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Sotiris C. Stamou
Robert M. Stiegel
Mark K. Reames
Eric Skipper
Larry T. Watts
Francis Robicsek
Kevin W. Lobdell
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J Thorac Cardiovasc Surg 2008;136:494-499
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Quality improvement program decreases mortality after cardiac surgery

Sotiris C. Stamou, MD, PhD, Sara L. Camp, NP, Robert M. Stiegel, MD, Mark K. Reames, MD, Eric Skipper, MD, Larry T. Watts, MD, Marcy Nussbaum, MS, Francis Robicsek, MD, PhD, Kevin W. Lobdell, MD*

Department of Thoracic and Cardiovascular Surgery, Carolinas Heart Institute, Carolinas Medical Center, Charlotte, NC

Received for publication June 4, 2007; revisions received July 27, 2007; accepted for publication August 27, 2007.

* Address for reprints: Kevin W. Lobdell, MD, Carolinas Heart Institute, 1000 Blythe Blvd, Charlotte, NC 28203. (Email: kevin.lobdell{at}carolinas.org).

Objective: This study investigated the effects of a quality improvement program and goal-oriented, multidisciplinary protocols on mortality after cardiac surgery.

Methods: Patients were divided into two groups: those undergoing surgery (coronary artery bypass grafting, isolated valve surgery, or coronary artery bypass grafting and valve surgery) after establishment of the multidisciplinary quality improvement program (January 2005–December 2006, n = 922) and those undergoing surgery before institution of the program (January 2002–December 2003, n = 1289). Logistic regression and propensity score analysis were used to adjust for imbalances in patients' preoperative characteristics.

Results: Operative mortality was lower in the quality improvement group (2.6% vs 5.0%, P < .01). Unadjusted odds ratio was 0.5 (95% confidence interval 0.3–0.8, P < .01); propensity score–adjusted odds ratio was 0.6 (95% confidence interval 0.4–0.99, P = .04). In multivariable analysis, diabetes (P < .01), chronic renal insufficiency (P = .05), previous cardiovascular operation (P = .04), congestive heart failure (P < .01), unstable angina (P < .01), age older than 75 years (P < .01), prolonged pump time (P < .01), and prolonged operation (P = .05) emerged as independent predictors of higher mortality after cardiac surgery, whereas quality improvement program (P < .01) and male sex (P = .03) were associated with lower mortality. Mortality decline was less pronounced in patients with than without diabetes (P = .04).

Conclusion: Application of goal-directed, multidisciplinary protocols and a quality improvement program were associated with lower mortality after cardiac surgery. This decline was less prominent in patients with diabetes, and focused quality improvement protocols may be required for this subset of patients.

Abbreviations and Acronyms AVR = aortic valve replacement; CABG = coronary artery bypass grafting; QIP = quality improvement program






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