group and 7 (13.7%) patients in the placebo group (adjusted hazard ratio 0.69, 95% confidence interval 0.20–2.34). CONCLUSIONS: These results show the feasibility of a trial evaluating Colchicine for the prevention of perioperative Atrial Fibrillation in patients undergoing lung resection surgery. This pilot study will serve as the foundation for the large multicentre COP-AF trial. [ABSTRACT FROM AUTHOR] more...
- Published
- 2018
- Full Text
- View/download PDF
28. Aspirin in patients undergoing noncardiac surgery
- Author
-
UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - (SLuc) Service d'anesthésiologie, Devereaux, P J, Mrkobrada, Marko, Sessler, Daniel I, Leslie, Kate, Alonso-Coello, Pablo, Kurz, Andrea, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Robinson, Andrea, Garg, Amit X, Rodseth, Reitze N, Botto, Fernando, Lurati Buse, Giovanna, Xavier, Denis, Chan, Matthew T V, Tiboni, Maria, Cook, Deborah, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C Y, VanHelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Baigent, Colin, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, Yusuf, Salim, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - (SLuc) Service d'anesthésiologie, Devereaux, P J, Mrkobrada, Marko, Sessler, Daniel I, Leslie, Kate, Alonso-Coello, Pablo, Kurz, Andrea, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Robinson, Andrea, Garg, Amit X, Rodseth, Reitze N, Botto, Fernando, Lurati Buse, Giovanna, Xavier, Denis, Chan, Matthew T V, Tiboni, Maria, Cook, Deborah, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C Y, VanHelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Baigent, Colin, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, and Yusuf, Salim more...
- Abstract
BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P=0.92). Major bleeding was more common in the aspirin group than in the placebo group (230 patients [4.6%] vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P=0.04). The primary and secondary outcome results were similar in the two aspirin strata. CONCLUSIONS: Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.). more...
- Published
- 2014
29. Clonidine in patients undergoing noncardiac surgery
- Author
-
UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - (SLuc) Service d'anesthésiologie, Devereaux, P J, Sessler, Daniel I, Leslie, Kate, Kurz, Andrea, Mrkobrada, Marko, Alonso-Coello, Pablo, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Robinson, Andrea, Garg, Amit X, Rodseth, Reitze N, Botto, Fernando, Lurati Buse, Giovanna, Xavier, Denis, Chan, Matthew T V, Tiboni, Maria, Cook, Deborah, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C Y, Vanhelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, Yusuf, Salim, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - (SLuc) Service d'anesthésiologie, Devereaux, P J, Sessler, Daniel I, Leslie, Kate, Kurz, Andrea, Mrkobrada, Marko, Alonso-Coello, Pablo, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Robinson, Andrea, Garg, Amit X, Rodseth, Reitze N, Botto, Fernando, Lurati Buse, Giovanna, Xavier, Denis, Chan, Matthew T V, Tiboni, Maria, Cook, Deborah, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C Y, Vanhelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, and Yusuf, Salim more...
- Abstract
BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. METHODS: We performed a blinded, randomized trial with a 2-by-2 factorial design to allow separate evaluation of low-dose clonidine versus placebo and low-dose aspirin versus placebo in patients with, or at risk for, atherosclerotic disease who were undergoing noncardiac surgery. A total of 10,010 patients at 135 centers in 23 countries were enrolled. For the comparison of clonidine with placebo, patients were randomly assigned to receive clonidine (0.2 mg per day) or placebo just before surgery, with the study drug continued until 72 hours after surgery. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: Clonidine, as compared with placebo, did not reduce the number of primary-outcome events (367 and 339, respectively; hazard ratio with clonidine, 1.08; 95% confidence interval [CI], 0.93 to 1.26; P=0.29). Myocardial infarction occurred in 329 patients (6.6%) assigned to clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio, 1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the clonidine group than in the placebo group had clinically important hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio 1.32; 95% CI, 1.24 to 1.40; P<0.001). Clonidine, as compared with placebo, was associated with an increased rate of nonfatal cardiac arrest (0.3% [16 patients] vs. 0.1% [5 patients]; hazard ratio, 3.20; 95% CI, 1.17 to 8.73; P=0.02). CONCLUSIONS: Administration of low-dose clonidine in patients undergoing noncardiac surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction; it did, however, increase the risk of clinically important hypotension and nonfatal cardiac more...
- Published
- 2014
30. One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery
- Author
-
Patrice Forget, Joel L. Parlow, Christian S. Meyhoff, Yannick Le Manach, Alben Sigamani, Matthew T. V. Chan, Mohammed Amir, Giovanni Landoni, Bruce M Biccard, Alparslan Turan, Andrea Kurz, Denis Xavier, Richard P. Whitlock, Gordon H. Guyatt, Germán Málaga, Ekaterina Popova, Juan Carlos Villar, Andre Lamy, David Torres, Kate Leslie, Daniel I. Sessler, Priya A. Kumar, Kumar Balasubramanian, Ian Gilron, Sadeesh Srinathan, Marko Mrkobrada, Michelle M. Graham, Pilar Paniagua, Chew Yin Wang, Shirley Pettit, Edith Fleischmann, Salim Yusuf, Otavio Berwanger, Philip J. Devereaux, David Conen, Sessler, Daniel I, Conen, David, Leslie, Kate, Yusuf, Salim, Popova, Ekaterina, Graham, Michelle, Kurz, Andrea, Villar, Juan Carlo, Mrkobrada, Marko, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Xavier, Deni, Chan, Matthew T V, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Torres, David, Wang, C Y, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Landoni, Giovanni, Manach, Yannick Le, Whitlock, Richard, Lamy, André, Balasubramanian, Kumar, Gilron, Ian, Turan, Alparslan, Pettit, Shirley, and Devereaux, P J more...
- Subjects
Male ,Internationality ,Time Factors ,medicine.medical_treatment ,Myocardial Infarction ,Infarction ,030204 cardiovascular system & hematology ,Placebo ,Clonidine ,Perioperative Care ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Aged ,Aspirin ,Analgesics ,business.industry ,Hazard ratio ,Anti-Inflammatory Agents, Non-Steroidal ,Percutaneous coronary intervention ,Perioperative ,Middle Aged ,medicine.disease ,Anesthesiology and Pain Medicine ,Anesthesia ,Female ,business ,medicine.drug ,Follow-Up Studies - Abstract
Background The authors previously reported that perioperative aspirin and/or clonidine does not prevent a composite of death or myocardial infarction 30 days after noncardiac surgery. Moreover, aspirin increased the risk of major bleeding and clonidine caused hypotension and bradycardia. Whether these complications produce harm at 1 yr remains unknown. Methods The authors randomized 10,010 patients with or at risk of atherosclerosis and scheduled for noncardiac surgery in a 1:1:1:1 ratio to clonidine/aspirin, clonidine/aspirin placebo, clonidine placebo/aspirin, or clonidine placebo/aspirin placebo. Patients started taking aspirin or placebo just before surgery; those not previously taking aspirin continued daily for 30 days, and those taking aspirin previously continued for 7 days. Patients were also randomly assigned to receive clonidine or placebo just before surgery, with the study drug continued for 72 h. Results Neither aspirin nor clonidine had a significant effect on the primary 1-yr outcome, a composite of death or nonfatal myocardial infarction, with a 1-yr hazard ratio for aspirin of 1.00 (95% CI, 0.89 to 1.12; P = 0.948; 586 patients [11.8%] vs. 589 patients [11.8%]) and a hazard ratio for clonidine of 1.07 (95% CI, 0.96 to 1.20; P = 0.218; 608 patients [12.1%] vs. 567 patients [11.3%]), with effect on death or nonfatal infarction. Reduction in death and nonfatal myocardial infarction from aspirin in patients who previously had percutaneous coronary intervention at 30 days persisted at 1 yr. Specifically, the hazard ratio was 0.58 (95% CI, 0.35 to 0.95) in those with previous percutaneous coronary intervention and 1.03 (95% CI, 0.91to 1.16) in those without (interaction P = 0.033). There was no significant effect of either drug on death, cardiovascular complications, cancer, or chronic incisional pain at 1 yr (all P > 0.1). Conclusions Neither perioperative aspirin nor clonidine have significant long-term effects after noncardiac surgery. Perioperative aspirin in patients with previous percutaneous coronary intervention showed persistent benefit at 1 yr, a plausible sub-group effect. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New more...
- Published
- 2020
31. Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial : a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients
- Author
-
Benjamin Deheshi, Gavin C A Wood, Aamer Nabi Nur, Maria Tiboni, Leslie Gauthier, Ekaterine Popova, Masood Umer, Patrice Forget, Parag Sancheti, Flávia Kessler Borges, Alben Sigamani, Philip J. Devereaux, Iain K. Moppett, Mitchell Winemaker, Wojciech Szczeklik, Mohit Bhandari, Abdel-Rahman Lawendy, Richard Kolesar, Vikas Tandon, Mariano Balaguer-Castro, Paweł Ślęczka, Shirley Pettit, Jordi Teixidor-Serra, Victoria Avram, Michael McGillion, Giovanni Landoni, Valerie Harvey, Ernesto Guerra-Farfán, Chew Yin Wang, Bobby John, Jordi Tomas-Hernandez, Ameen Patel, Anthony Adili, John Neary, Robert J. Feibel, Justin de Beer, Mmampapatla Thomas Ramokgopa, Richard Jenkinson, Bruce M Biccard, Jessica Vincent, Kim Alvarado, Harsha Shanthanna, Institut Català de la Salut, [Borges FK] Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada. [Bhandari M, Avram V] Department of Surgery, McMaster University, Hamilton, Ontario, Canada. [Patel A] Department of Medicine, McMaster University, Hamilton, Ontario, Canada. [Guerra-Farfán E, Teixidor-Serra J, Tomas-Hernandez J] Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. [Sigamani A] Department of Clinical Research, Narayana Health, Bangalore, India., Vall d'Hebron Barcelona Hospital Campus, Supporting clinical sciences, Anesthesiology, Borges, Flavia K, Bhandari, Mohit, Patel, Ameen, Avram, Victoria, Guerra-Farfán, Ernesto, Sigamani, Alben, Umer, Masood, Tiboni, Maria, Adili, Anthony, Neary, John, Tandon, Vika, Sancheti, Parag K, Lawendy, Abdelrahman, Jenkinson, Richard, Ramokgopa, Mmampapatla, Biccard, Bruce M, Szczeklik, Wojciech, Wang, Chew Yin, Landoni, Giovanni, Forget, Patrice, Popova, Ekaterine, Wood, Gavin, Nabi Nur, Aamer, John, Bobby, Ślęczka, Paweł, Feibel, Robert J, Balaguer-Castro, Mariano, Deheshi, Benjamin, Winemaker, Mitchell, de Beer, Justin, Kolesar, Richard, Teixidor-Serra, Jordi, Tomas-Hernandez, Jordi, Mcgillion, Michael, Shanthanna, Harsha, Moppett, Iain, Vincent, Jessica, Pettit, Shirley, Harvey, Valerie, Gauthier, Leslie, Alvarado, Kim, and Devereaux, P J more...
- Subjects
Male ,Time Factors ,accelerated surgery ,law.invention ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,Informed consent ,Protocol ,030212 general & internal medicine ,Stroke ,Medicine(all) ,Hip fracture ,Mortality rate ,Wounds and Injuries::Fractures, Bone::Femoral Fractures::Hip Fractures [DISEASES] ,General Medicine ,Middle Aged ,Other subheadings::Other subheadings::/surgery [Other subheadings] ,3. Good health ,Pulmonary embolism ,Research Design ,hip fracture ,randomised control trial ,Female ,medicine.medical_specialty ,heridas y lesiones::fracturas óseas::fracturas del fémur::fracturas de cadera [ENFERMEDADES] ,03 medical and health sciences ,Health Care Facilities, Manpower, and Services::Health Services::Preventive Health Services::Early Medical Intervention [HEALTH CARE] ,medicine ,Health Care Quality, Access, and Evaluation::Quality of Health Care::Health Care Evaluation Mechanisms::Epidemiologic Study Characteristics::Clinical Protocols::Clinical Trial Protocols as Topic [HEALTH CARE] ,Humans ,Articulació coxofemoral - Cirurgia ,Aged ,business.industry ,Hip Fractures ,Otros calificadores::Otros calificadores::/cirugía [Otros calificadores] ,Perioperative ,medicine.disease ,calidad, acceso y evaluación de la atención sanitaria::calidad de la atención sanitaria::mecanismos de evaluación de la atención sanitaria::características de los estudios epidemiológicos::protocolos clínicos::protocolos de ensayos clínicos como asunto [ATENCIÓN DE SALUD] ,Physical therapy ,instalaciones, servicios y personal de asistencia sanitaria::servicios de salud::servicios preventivos de salud::intervención médica temprana [ATENCIÓN DE SALUD] ,Observational study ,Surgery ,business ,030217 neurology & neurosurgery ,Assaigs clínics - Abstract
IntroductionAnnually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%–10% at 30 days and 10%–20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial—HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications.Methods and analysisHIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients.Ethics and disseminationAll centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources.Trial registration numberNCT02027896; Pre-results. more...
- Published
- 2019
32. Association between complications and death within 30 days after noncardiac surgery.
- Author
-
Spence J, LeManach Y, Chan MTV, Wang CY, Sigamani A, Xavier D, Pearse R, Alonso-Coello P, Garutti I, Srinathan SK, Duceppe E, Walsh M, Borges FK, Malaga G, Abraham V, Faruqui A, Berwanger O, Biccard BM, Villar JC, Sessler DI, Kurz A, Chow CK, Polanczyk CA, Szczeklik W, Ackland G, X GA, Jacka M, Guyatt GH, Sapsford RJ, Williams C, Cortes OL, Coriat P, Patel A, Tiboni M, Belley-Côté EP, Yang S, Heels-Ansdell D, McGillion M, Parlow S, Patel M, Pettit S, Yusuf S, and Devereaux PJ more...
- Subjects
- Aged, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Hemorrhage mortality, Prospective Studies, Sepsis mortality, Postoperative Complications mortality, Surgical Procedures, Operative mortality
- Abstract
Background: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications., Methods: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model., Results: We included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2-3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9-2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6-6.8; AF 12.0%)., Interpretation: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration: ClinicalTrials.gov, no. NCT00512109., Competing Interests: Competing interests: Clara Chow received support from the National Health and Medical Research Council of Australia and The Heart Foundation (Australia) for a career development fellowship. Robert Sapsford received nonfinancial support in the form of a research nurse funded by the National Institutes of Health Research, and lecture fees from Eli Lilly, MSD and Novo Nordisk. Denis Xavier received grants from Cadila Pharmaceuticals, Boehringer Ingelheim, Astra Zeneca India, Sanofi Aventis, Pfizer, Bristol–Myers Squibb, Medical Research Council (United Kingdom) and Wellcome Trust outside the submitted work. Emmanuelle Duceppe received a grant as a coapplicant on an investigator-initiated study and lecture fees from Roche Diagnostics. Philip J. Devereaux is a member of a research group with a policy of not accepting honorariums or other payments from industry for their own personal financial gain. They do accept honorariums or payments from industry to support research endeavours and costs to participate in meetings. Based on study questions Dr. Devereaux has originated and grants he has written, he has received grants from Abbott Diagnostics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, Coviden, Octapharma, Philips Healthcare, Roche Diagnostics, Siemens and Stryker. Dr Devereaux has participated in advisory board meetings for GlaxoSmithKline and Boehringer Ingelheim. He also attended an expert panel meeting with AstraZeneca and Boehringer Ingelheim. Roche Diagnostics provided Troponin T assays and financial support for the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study. No other competing interests were declared., (© 2019 Joule Inc. or its licensors.) more...
- Published
- 2019
- Full Text
- View/download PDF
33. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes.
- Author
-
Botto F, Alonso-Coello P, Chan MT, Villar JC, Xavier D, Srinathan S, Guyatt G, Cruz P, Graham M, Wang CY, Berwanger O, Pearse RM, Biccard BM, Abraham V, Malaga G, Hillis GS, Rodseth RN, Cook D, Polanczyk CA, Szczeklik W, Sessler DI, Sheth T, Ackland GL, Leuwer M, Garg AX, Lemanach Y, Pettit S, Heels-Ansdell D, Luratibuse G, Walsh M, Sapsford R, Schünemann HJ, Kurz A, Thomas S, Mrkobrada M, Thabane L, Gerstein H, Paniagua P, Nagele P, Raina P, Yusuf S, Devereaux PJ, Devereaux PJ, Sessler DI, Walsh M, Guyatt G, McQueen MJ, Bhandari M, Cook D, Bosch J, Buckley N, Yusuf S, Chow CK, Hillis GS, Halliwell R, Li S, Lee VW, Mooney J, Polanczyk CA, Furtado MV, Berwanger O, Suzumura E, Santucci E, Leite K, Santo JA, Jardim CA, Cavalcanti AB, Guimaraes HP, Jacka MJ, Graham M, McAlister F, McMurtry S, Townsend D, Pannu N, Bagshaw S, Bessissow A, Bhandari M, Duceppe E, Eikelboom J, Ganame J, Hankinson J, Hill S, Jolly S, Lamy A, Ling E, Magloire P, Pare G, Reddy D, Szalay D, Tittley J, Weitz J, Whitlock R, Darvish-Kazim S, Debeer J, Kavsak P, Kearon C, Mizera R, O'Donnell M, McQueen M, Pinthus J, Ribas S, Simunovic M, Tandon V, Vanhelder T, Winemaker M, Gerstein H, McDonald S, O'Bryne P, Patel A, Paul J, Punthakee Z, Raymer K, Salehian O, Spencer F, Walter S, Worster A, Adili A, Clase C, Cook D, Crowther M, Douketis J, Gangji A, Jackson P, Lim W, Lovrics P, Mazzadi S, Orovan W, Rudkowski J, Soth M, Tiboni M, Acedillo R, Garg A, Hildebrand A, Lam N, Macneil D, Mrkobrada M, Roshanov PS, Srinathan SK, Ramsey C, John PS, Thorlacius L, Siddiqui FS, Grocott HP, McKay A, Lee TW, Amadeo R, Funk D, McDonald H, Zacharias J, Villar JC, Cortés OL, Chaparro MS, Vásquez S, Castañeda A, Ferreira S, Coriat P, Monneret D, Goarin JP, Esteve CI, Royer C, Daas G, Chan MT, Choi GY, Gin T, Lit LC, Xavier D, Sigamani A, Faruqui A, Dhanpal R, Almeida S, Cherian J, Furruqh S, Abraham V, Afzal L, George P, Mala S, Schünemann H, Muti P, Vizza E, Wang CY, Ong GS, Mansor M, Tan AS, Shariffuddin II, Vasanthan V, Hashim NH, Undok AW, Ki U, Lai HY, Ahmad WA, Razack AH, Malaga G, Valderrama-Victoria V, Loza-Herrera JD, De Los Angeles Lazo M, Rotta-Rotta A, Szczeklik W, Sokolowska B, Musial J, Gorka J, Iwaszczuk P, Kozka M, Chwala M, Raczek M, Mrowiecki T, Kaczmarek B, Biccard B, Cassimjee H, Gopalan D, Kisten T, Mugabi A, Naidoo P, Naidoo R, Rodseth R, Skinner D, Torborg A, Paniagua P, Urrutia G, Maestre ML, Santaló M, Gonzalez R, Font A, Martínez C, Pelaez X, De Antonio M, Villamor JM, García JA, Ferré MJ, Popova E, Alonso-Coello P, Garutti I, Cruz P, Fernández C, Palencia M, Díaz S, Del Castillo T, Varela A, de Miguel A, Muñoz M, Piñeiro P, Cusati G, Del Barrio M, Membrillo MJ, Orozco D, Reyes F, Sapsford RJ, Barth J, Scott J, Hall A, Howell S, Lobley M, Woods J, Howard S, Fletcher J, Dewhirst N, Williams C, Rushton A, Welters I, Leuwer M, Pearse R, Ackland G, Khan A, Niebrzegowska E, Benton S, Wragg A, Archbold A, Smith A, McAlees E, Ramballi C, Macdonald N, Januszewska M, Stephens R, Reyes A, Paredes LG, Sultan P, Cain D, Whittle J, Del Arroyo AG, Sessler DI, Kurz A, Sun Z, Finnegan PS, Egan C, Honar H, Shahinyan A, Panjasawatwong K, Fu AY, Wang S, Reineks E, Nagele P, Blood J, Kalin M, Gibson D, and Wildes T more...
- Subjects
- Age Distribution, Aged, Cohort Studies, Humans, Male, Middle Aged, Myocardial Ischemia blood, Postoperative Complications blood, Prognosis, Prospective Studies, Troponin T blood, Myocardial Ischemia diagnosis, Myocardial Ischemia epidemiology, Patient Outcome Assessment, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Surgical Procedures, Operative
- Abstract
Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS., Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated "abnormal" laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria., Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom., Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality. more...
- Published
- 2014
- Full Text
- View/download PDF
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.