Quality improvement program in Latin America decreases mortality after cardiac surgery: a before-after intervention study

Imagem de Miniatura
Arquivos
art_MEJIA_Quality_improvement_program_in_Latin_America_decreases_mortality_2022.PDF (1.96 MB)
Citações na Scopus
1
Tipo de produção
article
Data de publicação
2022
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER
Autores
Citação
INTERNATIONAL JOURNAL OF SURGERY, v.106, article ID 106931, 8p, 2022
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: The current challenge of cardiac surgery (CS) is to improve outcomes in adverse scenarios. The aim of this study was to assess the impact of a quality improvement program (QIP) on hospital mortality in the largest CS center in Latin America.Methods: Patients were divided into two groups: before (Jan 2013-Dec 2015, n = 3534) and after establishment of the QIP (Jan 2017-Dec 2019, n = 3544). The QIP consisted of the implementation of 10 central initiatives during 2016. The procedures evaluated were isolated coronary artery bypass grafting surgery (CABG), mitral valve surgery, aortic valve surgery, combined mitral and aortic valve surgery, and CABG associated with heart valve surgery. Propensity Score Matching (PSM) was used to adjust for inequality in patients' preoperative characteristics before and after the implementation of QIP. A multivariate logistic regression model was built to predict hospital mortality and validated using discrimination and calibration metrics.Results: The PMS paired two groups using 5 variables, obtaining 858 patients operated before (non-QIP) and 858 patients operated after the implementation of the QIP. When comparing the QIP versus Non-QIP group, there was a shorter length of stay in all phases of hospitalization. In addition, the patients evolved with less anemia (P = 0.001), use of intra-aortic balloon pump (P = 0.003), atrial fibrillation (P = 0.001), acute kidney injury (P < 0.001), cardiogenic shock (P = 0.011), sepsis (P = 0.046), and hospital mortality (P = 0.001). In the multiple model, among the predictors of hospital mortality, the lack of QIP increased the chances of mortality by 2.09 times.Conclusion: The implementation of a first CS QIP in Latin America was associated with a reduction in length of hospital stay, complications and mortality after the cardiac surgeries analyzed.
Palavras-chave
Cardiovascular surgery, Database analysis, Quality improvement, Mortality reduction
URI
https://observatorio.fm.usp.br/handle/OPI/50446
Referências
  1. Arthur CPS, 2017, ARQ BRAS CARDIOL, V109, P290, DOI 10.5935/abc.20170129
  2. Atik FA, 2009, J THORAC CARDIOV SUR, V138, P253, DOI 10.1016/j.jtcvs.2009.03.047
  3. Bechtel Allison J, 2020, Anesthesiol Clin, V38, P403, DOI 10.1016/j.anclin.2020.01.007
  4. Clark SC, 2012, EUR J CARDIO-THORAC, V41, P993, DOI 10.1093/ejcts/ezs009
  5. Colafranceschi AS, 2020, ARQ BRAS CARDIOL, V114, P613, DOI 10.36660/abc.20200249
  6. D'Agostino RS, 2019, ANN THORAC SURG, V107, P24, DOI 10.1016/j.athoracsur.2018.10.004
  7. D'Alessandro C, 2007, J THORAC CARDIOV SUR, V134, P29, DOI 10.1016/j.jtcvs.2007.02.028
  8. Davies JM, 2001, CAN MED ASSOC J, V165, P1503
  9. Ferguson TB, 2003, JAMA-J AM MED ASSOC, V290, P49, DOI 10.1001/jama.290.1.49
  10. Lisboa LAF, 2014, REV BRAS CIR CARDIOV, V29, P1, DOI 10.5935/1678-9741.20140004
  11. Fitzgerald DC, 2022, J THORAC CARDIOV SUR, V163, P1015, DOI 10.1016/j.jtcvs.2020.04.141
  12. Grover F.L., 2001, DECADES EXPERIENCE Q
  13. Grover FL, 2001, ANN SURG, V234, P464, DOI 10.1097/00000658-200110000-00006
  14. Hajjar LA, 2010, JAMA-J AM MED ASSOC, V304, P1559, DOI 10.1001/jama.2010.1446
  15. Hannan EL, 2012, J AM COLL CARDIOL, V59, P2309, DOI 10.1016/j.jacc.2011.12.051
  16. Hickey GL, 2013, EUR J CARDIO-THORAC, V43, P1146, DOI 10.1093/ejcts/ezs584
  17. Holman WL, 2004, ANN SURG, V239, P99, DOI 10.1097/01.sla.0000103065.17661.8f
  18. Jessica M.D., 2018, DEBAKEY CARDIOVAS J, V14, DOI [10.14797/mdcj-14-2-77, DOI 10.14797/MDCJ-14-2-77]
  19. Karkouti K, 2004, TRANSFUSION, V44, P1453, DOI 10.1111/j.1537-2995.2004.04144.x
  20. Kurlansky PA, 2012, J THORAC CARDIOV SUR, V143, P287, DOI 10.1016/j.jtcvs.2011.10.043
  21. Li M, 2018, EUR J CARDIO-THORAC, V54, P491, DOI 10.1093/ejcts/ezy100
  22. Likosky DS, 2018, CIRC-CARDIOVASC QUAL, V11, DOI 10.1161/CIRCOUTCOMES.118.004756
  23. Orlandi BMM, 2020, PLOS ONE, V15, DOI 10.1371/journal.pone.0223343
  24. Mathew G, 2021, INT J SURG, V96, DOI 10.1016/j.ijsu.2021.106165
  25. Meja OAV, 2013, ARQ BRAS CARDIOL, V100, P246, DOI 10.5935/abc.20130043
  26. Mejia OA, 2016, EUR J CARDIO-THORAC, V50, P4, DOI 10.1093/ejcts/ezw087
  27. Mejia OAV, 2020, ARQ BRAS CARDIOL, V114, P603, DOI 10.36660/abc.20190736
  28. Miyata H, 2012, J THORAC CARDIOV SUR, V143, P1364, DOI 10.1016/j.jtcvs.2011.07.010
  29. Murphy GJ, 2015, NEW ENGL J MED, V372, P997, DOI 10.1056/NEJMoa1403612
  30. Nashef SAM, 2012, EUR J CARDIO-THORAC, V41, P734, DOI 10.1093/ejcts/ezs043
  31. Neuhauser D, 2011, BMJ QUAL SAF, V20, pI36, DOI 10.1136/bmjqs.2010.046334
  32. Osnabrugge RL, 2016, EUR J CARDIO-THORAC, V49, P397, DOI 10.1093/ejcts/ezv262
  33. Pagano D, 2016, EUR J CARDIO-THORAC, V50, P1006, DOI 10.1093/ejcts/ezw300
  34. Pettersson GB, 2013, J THORAC CARDIOV SUR, V145, P1159, DOI 10.1016/j.jtcvs.2012.11.035
  35. Samanidis George, 2020, Rev. bras. ter. intensiva, V32, P542, DOI [10.5935/0103-507X.20200091, 10.5935/0103-507x.20200091]
  36. Shahian DM, 2015, ANN SURG, V262, P526, DOI 10.1097/SLA.0000000000001422
  37. Shahian DM, 2010, J THORAC CARDIOV SUR, V139, P273, DOI 10.1016/j.jtcvs.2009.09.007
  38. Siciliano RF, 2020, INT J INFECT DIS, V90, P201, DOI 10.1016/j.ijid.2019.09.010
  39. Stamou SC, 2008, AM J CARDIOL, V102, P772, DOI 10.1016/j.amjcard.2008.04.061
  40. Stamou SC, 2008, J THORAC CARDIOV SUR, V136, P494, DOI 10.1016/j.jtcvs.2007.08.081
  41. Vervoort D, 2020, J THORAC CARDIOV SUR, V159, P987, DOI 10.1016/j.jtcvs.2019.04.039
  42. Mejia OAV, 2021, SCI REP-UK, V11, DOI 10.1038/s41598-020-80175-7
  43. Voisine P, 2006, EUR J CARDIO-THORAC, V29, P319, DOI 10.1016/j.ejcts.2005.12.021
  44. Wahba A, 2020, EUR J CARDIO-THORAC, V57, P210, DOI 10.1093/ejcts/ezz267
  45. Walshe K, 2001, QUAL HEALTH CARE, V10, P250, DOI 10.1136/qhc.0100250..
  46. Wang W, 2014, J CARDIOTHORAC SURG, V9, DOI 10.1186/s13019-014-0177-6
  47. Young MN, 2020, J AM HEART ASSOC, V9, DOI 10.1161/JAHA.119.014738

Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/11
Artigos e Materiais de Revistas Científicas - ODS/03