scholarly journals Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: an analysis of 25 730 patients undergoing CABG surgery under 30 surgeons over eight years

Heart ◽  
2007 ◽  
Vol 93 (6) ◽  
pp. 744-748 ◽  
Author(s):  
B. Bridgewater ◽  
A. D Grayson ◽  
N. Brooks ◽  
G. Grotte ◽  
B. M Fabri ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Outcome Data ◽  
Cabg Surgery ◽  
Surgery Outcome

Abstract 260: Restructuring a Failed Cardiac Surgery Program in an Under Served Minority Population County

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Jamie Brown ◽  
Murtaza Dawood ◽  
James S Gammie ◽  
Patrick Odonkor ◽  
Imran Siddiqi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Access To Health Care ◽  
Planning Process ◽  
Artery Bypass ◽  
Surgical Care ◽  
Cardiovascular Death ◽  
Outcome Data ◽  
National Database ◽  
Minority Population ◽  
Strict Adherence

Objectives: Fifty years ago, Donabedian described the conceptual framework for quality in healthcare as the triad of process, structure and outcome. These principals were applied to a failed urban cardiac surgery program (volume, efficiency, and quality) in an underserved county of 900,000 people in which cardiovascular death rates are up to double the neighboring county and public health studies demonstrate high rates of cardio metabolic syndrome as well as poor access to health care. Using Cardiac Surgery as a highly measured clinical service model our hypothesis was that strict attention to all details related to Donabedian’s triad would achieve acceptable quality of care in Cardiac Surgery. Methods: The 205 patients undergoing coronary artery bypass (CAB) formed the study group. We performed a preliminary 6 month planning process evaluating and improving equipment, human resources, facilities, and patient care protocols. Emphasis was placed staff education. This process was facilitated and modeled through training and oversight by a medical school/academic health center. All structure and processes and of care including preoperative, intraoperative, and postoperative protocols were recreated and rehearsed prior to program re-start. Data for all cardiac operations were recorded using the Society of Thoracic Surgeons National database (STS). Results: 205 coronary consecutive artery bypasses (CAB) were performed. Medical comorbid conditions were higher than the STS national mean. However, the risk adjusted outcome data for the first 205 CAB population yielded a mortality of 0.5% (expected 2.5%; O/E= 0.20) as well as a complication rate (Table 1) lower than expected. The first STS rating was 3-star for CAB, 2017 (top 10% of >1000 cardiac programs, p<0.05) indicating strict adherence to a quality-first standard of care. Conclusions: Strict attention to the process and structure fundamentals and details of Cardiac Surgical care in an underserved at risk population can result in acceptable outcomes and quality measures at low program volume.

scholarly journals Inferior outcomes following cardiac surgery in patients with a functioning renal allograft

2020 ◽  
Author(s):  
Ibrahim T Fazmin ◽  
Muhammad U Rafiq ◽  
Samer Nashef ◽  
Jason M Ali
Keyword(s):  
Cardiac Surgery ◽  
Renal Transplantation ◽  
Renal Allograft ◽  
Artery Bypass ◽  
Perioperative Period ◽  
Outcome Data ◽  
Term Survival ◽  
Logistic Euroscore ◽  
Prolonged Length ◽  
The Mean

Abstract OBJECTIVES Renal transplantation is an effective treatment for end-stage renal failure. The aim of this study was to evaluate outcomes for these patients undergoing cardiac surgery. METHODS A retrospective analysis identified patients with a functioning renal allograft at the time of surgery. A 2:1 propensity matching was performed. Patients were matched on: age, sex, left ventricle function, body mass index, preoperative creatinine, operation priority, operation category and logistic EuroSCORE. RESULTS Thirty-eight patients undergoing surgery with a functioning renal allograft were identified. The mean age was 62.4 years and 66% were male. A total of 44.7% underwent coronary artery bypass grafting and 26.3% underwent a single valve procedure. The mean logistic EuroSCORE was 10.65. The control population of 76 patients was well matched. Patients undergoing surgery following renal transplantation had a prolonged length of intensive care unit (3.19 vs 1.02 days, P &lt; 0.001) and hospital stay (10.3 vs 7.17 days, P = 0.05). There was a higher in-hospital mortality (15.8% vs 1.3%, P = 0.0027). Longer-term survival on Kaplan–Meier analysis was also inferior (P &lt; 0.001). One-year survival was 78.9% vs 96.1% and 5-year survival was 63.2% vs 90.8%. A further subpopulation of 11 patients with a failed renal allograft was identified and excluded from the main analysis; we report demographic and outcome data for them. CONCLUSIONS Patients with a functioning renal allograft are at higher risk of perioperative mortality and inferior long-term survival following cardiac surgery. Patients in this population should be appropriately informed at the time of consent and should be managed cautiously in the perioperative period with the aim of reducing morbidity and mortality.

Adult Ventricular Septal Defect Repair Using a Robotic Totally Endoscopic Approach: A Case Report

2020 ◽  
Vol 15 (4) ◽  
pp. 372-375
Author(s):  
Saeid Mirzai ◽  
Narutoshi Hibino ◽  
Gianluca Torregrossa ◽  
Husam H. Balkhy
Keyword(s):  
Cardiac Surgery ◽  
Ventricular Septal Defect ◽  
Minimally Invasive ◽  
Septal Defect ◽  
Outcome Data ◽  
Safe Procedure ◽  
Persistent Symptoms ◽  
Congenital Cardiac Anomalies ◽  
Robotic Cardiac Surgery ◽  
Defect Repair

The growth and advancement of minimally invasive cardiac surgery in recent years has allowed robotic and totally endoscopic procedures to become safe and effective options for the treatment of patients with various diseases of the heart. However, despite these advances, outcome data for robotic correction of congenital cardiac anomalies are scarce. This is particularly true for robotic ventricular septal defect (VSD) repair with initial experiences only recently having been published by a single group. Here, we present the case of a 29-year-old female who underwent robotic totally endoscopic VSD repair due to persistent symptoms with resolution of preoperative shunting and severe tricuspid regurgitation following surgery. This unique case adds to the limited data currently available in the literature on robotic VSD repair to show that it is a safe procedure when performed by a dedicated surgical team experienced in minimally invasive robotic cardiac surgery. We feel that, in this setting, the benefits of a robotic surgical approach can be afforded to more patients with excellent results.

QTc prolongation in children following congenital cardiac disease surgery

2011 ◽  
Vol 21 (4) ◽  
pp. 400-410 ◽  
Author(s):  
Rajesh Punn ◽  
John J. Lamberti ◽  
Raymond R. Balise ◽  
Stephen P. Seslar
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Cardiac Disease ◽  
Outcome Data ◽  
Qtc Prolongation ◽  
Number Of Children ◽  
Cross Clamp Time ◽  
Congenital Cardiac Disease ◽  
Hospital Stays

AbstractIntroductionQTc prolongation has been reported in adults following cardiopulmonary bypass; however, this phenomenon has not been studied in children with congenital cardiac disease. This study's aim was to formally assess QTc in children undergoing cardiac surgery.MethodsPre-operative and post-operative electrocardiograms during hospital stays were prospectively analysed on 107 consecutive patients under 18 years of age undergoing cardiac surgery. QTc was measured manually in leads II, V4, and V5. Measurements of 440 and 480 milliseconds were used to categorise patients. Peri-procedural data included bypass and cross-clamp time, medications, and electrolyte measurements. Outcome data included arrhythmias, length of mechanical ventilation, and hospital stay. Patients with post-operative new bundle branch block or ventricularly paced rhythm were excluded.ResultsIn all, 59 children were included, out of which 26 had new QTc over 440 milliseconds and 6 of 59 had new QTc over 480 milliseconds post-operatively. The mean increase in post-operative QTc was 25 milliseconds, p=0.0001. QTc over 480 was associated with longer cross-clamp time, p=0.003. Other risk factors were not associated with post-operative QTc prolongation. This phenomenon was transient with normalisation occurring in 67% of patients over 60 hours on average. One patient with post-operative QTc over 440 milliseconds developed ventricular tachycardia. There was no correlation between prolonged QTc and duration of mechanical ventilation, or hospital stay.ConclusionA significant number of children undergoing cardiac surgery showed transient QTc prolongation. The precise aetiology of QT prolongation was not discerned, though new QTc over 480 milliseconds was associated with longer cross-clamp time. In this cohort, transient QTc prolongation was not associated with adverse sequela.

Early Tracheal Extubation after Coronary Artery Bypass Graft Surgery Reduces Costs and Improves Resource Use

1996 ◽  
Vol 85 (6) ◽  
pp. 1300-1310. ◽  
Author(s):  
Davy C. H. Cheng ◽  
Jacek Karski ◽  
Charles Peniston ◽  
Ganesh Raveendran ◽  
Buvanendran Asokumar ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Resource Use ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cost Savings ◽  
Tracheal Extubation ◽  
Early Extubation ◽  
Total Cost ◽  
Cabg Surgery

Background Economics has caused the trend of early tracheal extubation after cardiac surgery, yet no prospective randomized study has directly validated that early tracheal extubation anesthetic management decreases costs when compared with late extubation after cardiac surgery. Methods This prospective, randomized, controlled clinical trial was designed to evaluate the cost savings of early (1-6 h) versus late tracheal extubation (12-22 h) in patients after coronary artery bypass graft (CABG) surgery. The total cost for the services provided for each patient was determined for both the early and late groups from hospital admission to discharge home. All costs applicable to each of the services were classified into direct variables, direct fixed costs, and overhead (an indirect cost). Physician fees and heart catheterization costs were included. The total service cost was the sum of unit workload and overhead costs. Results One hundred patients having elective CABG who were younger than 75 yr were studied. Including all complications, early extubation (n = 50) significantly reduced cardiovascular intensive care unit (CVICU) costs by 53% (P &lt; 0.026) and the total CABG surgery cost by 25% (P &lt; 0.019) when compared with late extubation (n = 50). Forty-one patients (82%) in each group were tracheally extubated within the defined period. In the early extubation group, the actual departmental cost savings in CVICU nursing and supplies was 23% (P &lt; 0.005), in ward nursing and supplies was 11% (P &lt; 0.05), and in respiratory therapy was 12% (P &lt; 0.05). The total cost savings per patient having CABG was 9% (P &lt; 0.001). Further cost savings using discharge criteria were 51% for CVICU nursing and supplies (P &lt; 0.001), 9% for ward nursing and supplies (P &lt; 0.05), and 29% for respiratory therapy (P &lt; 0.001), for a total cost savings per patient of 13% (P &lt; 0.001). Early extubation also reduced elective case cancellations (P &lt; 0.002) without any increase in the number of postoperative complications and readmissions. Conclusions Early tracheal extubation anesthetic management reduces total costs per CABG surgery by 25%, predominantly in nursing and in CVICU costs. Early extubation reduces CVICU and hospital length of stay but does not increase the rate or costs of complications when compared with patients in the late extubation group. It shifts the high CVICU costs to the lower ward costs. Early extubation also improves resource use after cardiac surgery when compared with late extubation.

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