Quality improvement program in Latin America decreases mortality after cardiac surgery: a before-after intervention
Omar Asdrúbal Vilca Mejia1, Gabrielle Barbosa Borgomoni1, Luís Roberto Palma Dallan1
1Department of Cardiopneumology, Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
Insights
Implementing a quality improvement program in cardiac surgery significantly reduced hospital mortality, complications, and length of stay. This cardiac surgery quality improvement program demonstrated improved patient outcomes in Latin America.
Area of Science:
- Cardiovascular Surgery
- Healthcare Quality Improvement
- Public Health
Background:
- Cardiac surgery (CS) faces challenges in improving outcomes, especially in high-risk scenarios.
- Assessing the impact of quality improvement programs (QIPs) is crucial for enhancing patient care.
- The largest CS center in Latin America served as the study setting.
Purpose of the Study:
- To evaluate the effectiveness of a novel quality improvement program (QIP) on hospital mortality.
- To analyze the impact of the QIP on patient outcomes and complications following cardiac surgery.
- To establish a benchmark for quality improvement initiatives in Latin American cardiac surgery centers.
Main Methods:
- A comparative study design was employed, dividing patients into pre-QIP (2013-2015) and post-QIP (2017-2019) groups.
- Propensity Score Matching (PSM) was utilized to control for preoperative differences between the groups.
- Key cardiac surgical procedures including coronary artery bypass grafting (CABG) and valve surgeries were analyzed.
Main Results:
- The QIP was associated with a significant reduction in hospital mortality (P=0.001).
- Patients in the QIP group experienced shorter hospital stays and fewer complications, including anemia, acute kidney injury, and sepsis.
- The absence of the QIP was independently associated with a 2.09-fold increase in the odds of hospital mortality.
Conclusions:
- The first CS QIP implemented in Latin America successfully reduced hospital mortality and complications.
- The program led to improvements in hospital length of stay and overall patient recovery.
- This study highlights the significant benefits of structured quality improvement programs in cardiac surgery.
Background:
The current challenge of cardiac surgery (CS) is to improve outcomes in adverse scenarios. The aim of this study was to assess the impact of a quality improvement program (QIP) on hospital mortality in the largest CS center in Latin America.
Methods:
Patients were divided into two groups: before (Jan 2013-Dec 2015, n = 3534) and after establishment of the QIP (Jan 2017-Dec 2019, n = 3544). The QIP consisted of the implementation of 10 central initiatives during 2016. The procedures evaluated were isolated coronary artery bypass grafting surgery (CABG), mitral valve surgery, aortic valve surgery, combined mitral and aortic valve surgery, and CABG associated with heart valve surgery. Propensity Score Matching (PSM) was used to adjust for inequality in patients' preoperative characteristics before and after the implementation of QIP. A multivariate logistic regression model was built to predict hospital mortality and validated using discrimination and calibration metrics.
Results:
The PMS paired two groups using 5 variables, obtaining 858 patients operated before (non-QIP) and 858 patients operated after the implementation of the QIP. When comparing the QIP versus Non-QIP group, there was a shorter length of stay in all phases of hospitalization. In addition, the patients evolved with less anemia (P = 0.001), use of intra-aortic balloon pump (P = 0.003), atrial fibrillation (P = 0.001), acute kidney injury (P < 0.001), cardiogenic shock (P = 0.011), sepsis (P = 0.046), and hospital mortality (P = 0.001). In the multiple model, among the predictors of hospital mortality, the lack of QIP increased the chances of mortality by 2.09 times.
Conclusion:
The implementation of a first CS QIP in Latin America was associated with a reduction in length of hospital stay, complications and mortality after the cardiac surgeries analyzed.
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