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Surgical Turned-Downed CHIP Cases-Can PCI Save the Day?

ABSTRACT: Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question remains whether the benefits of PCI outweigh its risks in this controversial subpopulation. When CHIP (Complex High risk Indicated Percutaneous coronary interventions) is selected for these very complex individuals, there is no unanimity regarding the goals for interventional revascularization (for instance, the ambition to achieve completeness of revascularization vs. more targeted or selective PCI). The recognition that, worldwide, these patients are becoming increasingly prevalent and increasingly commonplace in the cardiac catheterization labs, along with the momentum for more complex interventional procedures and expanding skillsets, gives us a timely opportunity to better examine the outcomes for these patients and inform clinical decision-making.

SUBMITTER: Achim A

PROVIDER: S-EPMC9021524 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Surgical Turned-Downed CHIP Cases-Can PCI Save the Day?

Achim Alexandru A Marc Madalin M Ruzsa Zoltan Z

Frontiers in cardiovascular medicine 20220407

Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question rem ...[more]

PMID: 35463754

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Project description:ObjectiveThis study aimed to analyze the characteristics of surgical litigation cases and the risk factors that contribute to catastrophic compensation.MethodsWe downloaded and retrieved all cases related to surgical litigation cases from the China Jufaanli Database between 2008 and 2023. Multivariate logistic regression analysis was employed to identify independent risk factors that may contribute to catastrophic compensation.ResultsThis study included a total of 8,331 successfully resolved surgical litigation cases. Of these, 5,114 hospitals were defendants, with 25.34% of them involved in two or more lawsuits, thereby categorized as "repeat defendants." The total compensation amount was $269,163,545, with the highest compensation reaching $540,008. Most surgical litigation cases were concentrated in the eastern regions of China, with tertiary hospitals being the most frequently involved. The most common type of injury outcome was patient death. Compensation amounts and high compensation rates for severe disability exceeded those for death (p < 0.05). Independent risk factors associated with catastrophic compensation in surgical medical liability disputes included: Eastern region (OR = 1.462, 95% CI 1.038-2.060), secondary liability (OR = 2.457, 95% CI 1.633-3.696), main liability (OR = 9.353, 95% CI 6.195-14.121), major or full liability (OR = 10.878, 95% CI 7.152-16.546), severe disability (OR = 24.605, 95% CI 3.395-178.337), neurosurgery (OR = 3.488, 95% CI 2.265-5.373), thoracic surgery (OR = 1.810, 95% CI 1.017-3.219), general surgery (OR = 2.465, 95% CI 1.593-3.816), hepatobiliary surgery (OR = 3.251, 95% CI 1.980-5.338), gastrointestinal surgery (OR = 2.260, 95% CI 1.391-3.671), cardiovascular surgery (OR = 2.544, 95% CI 1.367-4.733), vascular surgery (OR = 2.916, 95% CI 1.246-6.827), and spinal surgery (OR = 2.921, 95% CI 1.763-4.841).ConclusionThis study analyzes the characteristics of surgical medical malpractice disputes in China from multiple perspectives and identifies independent risk factors for catastrophic compensation in surgical malpractice litigation. Our research has the potential to aid medical institutions in preventing and reducing surgical malpractice disputes, while also contributing to the provision of improved surgical care and nursing services for patients.

Project description:Mitochondrial 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) synthase (mHS) deficiency is an autosomal recessive disorder of ketone body synthesis caused by biallelic pathogenic variants in HMGCS2. Clinical symptoms are precipitated by prolonged fasting and/or intercurrent illness with onset before the first year of life. Clinically, patients may present with hypo-/ non-ketotic hypoglycemia, metabolic acidosis, hyperammonemia, lethargy, hepatomegaly, and encephalopathy. During periods of decompensation, elevations of 4-hydroxy-6-methyl-2-pyrone (4-HMP), several hydroxylated hexanoic and hexenoic acid species, and medium-chain dicarboxylic acids in the absence of significant ketonuria may be observed in the urine organic acid profile. Abnormalities may also be observed in plasma which includes elevated acetylcarnitine (C2) and 3-hydroxybutyryl/3-hydroxyisobutyryl (C4-OH) carnitine. We report a patient who presented to the ED at 13 months of age with an undetectable point-of-care blood glucose level. Continuous infusion of dextrose-containing intravenous (IV) fluids were required to correct the hypoglycemia and routine chemistries were notable for an anion gap metabolic acidosis, transaminasemia, and elevated creatine kinase and lactate dehydrogenase. Urine and blood ketones were undetectable. Qualitative assessment of urine organic acids collected ∼46 and ∼ 99 h post-admission were significant for mild elevations of 4-HMP and hydroxy-hexanoic and hydroxy-hexenoic acid species with a notable absence of ketones. Previously, biochemical abnormalities in urine have been shown to normalize in as few as 27 h after treatment giving providers a narrow window with which to obtain a critical sample. Direct communication of laboratory findings to the ordering provider guided the molecular testing and assisted in results interpretation to confirm the molecular diagnosis. Our case emphasizes the importance of collecting samples for biochemical analysis even if the critical period has been missed and acute metabolic decompensation seems to be resolved, as residual abnormalities observed in our patient greatly narrowed the differential diagnosis.

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Surgical Turned-Downed CHIP Cases-Can PCI Save the Day?

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Surgical Turned-Downed CHIP Cases-Can PCI Save the Day?

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