Most deaths in low-risk cardiac surgery could be avoidable.

Area of Science:

• Cardiology
• Surgical Outcomes
• Patient Safety

Background:

• Cardiac surgery mortality rates have declined, but avoidable deaths (AD), particularly in low-risk patients, remain a concern.
• Root causes and triggers of these deaths are often unknown, hindering quality improvement efforts.

Purpose of the Study:

• To identify seminal events (SE) contributing to avoidable deaths in low-risk cardiac surgery using Phase of Care Mortality Analysis (POCMA).
• To provide data for improving the quality and safety of future cardiac surgical procedures.

Main Methods:

• Analysis of avoidable deaths in low-risk cardiac surgery patients in São Paulo State.
• Phase of Care Mortality Analysis (POCMA) to identify seminal events (SE).
• Logistic regression to identify independent predictors of avoidable deaths (AD).

Main Results:

• Only one-third of AD were linked to specific surgical issues; 75% were deemed avoidable upon review.
• Pre-operative SE included issues with judgment, patient evaluation, and preparation.
• Intra-operative SE often related to the choice of surgical technique.
• Sepsis was a major factor in intensive care unit (ICU) deaths (75% of AD).
• Ward phase deaths were linked to failure in recognizing/managing clinical decompensation and sepsis.

Conclusions:

• Avoidable deaths in low-risk cardiac surgery are frequently linked to non-surgical factors, particularly in pre-operative and intra-operative phases.
• Targeting pre-operative patient assessment and optimizing surgical techniques are crucial for reducing mortality.
• Hospital-acquired infections, age, and specific surgical histories are independent predictors of avoidable deaths.