Dataset Information

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

ABSTRACT: It is observed that death rates in cardiac surgery has decreased, however, root causes that behave like triggers of potentially avoidable deaths (AD), especially in low-risk patients (less bias) are often unknown and underexplored, Phase of Care Mortality Analysis (POCMA) can be a valuable tool to identify seminal events (SE), providing valuable information where it is possible to make improvements in the quality and safety of future procedures. Our results show that in São Paul State, only one third of AD in low-risk cardiac surgery was related to specific surgical problems. After a revisited analysis, 75% of deaths could have been avoided, which in the pre-operative phase, the SE was related judgment, patient evaluation and preparation. In the intra-operative phase, most occurrences could have been avoided if other surgical technique had been used. Sepsis was responsible for 75% of AD in the intensive care unit. In the ward phase, the recognition/management of clinical decompensations and sepsis were the contributing factors. Logistic regression model identified age, previous coronary stent implantation, coronary artery bypass grafting?+?heart valve surgery,???2 combined heart valve surgery and hospital-acquired infection as independent predictors of AD.

SUBMITTER: Mejia OAV

PROVIDER: S-EPMC7806717 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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

Mejia Omar Asdrúbal Vilca OAV Borgomoni Gabrielle Barbosa GB Lima Eduardo Gomes EG Guerreiro Gustavo Pampolha GP Dallan Luís Roberto LR de Barros E Silva Pedro P Nakazone Marcelo Arruda MA Junior Orlando Petrucci OP Gomes Walter José WJ de Oliveira Marco Antonio Praça MAP Sousa Alexandre A Campagnucci Valquíria Pelisser VP Tiveron Marcos Gradim MG Rodrigues Alfredo José AJ Tineli Rafael Ângelo RÂ Rocha E Silva Roberto R Lisboa Luiz Augusto Ferreira LAF Jatene Fabio Biscegli FB

Scientific reports 20210113 1

It is observed that death rates in cardiac surgery has decreased, however, root causes that behave like triggers of potentially avoidable deaths (AD), especially in low-risk patients (less bias) are often unknown and underexplored, Phase of Care Mortality Analysis (POCMA) can be a valuable tool to identify seminal events (SE), providing valuable information where it is possible to make improvements in the quality and safety of future procedures. Our results show that in São Paul State, only one ...[more]

PMID: 33441748

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Project description:BackgroundAudits provide a rational framework for quality improvement by systematically assessing clinical practices against accepted standards with the aim to develop recommendations and interventions that target modifiable deficiencies in care. Most childbirth-associated mortality audits in developing countries are focused on a single facility and, up to now, the avoidable factors in maternal and perinatal deaths cataloged in these reports have not been pooled and analyzed. We sought to identity the most frequent avoidable factors in childbirth-related deaths globally through a systematic review of all published mortality audits in low and lower-middle income countries.MethodsWe performed a systematic review of published literature from 1965 to November 2011 in Pubmed, Embase, CINAHL, POPLINE, LILACS and African Index Medicus. Inclusion criteria were audits from low and lower-middle income countries that identified at least one avoidable factor in maternal or perinatal mortality. Each study included in the analysis was assigned a quality score using a previously published instrument. A meta-analysis was performed for each avoidable factor taking into account the sample sizes and quality score from each individual audit. The study was conducted and reported according to PRISMA guidelines for systematic reviews.ResultsThirty-nine studies comprising 44 datasets and a total of 6,205 audited deaths met inclusion criteria. The analysis yielded 42 different avoidable factors, which fell into four categories: health worker-oriented factors, patient-oriented factors, transport/referral factors, and administrative/supply factors. The top three factors by attributable deaths were substandard care by a health worker, patient delay, and deficiencies in blood transfusion capacity (accounting for 688, 665, and 634 deaths attributable, respectively). Health worker-oriented factors accounted for two-thirds of the avoidable factors identified.ConclusionsAudits provide insight into where systematic deficiencies in clinical care occur and can therefore provide crucial direction for the targeting of interventions to mitigate or eliminate health system failures. Given that the main causes of maternal and perinatal deaths are generally consistent across low resource settings, the specific avoidable factors identified in this review can help to inform the rational design of health systems with the aim of achieving continued progress towards Millennium Development Goals Four and Five.

Project description:BACKGROUND:Low cardiac output syndrome (LCOS) is an important complication of cardiac surgery. It is associated with increased morbidity and mortality. The incidence of LCOS after surgery is high in patients with congenital heart disease (CHD). Therefore, determining the risk factors of LCOS has clinical significance for the management of CHD. This study aimed to analyze the risk factors of LCOS. METHODS:We conducted a retrospective analysis of children with CHD who underwent cardiac surgery at Shanghai Children's Medical Center between January 1, 2014, and December 31, 2017. Demographic characteristics and baseline data were extracted from the health data resource center of the hospital, which integrates clinical routine data including medical records, diagnoses, orders, surgeries, laboratory tests, imaging, nursing, and other subsystems. Logistic regressions were performed to analyze the risk factors of LCOS. RESULTS:Overall, 8660 infants with CHD were included, and 864 (9.98%) had LCOS after surgery. The multivariate regression analysis identified that age (OR 0.992, 95% CI: 0.988-0.997, p?=?0.001), tricuspid regurgitation (1.192, 1.072-1.326, p?=?0.001), Risk Adjustment in Congenital Heart Surgery-1 risk grade (1.166, 1.011-1.345, p?=?0.035), aortic shunt (left-to-right: 1.37, 1.005-1.867, p?=?0.046; bi-directional: 1.716, 1.138-2.587, p?=?0.01), atrial shunt (left-to-right: 1.407, 1.097-1.805, p?=?0.007; right-to-left: 3.168, 1.944-5.163, p?<?0.001; bi-directional: 1.87, 1.389-2.519, p?<?0.001), ventricular level shunt (left-to-right: 0.676, 0.486-0.94, p?=?0.02; bi-directional: 2.09, 1.611-2.712, p?<?0.001), residual shunt (3.489, 1.502-8.105, p?=?0.004), left ventricular outflow tract obstruction (3.934, 1.673-9.254, p?=?0.002), right ventricular outflow tract obstruction (3.638, 1.225-10.798, p?=?0.02), circulating temperature (mild hypothermia: 1.526, 95% CI: 1.205-1.934, p?<?0.001; middle and low temperature: 1.738, 1.236-2.443, p?=?0.001), duration of cardiopulmonary bypass (1.009, 1.006-1.012, p?<?0.001), myocardial preservation using histidine-tryptophan-ketoglutarate (1.677, 1.298-2.167, p?<?0.001), and mitral insufficiency (1.714, 1.239-2.37, p?<?0.001) were independent risk predictors of LCOS. CONCLUSIONS:The incidence of postoperative LCOS in CHD children remains high. Circulation temperature, myocardial preservation using histidine-tryptophan-ketoglutarate, and usage of residual shunt after surgery were independent risk predictors for LCOS.

Project description:Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies. Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa. Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals. A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the 'three delays framework' (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs-a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care. Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems. A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.

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

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

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