Biomedical subjects

H-J Geissler

Publications and source records attributed to H-J Geissler.

3 recordsLinked to original sources

PubMed2005

Risk stratification models fail to predict hospital costs of cardiac surgery patients.

BACKGROUND: The aim of this prospective study was to determine if commonly used risk stratification models can predict total hospital costs in cardiac surgical patients. METHODS: Between October 1st and December 31st 2003, all consecutive adult patients undergoing cardiac surgery on CPB at our institution were classified using seven risk stratification scoring systems: EuroSCORE, Cleveland, Parsonnet, Ontario, French, Pons, and CABDEAL. Total hospital costs for each patient were calculated on a daily basis including preoperative diagnostic tests, operating room costs, disposable materials, drugs, blood components, costs for personnel, and hospital fixed-costs. Linear regression analysis was used to determine the correlation between costs and the seven risk stratifications models as well as length of stay (LOS) on ICU. The Spearman correlation coefficient was calculated from the regression line, and an analysis of residuals was performed to determine the quality of the regression. RESULTS: A total of 252 patients were operated for CABG (n=175), valve (n=39), CABG plus valve (n=21), thoracic aorta (n=13) and miscellaneous (2 myxoma, 1 ASD, 1 pulmonary embolism). Mean age of the patients was 66.0+/-11.4 years, 29.4% were female. LOS on ICU was 3.3+/-6.3 days and the 30-day mortality rate was 6.7%. Spearman correlation between the seven risk stratification models and hospital costs was below r=0.32 (p=0.0001), but was r=0.94 (p=0.0001) between ICU LOS and costs. CONCLUSIONS: Total hospital costs can be identified by length of ICU stay. None of the common risk stratification models accurately predicted total hospital costs in cardiac surgical patients.

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PubMed2005

VDD-pacemaker in children--a long-term therapy?

AIMS: Transvenous AV-synchronous pacing in children started with the invention of smaller sized VDD leads and miniaturization of pacemakers. Whether or not this is a favourable long-term therapy was retrospectively investigated by us based on data from our records. METHODS: From May 1977 to July 2001 we implanted pacemakers in 104 children younger than 15 years of age. In 55 patients transvenous leads were implanted. Twelve of these (21.8 %) received a VDD pacemaker for hemodynamic reasons. RESULTS: Ages ranged from 11 months to 14.5 years (mean 7.7 +/- 4.3 y). Sizes of the children ranged from 67 to 141 cm (mean 105.9 +/- 15.5 cm) and body weight ranged from 5.3 to 62.0 kg (mean 22.5 +/- 9.8 kg). The mean follow-up period was 47.5 +/- 15.1 months. In 86.3 % of the time during follow-up pacemakers of which we obtained data were working in the VDD mode. Five of the twelve VDD patients (41.7 %) had to be reoperated because of severe traction on the leads. In all five patients the VDD systems were explanted and the patients changed to dual chamber pacemakers. The period of time between implantation and VDD lead explantation ranged from 24 to 74 months (48.6 +/- 18.5). CONCLUSIONS: VDD pacemakers can be implanted safely even in children with a low complication rate perioperatively. 41.7 % of our VDD patients had to be reoperated within the surveillance time because of severe lead tension due to thoracic growth. In our experience VDD pacemakers in smaller children seem to be a temporary solution to bridge AV-synchrony from a young age to DDD pacing in young adulthood.

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PubMed2002

Cardiopulmonary bypass copolymer surface modification reduces neither blood loss nor transfusions in coronary artery surgery.

OBJECTIVE: Surface-modifying additives (SMA) have been suggested for improving cardiopulmonary bypass (CPB) circuit biocompatibility, potentially minimizing inflammatory complications and bleeding associated with CPB. The purpose of this prospective, randomized clinical study was to compare a novel copolymer surface-modified CPB circuit (SMARXT; COBE Cardiovascular) against the unmodified circuit. METHODS: We randomized 122 patients with isolated coronary artery disease subjected to first-time surgery on CPB into either the SMA (n = 62) or the control group (n = 60). Exclusion criteria included renal insufficiency, liver disease, coagulopathy, anticoagulation therapy < 6 days preop, carotid artery stenosis > 70 %, and a history of stroke. We collected perioperative clinical data including drainage blood loss, transfusion requirements, duration of mechanical ventilation, and ICU stay. Platelet function was determined pre- and post-CPB. RESULTS: SMA patients received 3.2 +/- 0.9 (SD) grafts during 48 +/- 16 min of aortic cross clamp and 91 +/- 30 min CPB (Control: 3.0 +/- 0.9 grafts; p = 0.33, 46 +/- 14 min AXC; p = 0.36, and 84 +/- 23 min CPB; p = 0.14). In the SMA group, 23 patients (37 %) received red blood-cell transfusions, 9 patients (15 %) fresh frozen plasma, and 3 patients (5 %) received platelets (control: n = 27 [46 %], p = 0.44; n = 10 [17 %], p = 0.91; and n=4 [7 %], p = 0.71, respectively). Platelet count on CPB fell to the same level in both groups. In SMA patients, platelet function decreased from 94.2 +/- 24.9 % pre-CPB to 79.5 +/- 32.8 % post-CPB (p = 0.043) (control: from 87.7 +/- 25.6 % to 69.4 +/- 34.7 %; p = 0.001). Postoperative drainage blood loss, mechanical ventilation duration, and ICU stay were similar in both groups (p > 0.3). One patient of the control group was excluded due to surgical bleeding, and one SMA patient died. CONCLUSIONS: Our results show that the surface-modified CPB circuit decreased neither blood loss nor transfusions despite slightly better platelet function preservation compared to the unmodified circuit. This type of CPB circuit surface modification does not appear to improve clinical outcome in low-risk coronary artery surgery patients.

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