Cardiothoracic Surgery

PROTECT: a 61,289-patient geriatric perioperative cohort enabling risk models

PROTECT is an ongoing ambispective cohort of 61,289 inpatients aged ≥65 across three tertiary centers with high-frequency intraoperative biosignals and standardized pre-anesthesia assessment. Postoperative follow-up reached 96.5% at 48 hours and 72.1% at 30 days, with a reported 30-day all-cause mortality of 0.7%. Most common postoperative complications were pulmonary infection (13.0%), nausea (11.9%), hepatic dysfunction (9.9%), and ICU admission (8.6%). The dataset has already produced prediction models for major complications and supports granular risk profiling in geriatric surgical patients. 1

Frameworks for credible observational evaluation of cardiovascular devices

This review recommends the target-trial framework to structure observational analyses of cardiovascular devices to improve causal interpretability. The authors emphasize aligning research question, available data, and transparent analytic steps to limit bias in device safety and effectiveness assessments. They caution that observational device studies vary widely in rigor and that credible real-world evidence needs principled design and reporting. Observational analyses can supplement trial data but require methods that pre-specify comparisons, confounding control, and sensitivity analyses. 2

Transitional care reduces HF-specific readmissions and improves self-care confidence in older adults

Meta-analysis of eight RCTs (967 participants) found transitional care interventions improved self-care confidence and reduced heart failure–specific readmissions. There were no consistent effects on self-care maintenance, management, or heart-failure knowledge across trials. Certainty of evidence ranged from very low to moderate, and heterogeneity limits generalizability. Optimal intervention components remain undefined, signalling need for larger, better-reported trials before broad practice change. 3