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Abstract P249: Prospective Monitoring of Pediatric Cardiac Surgery Program Complications

Authors :
Camille L Hancock-Friesen
Ganesh Shanmugam
Hayley J Burton
Andrew E Warren
Stacy B O'Blenes
Source :
Circulation: Cardiovascular Quality and Outcomes. 4
Publication Year :
2011
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2011.

Abstract

Background: The next horizon for improving pediatric cardiac surgery outcomes is the standardization and systematic tracking of complications. Methods: IWK REB approval was obtained. The Multisocietal Database Committee short list of complications (52) were captured prospectively for all pediatric cardiac operations at the IWK Oct 1 2009-Sept 30 2010. Morbidity burden was calculated by multiplying a severity coefficient (1-3) by frequency of complication in each surgical complexity strata using RACHS categories. Death was included as a complication (severity coefficient= 5). Indexed morbidity was calculated for each RACHS category by dividing morbidity burden by number of procedures. Results: A total of 110 procedures were performed on 86 patients. 83 of the 86 index procedures were open and 22 of the patients were neonates. The procedural mortality rate was 3.6%. Forty one (41/86, 47.7%) of the index procedures had a total of 89 complications. Sixty-four patients were in RACHS category 2 or 3. The most common complications were pulmonary (22) arrhythmias (16), or operative (16), accounting for 61%(54/89) of total complications. The indexed morbidity was 0 for RACHS1, 1.55 for RACHS 2, 2.63 for RACHS 3, 1.81for RACHS 4, and 2.81 for RACHS5/6. The CUSUM plots the occurrence of any complication in each case versus morbidity burden, illustrating the effect of complication severity on the slope of the curve. Conclusions: A high rate of perioperative complications are recorded when tracked prospectively using standardized definitions. Adjusting complications for severity may identify areas for improving patient outcomes that are missed by simply recording their occurrence.

Details

ISSN :
19417705 and 19417713
Volume :
4
Database :
OpenAIRE
Journal :
Circulation: Cardiovascular Quality and Outcomes
Accession number :
edsair.doi...........e35128aeae3559495397002fc51bacc1
Full Text :
https://doi.org/10.1161/circoutcomes.4.suppl_2.ap249