Quality improvement program decreases mortality after cardiac surgery
| Autor: | Sara L. Camp, Francis Robicsek, Kevin W. Lobdell, Mark K. Reames, Robert M. Stiegel, Larry T. Watts, Eric Skipper, Sotiris C. Stamou, Marcy Nussbaum |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Quality Assurance Health Care Logistic regression Aortic valve replacement Internal medicine Diabetes mellitus Epidemiology medicine Humans Hospital Mortality Cardiac Surgical Procedures Coronary Artery Bypass Aged Evidence-Based Medicine business.industry medicine.disease Heart Valves Cardiac surgery medicine.anatomical_structure Heart failure Practice Guidelines as Topic Propensity score matching Cardiology Female Surgery Guideline Adherence business Cardiology and Cardiovascular Medicine Artery |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 136(2):494-499.e8 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2007.08.081 |
| Popis: | ObjectiveThis study investigated the effects of a quality improvement program and goal-oriented, multidisciplinary protocols on mortality after cardiac surgery.MethodsPatients were divided into two groups: those undergoing surgery (coronary artery bypass grafting, isolated valve surgery, or coronary artery bypass grafting and valve surgery) after establishment of the multidisciplinary quality improvement program (January 2005–December 2006, n = 922) and those undergoing surgery before institution of the program (January 2002–December 2003, n = 1289). Logistic regression and propensity score analysis were used to adjust for imbalances in patients' preoperative characteristics.ResultsOperative mortality was lower in the quality improvement group (2.6% vs 5.0%, P < .01). Unadjusted odds ratio was 0.5 (95% confidence interval 0.3–0.8, P < .01); propensity score–adjusted odds ratio was 0.6 (95% confidence interval 0.4–0.99, P = .04). In multivariable analysis, diabetes (P < .01), chronic renal insufficiency (P = .05), previous cardiovascular operation (P = .04), congestive heart failure (P < .01), unstable angina (P < .01), age older than 75 years (P < .01), prolonged pump time (P < .01), and prolonged operation (P = .05) emerged as independent predictors of higher mortality after cardiac surgery, whereas quality improvement program (P < .01) and male sex (P = .03) were associated with lower mortality. Mortality decline was less pronounced in patients with than without diabetes (P = .04).ConclusionApplication of goal-directed, multidisciplinary protocols and a quality improvement program were associated with lower mortality after cardiac surgery. This decline was less prominent in patients with diabetes, and focused quality improvement protocols may be required for this subset of patients. |
| Databáze: | OpenAIRE |
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