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Published on: March 27, 2018
Analysis of mortality in low-risk patients undergoing coronary artery bypass grafting
Canturk Cakalagaoglu1, Cengiz Koksal, Taylan Adademir
1Cardiovascular Surgery Clinic, Kartal Kosuyolu Research and Training Hospital, Kartal, Istanbul, Turkey.
Insights
Early coronary artery bypass graft (CABG) mortality is low, but nearly half of deaths in low-risk patients are preventable. Addressing technical and system errors can improve surgical outcomes and patient care.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes Research
- Patient Safety
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure.
- Assessing early mortality and its causes in low-risk CABG patients is crucial for improving surgical quality.
- Identifying preventable deaths can guide quality improvement initiatives.
Purpose of the Study:
- To determine the early mortality rate in low-risk CABG patients (EuroSCORE ≤ 2).
- To examine the causes of death in this cohort.
- To identify avoidable factors contributing to mortality for future surgical improvements.
Main Methods:
- Retrospective review of all low-risk patients who died post-CABG.
- Independent review of peri-operative data to classify causes of death.
- Categorization of deaths into non-preventable, preventable (technical error), and preventable (system error).
Main Results:
- The early mortality rate was 0.93% (24/2570 patients).
- Preventable deaths accounted for 45.8% (11/24) of early mortality.
- Key preventable factors included graft thrombosis (technical error) and delays in treating reversible conditions (system error).
Conclusions:
- Technical errors, particularly in left internal mammarian artery harvesting and anastomosis, contribute to preventable deaths.
- System errors, such as delayed patient transfer and treatment, also impact outcomes.
- Implementing standardized protocols for surgical techniques and patient management can enhance care quality and patient outcomes in CABG surgery.
Aim:
The aims of this study were to determine the early mortality rate in low-risk coronary artery bypass graft (CABG) patients and examine the causes of death, to identify problems that could be avoided in future surgeries.
Methods:
All low-risk patients (EuroSCORE ≤ 2) who died after CABG were included. Their peri-operative information was meticulously studied by internal and independent external reviewers to identify causes of death, which were classified as: cardiac or non-cardiac; and a further division as: (1) non-preventable, (2) preventable (technical error), and (3) preventable (system error).
Results:
Early mortality was 0.93% (24/2570). Eleven patients (45.8%) were classified as preventable deaths. In six of them the main problem was identified as graft thrombosis, which was secondary to a technical error of either the harvesting or anastomosis of the left internal mammarian artery. There were also five system errors identified as delays in the treatment of an identified and potentially reversible problem.
Conclusion:
Correction of technical and system errors, such as harvesting of the left internal mammarian artery, haemostasis during surgery, and establishing standard protocols for the transfer of patients from ward to intensive care units will eventually lead to improvement in both the quality of care and patient outcomes, even in low-risk groups.
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