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Published on: January 22, 2011
Innovative uses of a cardiothoracic database
1Section of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. william.nugent@Hitchcock.org
Insights
The Northern New England Cardiovascular Disease Study Group identified low cardiac output syndrome as the most common cause of death after open heart surgery. This finding drives regional efforts to prevent and treat this complication.
Area of Science:
- Cardiovascular Surgery
- Outcomes Research
- Quality Improvement in Healthcare
Background:
- The Northern New England Cardiovascular Disease Study Group (NNECDS) has maintained a voluntary cardiac surgical database since 1987.
- The database includes risk-stratified data on over 60,000 patients undergoing open heart surgery.
- Previous analyses revealed significant inter-center variations in mortality rates not attributable to patient case mix.
Purpose of the Study:
- To investigate the causes of mortality variation identified in previous analyses.
- To define and identify the "mode of death" in cardiac surgical patients.
- To inform regional strategies for improving patient outcomes.
Main Methods:
- A regional retrospective review of deaths following open heart surgery was conducted.
- The "mode of death" was defined as the initiating event in the fatal sequence.
- Data analysis focused on identifying the most frequent modes of death.
Main Results:
- Low cardiac output syndrome was identified as the most common mode of death.
- This finding highlights a critical area for intervention in the perioperative period.
- Significant variation in mortality rates between institutions was previously noted.
Conclusions:
- Low cardiac output syndrome is a primary driver of mortality after open heart surgery in the region.
- Regional initiatives are now focused on the prevention, early detection, and management of low cardiac output syndrome.
- Improving the care of patients experiencing low cardiac output syndrome is a key goal for the NNECDS.
Abstract:
This report describes the activities of the Northern New England Cardiovascular Disease Study Group. The group consists of representatives from six institutions: Eastern Maine Medical Center in Bangor, and Maine Medical Center in Portland, ME; Optima Health Care in Manchester and Dartmouth-Hitchcock Medical Center in Lebanon, NH; Fletcher Allen Health Care in Burlington, VT; and Beth Israel-Deaconess Medical Center in Boston, MA. The Northern New England Cardiovascular Disease Study Group maintains a voluntary primary cardiac surgical database that has risk-stratified information on more than 60,000 consecutive patients who have undergone open heart surgical procedures in northern New England since 1987. In 1991, the group reported that significant variation in mortality rate existed between centers, a difference not explained by case mix. The finding led to a regional retrospective review of deaths in an effort to identify "mode of death." Mode of death is defined as that event that started the chain of events ultimately leading to the death of the patient. The most common mode of death was found to be low cardiac output syndrome. This information has led to a regional effort toward prevention, early recognition, and successful treatment of low cardiac output syndrome in the perioperative period.
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