Original article
Adult cardiac
A Method to Evaluate Cardiac Surgery Mortality: Phase of Care Mortality Analysis

Presented at the Forty-seventh Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2011.
https://doi.org/10.1016/j.athoracsur.2011.07.057Get rights and content

Background

This is a study of a method of mortality review, adopted by the Michigan Society of Thoracic and Cardiovascular Surgeons, to enhance understanding of mortality and potentially avoidable deaths after cardiac surgery, utilizing a voluntary statewide database.

Methods

A system to categorize mortality was developed utilizing a phase of care mortality analysis approach as well as providing criteria to classify mortality as potentially “avoidable.” For each mortality, the operating surgeon categorized a cardiac surgery mortality trigger into 1 of 5 time frames: preoperative, intraoperative, intensive care unit (ICU), postoperative floor, and discharge.

Results

A total of 53,674 adult cardiac operations were performed from January 1, 2006 to June 30, 2010 with a crude mortality of 3.5% (1,905 of 53,674). Of the mortalities analyzed, 35% (618 of 1,780) were preoperative, 25% (451 of 1,780) were ICU, 19% (333 of 1,780) were intraoperative, 11% (198 of 1,780) were floor, and 10% (180 of 1,780) were discharge phase. “Avoidable” mortality triggers occurred in 53% (174 of 333) of the intraoperative, 41% (253 of 618) and (184 of 451) of the preoperative and ICU phases, 42% (83 of 198) of the floor, and 19% (35 of 180) of the discharge phase. Overall potentially avoidable mortality was 41% (729 of 1780). Thirty-six percent (644 of 1,780) of the mortalities were coronary artery bypass grafting patients and 29% (188 of 644) of these were in the preoperative phase, with a mean predicted risk of 16%.

Conclusions

This analysis identifies the occurrence of potentially avoidable mortalities in the 4 hospital phases of care, with the largest absolute number of avoidable mortalities occurring in the preoperative phase. A focus on these phases of care provides significant opportunity for quality improvement initiatives. Utilizing phase of care mortality analysis stimulates surgeons and hospitals to develop and refine mortality reviews and provides a structured statewide platform for discussion, education, quality improvement, and enhanced outcomes.

Section snippets

Patients and Methods

After being tested and refined at Beaumont Hospital, the POCMA concept and methodology was introduced in 2006 to the MSTCVS Quality Collaborative with a series of lectures and data analyses to provide opportunity for shared learning from a structured review of all cardiac mortalities in the state. Cardiac surgeons and team members were shown how to identify a seminal event (death trigger) that initiated deterioration resulting in death for each mortality. This seminal event identified the root

Results

A total of 53,674 adult cardiac operations were performed in the state of Michigan between January 1, 2006 and June 30, 2010 (Table 1). The unadjusted operative mortality for all cardiac procedures was 3.5%. The overall unadjusted mortality rate for all cardiac procedures decreased from 3.76% in 2006 to 2.98% (p = 0.064) in 2010. Isolated coronary artery bypass (CAB) mortality rates decreased from 2.23% to 1.66% (p = 0.233) over the same period. Year over year trends were analyzed using the

Comment

Cardiac surgery achieves excellent outcomes in highly complex procedures in patients with escalating comorbidity profiles. Despite this high degree of reliability, cardiac surgeons are both challenged and driven to achieve a greater degree of success. The classic morbidity and mortality or death and complications review methodology often fails to recognize the multidisciplinary care aspects of cardiac surgery. Realizing an inherent learning opportunity for a quality collaborative, a refined

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Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.