This project has shown that transfusion practice can be changed and savings in blood usage can be achieved through the successful implementation of the single unit transfusions policy. Key to the implementation was engagement from key medical staff within the medical department in which the policy was implemented and support from the hospital transfusion team. Continued attention and training shall be needed to support these, and implement other, patient blood management recommendations.

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Background: This study aims to determine the long-term outcomes and rate of reoperation among BAV patients with aortic diameter of 5–5.5cm who underwent immediate surgical repair versus surveillance. Methods: A total of 148 BAV patients with aortic aneurysm measuring 5–5.5cm were identified between 1993 to 2019. Patients were categorized into two groups: immediately operated (n=89), versus watched group (n=59) i.e., monitored until either symptomatic, aortic diameter ≥ 5.5 cm or operated at surgeons’ discretion/patient preference. Results: Compared to the immediately operated group the watched group had significantly lower proportion of proximal aorta replacement (86% vs 100%). The mean size of proximal thoracic aorta at initial encounter, including aortic root, ascending, and arch, for the watched group was 52.1 ± 1.62mm and 52.6 ± 1.81mm in the immediately operated group, p=0.06. There was no significant difference in 10-year survival between the watched group 94% (95% CI: 79%, 99%) vs immediately operated group 96.5% (95% CI: 86%, 99%), p=0.90. Initial operation rate for the watched group during 10-year follow-up was 85%. The operative mortality in both groups was 0%. The 10-year reoperation rate between groups was similar: 3.5% (95% CI: 0.9%, 9.1%) in the immediately operated group vs 7.7% (95% CI: 2.4%, 17.1%) in the patients who eventually had surgery in the watched group, p= 0.30. Conclusions Our study showed that the rate of reoperation was similar between groups and survival outcomes were acceptable in observed asymptomatic BAV patients without significant family history and with proximal aortic diameter of 5–5.5cm.

BACKGROUND Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain which adversely impact outcomes. Prior work examining pediatric and non-surgical adult patients has documented the effectiveness of inexpensive non-pharmacological techniques to reduce anxiety and pain, as well as healthcare costs and length of hospitalization. However, the impact of non-pharmacological interventions administered by a dedicated “comfort coach” has not been evaluated in an adult surgical setting. OBJECTIVE The objective of this trial is to assess whether non-pharmacological interventions administered by a trained comfort coach impact patient experience, opioid use, and healthcare utilization compared to usual care in adult cardiac surgery patients. This study has three specific aims: (1) assess the effect of a comfort coach on patient experience, (2) measure differences in inpatient and outpatient opioid use and postoperative healthcare utilization, and (3) qualitatively evaluate the comfort coach intervention. METHODS To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at six points: (1) preoperative outpatient clinic, (2) preoperative care unit on the day of surgery, (3) extubation, (4) chest tube removal, (5) hospital discharge, and (6) at 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at (1) preoperative outpatient clinic, (2) discharge, (3) 30-day follow-up, and (4) 90-day follow-up. For aim 2, we will record inpatient opioid use and collect post-discharge opioid use and pain-related outcomes through an 11-item questionnaire administered at 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and at an unplanned doctor’s office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 after surgery. For aim 3, we will perform semi-structured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. RESULTS This trial, funded by Blue Cross Blue Shield Foundation of Michigan in 2019, is presently enrolling patients with anticipated manuscript submissions Data generated from this mixed methods study will highlight effective non-pharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. Findings from this study may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery.from our primary aims targeted for the end of 2020. CONCLUSIONS Data generated from this mixed methods study will highlight effective non-pharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. Findings from this study may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. CLINICALTRIAL ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021.

Background Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. Objective This trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. Methods To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor’s office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. Results This trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. Conclusions Data generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study’s findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. Trial Registration ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021 International Registered Report Identifier (IRRID) DERR1-10.2196/21350