Impact of a quality improvement initiative with a dedicated anesthesia team on outcomes after surgery for adult congenital heart disease

Figures

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  Monthly in-hospital mortality rates before and after introduction of the program changes.

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  Figure 1. Interrupted time series model for in-hospital mortality. The monthly in-hospital mortality rate surrounding the program changes was analyzed using an interrupted time series model. Each year was divided into 3 equal parts: January to April, May to August, and September to December. Within each time interval, outcome rates were computed. Percentages were subjected to empirical logistic transformation. Before the program changes, in-hospital mortality rates were decreasing at a yearly rate of −0.075% (95% CI, –0.179 to 0.028, P = .154). At the time of the intervention, there is a decrease in in-hospital mortality rate of −0.091% (95% CI, –4.764 to 4.583, P = .97). The sustained effect is a decrease in the yearly rate of change of the in-hospital mortality rate of −0.285% (95% CI, –0.908 to 0.339, P = .37) after the intervention. The analysis suggests that after the program changes, the in-hospital mortality rate decreased at a yearly rate of 0.36%.

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  Figure 2. Mortality after adult congenital cardiac surgery, before and after the introduction of a quality improvement program, was assessed. A dedicated ACHD anesthesia team was introduced within the cardiac group. Use of factor concentrates was introduced contemporaneously. In-hospital and 1-year mortality rates were reduced. Incidence of AKI, stroke, and BPE was unchanged. Chest reexplorations were reduced. This was despite more complex patients. AKI, Acute kidney injury; ICU, intensive care unit; ACHD, adult congenital heart disease.

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  Figure 3. Interrupted time series model for BPE. The monthly BPE rate surrounding the program changes was analyzed using an interrupted time series model. Each year was divided into 3 equal parts: January to April, May to August, and September to December. Within each time interval, outcome rates were computed. Percentages were subjected to empirical logistic transformation. Before the program changes, BPE rates were decreasing at a yearly rate of −0.413% (95% CI, –0.811 to −0.015, P = .042). At the time of the intervention, there is an increase of BPE of 9.027% (95% CI, –8.963 to 27.017, P = .33). The sustained effect is an increase in the yearly rate of change of 0.437% (95% CI, –1.964 to 2.838, P = .72). The analysis suggests that after the intervention, BPE rates increase at a yearly rate 0.024%. BPE, Blood product exposure.

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