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Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study.
Mejia, Omar A V; Borgomoni, Gabrielle B; de Freitas, Fabiane Letícia; Furlán, Lucas S; Orlandi, Bianca Maria M; Tiveron, Marcos G; Silva, Pedro Gabriel M de B E; Nakazone, Marcelo A; Oliveira, Marco A P de; Campagnucci, Valquíria P; Normand, Sharon-Lise; Dias, Roger D; Jatene, Fábio B.
Afiliación
  • Mejia OAV; Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo.
  • Borgomoni GB; Hospital Samaritano Paulista.
  • de Freitas FL; Hospital Paulistano.
  • Furlán LS; Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo.
  • Orlandi BMM; Hospital Samaritano Paulista.
  • Tiveron MG; Hospital Paulistano.
  • Silva PGMBE; Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo.
  • Nakazone MA; Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo.
  • Oliveira MAP; Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculty of Medicine, University of São Paulo.
  • Campagnucci VP; Irmandade da Santa Casa de Misericórdia de Marília, Marília.
  • Normand SL; Hospital Samaritano Paulista.
  • Dias RD; Hospital De Base de São José do Rio Preto, São José de Rio Preto.
  • Jatene FB; Beneficência Portuguesa de São Paulo.
Int J Surg ; 110(5): 2535-2544, 2024 May 01.
Article en En | MEDLINE | ID: mdl-38349204
ABSTRACT

BACKGROUND:

The impact of quality improvement initiatives program (QIP) on coronary artery bypass grafting surgery (CABG) remains scarce, despite improved outcomes in other surgical areas. This study aims to evaluate the impact of a package of QIP on mortality rates among patients undergoing CABG. MATERIALS AND

METHODS:

This prospective cohort study utilized data from the multicenter database Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II), spanning from July 2017 to June 2019. Data from 4018 isolated CABG adult patients were collected and analyzed in three phases before-implementation, implementation, and after-implementation of the intervention (which comprised QIP training for the hospital team). Propensity Score Matching was used to balance the groups of 2170 patients each for a comparative analysis of the following

outcomes:

reoperation, deep sternal wound infection/mediastinitis ≤30 days, cerebrovascular accident, acute kidney injury, ventilation time >24 h, length of stay <6 days, length of stay >14 days, morbidity and mortality, and operative mortality. A multiple regression model was constructed to predict mortality outcomes.

RESULTS:

Following implementation, there was a significant reduction of operative mortality (61.7%, P =0.046), as well as deep sternal wound infection/mediastinitis ( P <0.001), sepsis ( P =0.002), ventilation time in hours ( P <0.001), prolonged ventilation time ( P =0.009), postoperative peak blood glucose ( P <0.001), total length of hospital stay ( P <0.001). Additionally, there was a greater use of arterial grafts, including internal thoracic ( P <0.001) and radial ( P =0.038), along with a higher rate of skeletonized dissection of the internal thoracic artery.

CONCLUSIONS:

QIP was associated with a 61.7% reduction in operative mortality following CABG. Although not all complications exhibited a decline, the reduction in mortality suggests a possible decrease in failure to rescue during the after-implementation period.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Puente de Arteria Coronaria / Mejoramiento de la Calidad Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Int J Surg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Puente de Arteria Coronaria / Mejoramiento de la Calidad Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Int J Surg Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos