Quality improvement program in Latin America decreases mortality after cardiac surgery: a before-after intervention study

• Published in: International journal of surgery (London, England) Vol. 106; p. 106931
• Main Authors: Mejia, Omar Asdrúbal Vilca, Borgomoni, Gabrielle Barbosa, Palma Dallan, Luís Roberto, Mioto, Bruno Mahler, Duenhas Accorsi, Tarso Augusto, Lima, Eduardo Gomes, de Matos Soeiro, Alexandre, Lima, Felipe Gallego, Manuel de Almeida Brandão, Carlos, Alberto Pomerantzeff, Pablo Maria, Oliveira Dallan, Luís Alberto, Ferreira Lisboa, Luiz Augusto, Jatene, Fábio Biscegli
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.10.2022
• Subjects: Cardiovascular surgery; Database analysis; Mortality reduction; Quality improvement; Cardiovascular surgery; Quality improvement; Database analysis; Mortality reduction
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2022.106931

The current challenge of cardiac surgery (CS) is to improve outcomes in adverse scenarios. The aim of this study was to assess the impact of a quality improvement program (QIP) on hospital mortality in the largest CS center in Latin America. Patients were divided into two groups: before (Jan 2013–Dec 2015, n = 3534) and after establishment of the QIP (Jan 2017–Dec 2019, n = 3544). The QIP consisted of the implementation of 10 central initiatives during 2016. The procedures evaluated were isolated coronary artery bypass grafting surgery (CABG), mitral valve surgery, aortic valve surgery, combined mitral and aortic valve surgery, and CABG associated with heart valve surgery. Propensity Score Matching (PSM) was used to adjust for inequality in patients’ preoperative characteristics before and after the implementation of QIP. A multivariate logistic regression model was built to predict hospital mortality and validated using discrimination and calibration metrics. The PMS paired two groups using 5 variables, obtaining 858 patients operated before (non-QIP) and 858 patients operated after the implementation of the QIP. When comparing the QIP versus Non-QIP group, there was a shorter length of stay in all phases of hospitalization. In addition, the patients evolved with less anemia (P = 0.001), use of intra-aortic balloon pump (P = 0.003), atrial fibrillation (P = 0.001), acute kidney injury (P < 0.001), cardiogenic shock (P = 0.011), sepsis (P = 0.046), and hospital mortality (P = 0.001). In the multiple model, among the predictors of hospital mortality, the lack of QIP increased the chances of mortality by 2.09 times. The implementation of a first CS QIP in Latin America was associated with a reduction in length of hospital stay, complications and mortality after the cardiac surgeries analyzed. [Display omitted] •Mortality after cardiac surgery decreased by 52.6% after a QIP in Latin America.•Length of stay and postoperative events were also favorably impacted by a QIP.•QIP have the potential to improve cardiac surgery outcomes worldwide.