Patient Safety Indicators are an insufficient performance metric to track and grade outcomes of open aortic repair

Abstract Background Patient Safety Indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance. Aim the study aimed to measure the association between the AHRQ patient safety indicator PSI9 (Perioperative hemorrhage or hematoma) and the clinical outcome including death, readmission within 30 days and length of stay at the cardiothoracic surgery hospital Ain Shams University. Methods exploratory prospective cohort study was conducted to follow up patients from admission till 1 month after discharge at the cardiothoracic surgery hospital who fulfills the inclusion criteria. Data were collected for 330 patients through basic information sheet and follow-up sheet. Results the incidence rate of PSI9 was 49.54 per 1000 discharges. Demographic data was not significantly associated with increased incidence of PSI9. The risk of development of PSI9 was significantly higher in patients admitted directly to ICU [relative risk (RR) =5.6]. The risk of death and readmission was higher in cases developed PSI9 than the cases without PSI9 [RR = 2.40 (0.60-9.55) and 2.43 (0.636 - 9.48) respectively]. Conclusion high incidence rate of PSI9 and the incidence is higher in male gender and 60 years old and more patients. Those patients developed PSI9 were at high risk for readmission and death. Recommendations the hospital administration should consider strategies and policies to decrease the rate of PSI9 and subsequent unfavorable clinical outcomes.

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The fate of the downstream aorta after open aortic repair for acute DeBakey type I aortic dissection: total arch replacement with elephant trunk technique versus non-total arch replacement†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy381 ◽

2018 ◽

Vol 55 (5) ◽

pp. 966-974 ◽

Cited By ~ 7

Author(s):

Yuki Ikeno ◽

Koki Yokawa ◽

Yojiro Koda ◽

Yasuko Gotake ◽

Soichiro Henmi ◽

...

Keyword(s):

Aortic Dissection ◽

Total Arch Replacement ◽

Type I ◽

Elephant Trunk ◽

Aortic Repair ◽

Open Aortic Repair ◽

Elephant Trunk Technique

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Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?

Journal of General Internal Medicine ◽

10.1007/s11606-008-0665-2 ◽

2008 ◽

Vol 23 (9) ◽

pp. 1373-1378 ◽

Cited By ~ 33

Author(s):

Thomas Isaac ◽

Ashish K. Jha

Keyword(s):

Patient Safety ◽

Hospital Quality ◽

Patient Safety Indicators

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Comparison of perioperative outcomes in endovascular versus open repair for juxtarenal and pararenal aortic aneurysms: A propensity-matched analysis

Vascular ◽

10.1177/1708538116681911 ◽

2016 ◽

Vol 25 (4) ◽

pp. 339-345 ◽

Cited By ~ 7

Author(s):

Nathan T Orr ◽

Daniel L Davenport ◽

David J Minion ◽

Eleftherios S Xenos

Keyword(s):

Length Of Stay ◽

Mortality Rates ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Hospital Length Of Stay ◽

Perioperative Outcomes ◽

Propensity Scoring ◽

Aortic Repair ◽

Open Aortic Repair ◽

Significant Difference

Objective Endoluminal aortic aneurysm repair is suitable within certain anatomic specifications. This study aims to compare 30-day outcomes of endovascular versus open repairs for juxtarenal and pararenal aortic aneurysms (JAA/PAAs). Methods The ACS-NSQIP database was queried from 2012 to 2015 for JAA/PAA repairs. Procedures characterized as emergent were included in the study; however, failed prior repairs and ruptured aneurysms were excluded. The preoperative and perioperative patient characteristics, operative techniques, and outcome variables were compared between the open aortic repair and the endovascular aortic repair groups. Propensity scoring was performed to clinically match open aortic repair and endovascular aortic repair groups on preoperative risk and select perioperative factors that differed significantly in the unmatched groups. Outcome comparisons were then performed between matched groups. Results A total of 1005 (789 JAAs and 216 PAAs) aneurysm repairs were included in the study. Of these, there were 395 endovascular aortic repairs and 610 open aortic repairs. Propensity scoring created a matched group of 263 endovascular aortic repair and 263 open aortic repair patients. There was no statistically significant difference in 30-day mortality rates between matched endovascular aortic repair and open aortic repair patients (2.7% vs. 5.7%). The endovascular aortic repair group had a shorter ICU length of stay and overall hospital stay. The 30-day morbidity significantly favored endovascular aortic repair over open aortic repair (16% vs. 35%, p < 0.001). The main drivers of morbidity for endovascular aortic repair versus open aortic repair included return to the OR (6.8% vs. 15%, p < 0.001), rate of cardiac or respiratory failure (7.6% vs. 21%, p = 0.001), rate of renal insufficiency or failure (3.8% vs. 9.9%, p = 0.009), and rate of pneumonia (1.5% vs. 6.8%, p = 0.004). Conclusions There is no difference in mortality rates between endovascular aortic repair versus open aortic repair when repairing JAAs/PAAs. There is a significant difference in overall morbidity, and ICU and hospital length of stay favoring endovascular aortic repair over open aortic repair. This supports the expanded applicability and efficacy of endovascular repair for complex aneurysms.

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