Towards excellence in cardiac surgery: experience from a developing country

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Quality Improvement

Background:

• Cardiac surgery outcomes vary globally.
• Benchmarking against established databases is crucial for quality assessment.
• The Aga Khan University Hospital (AKU) sought to evaluate its cardiac surgery performance.

Purpose of the Study:

• To measure the performance of cardiac surgeries at AKU.
• To compare AKU's outcomes with a large, internationally recognized database (American Society of Thoracic Surgeons National Cardiac Database - STS-NCD).

Main Methods:

• A cross-sectional study design using prospectively collected data from January 2006 to December 2010.
• Analysis of 2198 Coronary Artery Bypass Graft (CABG) surgeries performed at AKU.
• Retrospective comparison of AKU patient characteristics and outcomes against the STS-NCD.

Main Results:

• AKU had a higher 30-day mortality (2.7% vs. 1.5%) but lower rates of stroke, prolonged ventilation, deep sternal wound infection, and reoperation compared to STS-NCD.
• Renal failure incidence was higher at AKU (5.4% vs. 3.6%).
• AKU showed significantly lower 30-day readmission rates (3.9% vs. 9.1%).

Conclusions:

• Cardiac surgery outcomes at AKU compare favorably with the STS benchmark.
• This study demonstrates that high-quality cardiac surgical care can be achieved in Pakistan.
• The findings support the potential for global excellence in cardiac surgery outcomes.