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December 19, 2003世界华文文学论坛

Relationship Between Processes of Care and Coronary Bypass Operative Mortality and Morbidity

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Key result

Intraoperative transesophageal echo and hemoconcentration/ultrafiltration during CABG were associated with increased risk of perioperative mortality and morbidity (OR 1.60 and 1.36, respectively).

Why the study?

Do specific intraoperative processes of care (such as TEE, inotropes, and hemoconcentration) affect perioperative mortality and morbidity in patients undergoing CABG?

Population

3,988 patients who underwent coronary artery bypass grafting at 14 VA medical centers between 1992 and 1996.

Comparison

Specific intraoperative processes of care… vs Patients not receiving these specific…

Design

Cohort

Follow-up

perioperative

Authors

MOMaureen M. O’BrienUniversity of Colorado Anschutz Medical CampusASA. Laurie ShroyerCardiac SurgeryTMThomas MoritzFlorida State University

Discussion

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Implication

Processes of care may link to cardiac surgery outcomes; leaves open whether optimizing them improves results.

Key Points

  • Determine the association between specific processes of care across preoperative evaluation, intraoperative management, and senior physician supervision with perioperative morbidity and mortality following coronary artery bypass graft surgery.
  • Prospective cohort of 3,988 patients undergoing coronary artery bypass grafting across 14 VA medical centers between 1992 and 1996.
  • Evaluated 734 baseline risk, process, and structural variables, filtering down to 39 candidate care processes.
  • Utilized multivariable logistic regression adjusting for 17 patient risk factors and controlling for intraoperative complications.
  • Initial multivariable modeling showed operative duration, inotropic agent use, systemic hypothermia depth, transesophageal echocardiography, and hemoconcentration/ultrafiltration were significant predictors of perioperative mortality and morbidity.
  • In a secondary model omitting intermediate complication factors like inotrope use and operative time, transesophageal echocardiography (OR 1.60) and hemoconcentration/ultrafiltration (OR 1.36) remained significantly associated with increased risk of the composite adverse outcome.

Study Design

Type

Cohort (n=3,988)

Multicenter

Yes

Structured PICO

Do specific intraoperative processes of care (such as TEE, inotropes, and hemoconcentration) affect perioperative mortality and morbidity in patients undergoing CABG?

P
Population
3,988 patients who underwent coronary artery bypass grafting at 14 VA medical centers between 1992 and 1996.
E
Exposure
Specific intraoperative processes of care, including the use of inotropic agents, transesophageal echocardiography (TEE), and hemoconcentration/ultrafiltration.
C
Comparator
Patients not receiving these specific intraoperative processes of care (assessed via multivariable logistic regression).
O
Outcome
Composite outcome of perioperative mortality and morbidity.composite

Main Result

Odds Ratio: 1.6

Certain intraoperative processes of care, including TEE and hemoconcentration/ultrafiltration, are associated with increased perioperative morbidity and mortality in CABG patients, highlighting the need for further evaluation of these practices.

Cite This Study

O’Brien et al. (2003) conducted a cohort in Coronary artery bypass grafting (n=3,988). Intraoperative transesophageal echo and hemoconcentration/ultrafiltration was evaluated on Composite of perioperative mortality and morbidity (OR 1.60). Intraoperative transesophageal echo and hemoconcentration/ultrafiltration during CABG were associated with increased risk of perioperative mortality and morbidity (OR 1.60 and 1.36, respectively).

synapsesocial.com/papers/6a6d2484e36a167817dfe104https://doi.org/10.1097/01.mlr.0000102295.08379.57
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