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Adaptation And Use of the Papworth Haemostasis Checklist - Clinical Outcomes Analysis at Hospital Estadual Mário
Pedro Borghesi Poltronieri1, Andrea Cristina Oliveira Freitas2, Caroline Hamati Rosa Batista1
1Faculdade de Medicina, Centro Universitário FMABC, Santo André, São Paulo, Brazil.
Insights
Implementing an adapted Papworth Haemostasis Checklist in cardiovascular surgery significantly reduced patient mortality by improving intraoperative hemostasis and preventing postoperative bleeding complications.
Area of Science:
- Cardiovascular Surgery
- Surgical Hemostasis
- Patient Safety
Background:
- Postoperative bleeding is a major complication in cardiovascular surgery.
- Adequate intraoperative hemostasis is crucial for better patient outcomes.
- Standardized checklists can improve surgical safety and reduce complications.
Purpose of the Study:
- To evaluate the impact of an adapted Papworth Haemostasis Checklist on postoperative bleeding rates.
- To assess the effect of the checklist on complications, reoperations, and mortality in cardiovascular surgery patients.
- To improve bleeding prevention strategies in a Brazilian cardiovascular surgery department.
Main Methods:
- A non-randomized controlled clinical trial involving 200 cardiac surgery patients.
- Adaptation and translation of the Papworth Haemostasis Checklist to Brazilian standards.
- Checklist use prior to chest wall closure, with 30-day follow-up.
Main Results:
- A reduction in 24-hour drain output, postoperative complications, and reoperations was observed post-checklist implementation.
- A statistically significant reduction in mortality was noted (8 deaths vs. 2 deaths; P=0.05).
- While not all reductions reached statistical significance, the trend indicated improved outcomes.
Conclusions:
- The adapted Papworth Haemostasis Checklist is an effective intervention for preventing postoperative bleeding in cardiovascular surgery.
- The checklist implementation directly contributed to a reduction in patient deaths.
- Standardizing hemostasis assessment improves patient safety and reduces adverse surgical outcomes.
Introduction:
Postoperative bleeding is one of the main causes of complications in cardiovascular surgery, which highlights the importance of ensuring adequate intraoperative hemostasis, providing a better patient outcome. This study aimed to improve the prevention of postoperative bleeding in the Cardiovascular Surgery Department of the Hospital Estadual Mário Covas (Santo André, Brazil) using an adapted version of the Papworth Haemostasis Checklist to assess the impact of this standardization on bleeding rate, postoperative complications, reoperation, and mortality.
Methods:
This is a non-randomized controlled clinical trial, whose non-probabilistic sample consisted of patients undergoing cardiac surgery in the abovementioned service within a two-year interval. The Papworth Haemostasis Checklist was adapted to the Brazilian laboratory parameters and the questions were translated into Portuguese. This checklist was used before the surgeon started the chest wall closure. Patients were followed up until 30 days after surgery. A P-value < 0.05 was considered statistically relevant.
Results:
This study included 200 patients. After the checklist, a reduction in 24-hour drain output, postoperative complications, and reoperation was observed, although statistical significance was not reached. Finally, there was a significant reduction in the number of deaths (8 vs. 2; P=0.05).
Conclusion:
The use of the adapted checklist in our hospital proved to be an effective intervention to improve the prevention of postoperative bleeding, with a direct impact in the number of deaths in the study period. The reduction in deaths was possible thanks to the reduction in the bleeding rate, postoperative complications, and reoperations for bleeding.
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