Most deaths in low-risk cardiac surgery could be avoidable

Abstract

It is observed that death rates in cardiac surgery has decreased, however, root causes that behave like triggers of potentially avoidable deaths (AD), especially in low-risk patients (less bias) are often unknown and underexplored, Phase of Care Mortality Analysis (POCMA) can be a valuable tool to identify seminal events (SE), providing valuable information where it is possible to make improvements in the quality and safety of future procedures. Our results show that in São Paul State, only one third of AD in low-risk cardiac surgery was related to specific surgical problems. After a revisited analysis, 75% of deaths could have been avoided, which in the pre-operative phase, the SE was related judgment, patient evaluation and preparation. In the intra-operative phase, most occurrences could have been avoided if other surgical technique had been used. Sepsis was responsible for 75% of AD in the intensive care unit. In the ward phase, the recognition/management of clinical decompensations and sepsis were the contributing factors. Logistic regression model identified age, previous coronary stent implantation, coronary artery bypass grafting + heart valve surgery, ≥ 2 combined heart valve surgery and hospital-acquired infection as independent predictors of AD.

Figure 1

Flowchart of patient selection in the São Paulo Phase of Care Mortality Analysis study. Description about the selection of patients used for this analysis.

Figure 2

Phase of care mortality analysis seminal event in hospitalization phases. Using the POCMA analysis tool, the SE were categorized according to the perioperative phase of care.

Figure 3

Phase of care mortality analysis comparison between surgery populations. Association between perioperative care phase SE and surgical procedure.

Figure 4

ROC curve of the São Paulo Phase of Care Mortality Analysis study. Figure was generated using R statistical software version 3.6.0¹⁵.