Innovative uses of a cardiothoracic database.

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.