Resultados da implementação de modelo organizacional de um serviço de cirurgia cardiovascularResults of the establishment of an organizational model in a cardiovascular surgery service Abstract Objective: Increasing complexity of patients referred to cardiac surgery demands more effective heart centers, in order to maintain the same quality. The aim of this study is to examine the short-term effect of adoption of an organizational model on surgical outcomes.Methods: From January 2006 to June 2007, 367 consecutive adult patients underwent cardiovascular surgery. Pre-, intra-and postoperative data were prospectively collected and transferred to an institutional database. Organizational model was established in August 2006, and based on integrated multiprofessional team work patient-centered, evidence-based medicine with standardized patient care and personal conflict management. The outcomes studied were hospital mortality and combined adverse events (death, stroke, acute myocardial infarction and acute renal failure), by using multivariate logistic regression analysis. Results:After establishment of such model, there was reduction of hospital mortality (from 12% to 3.6%, relative risk= 0.3; P=0.003) and combined events (from 22% to 15%, relative risk=0.68; P=0.11). Operations performed previously to the model were independently associated with higher mortality (OR=2.5; P=0.04), adjusted to preoperative characteristics and Euroscore risk stratification system. Rev Bras Cir Cardiovasc 2009; 24(2): 116-125 relevance, because they are the base of cardiovascular surgery programs of excellence [5]. Quality control programs aim at adequacy of hospitals units and professionals involved in order to provide the best possible medical care. With this, the influence of organizational factors in the surgical outcomes can be minimized, with only the team human error [6] and individual factors linked to the patient, such as, socioeconomic status, severity of the disease and its comorbidities [7,8].Although the literature is extremely important for the development of medical practice in various specialties, there are few publications aiming at hospital organizational aspect and its quality control. Little evidences correlates integrated measures for care to outcomes after heart surgery [9-11], which encourages broad discussion on the subject, considering the increasing transparency of the outcomes of medical procedures to the lay public [12] and the consequent tendency of payment based on parameters such as quality and performance [13].The aim of this study is to assess the short-term impact of the adoption of an organizational model of cardiovascular surgery service on the surgical outcomes.
Extracorporeal membrane oxygenation has been used to treat refractory hypoxemia in numerous clinical scenarios. The fundamental principles for the management of massive hemoptysis patients include protecting the airway and healthy lung, locating the source of bleeding and controlling the hemorrhage. We report the case of a patient with acute respiratory failure associated with massive hemoptysis secondary to lung laceration during cardiac surgery. The use of extracorporeal membrane oxygenation allowed patient survival. However, due to the great difficulty in managing pulmonary clots after hemoptysis, it was necessary to use an unusual therapy involving endobronchial infusion of a thrombolytic agent as described in rare cases in the literature.
Background Infection after cardiovascular surgery is multifactorial. We sought to determine whether the anthropometric profile influences the occurrence of infection after isolated coronary artery bypass grafting (CABG). Methods Between January 2011 and June 2016, 1777 consecutive adult patients were submitted to isolated coronary artery bypass grafting. Mean age was 61.7 ± 9.8 years and 1193 (67.1%) were males. Patients were divided into four groups according to the body mass index (BMI) classification: underweight (BMI < 18.5 kg/m2; N = 17, 0.9%), normal range (BMI: 18.5–24.99 kg/m2; N = 522, 29.4%), overweight (BMI: 25–29.99 kg/m2; N = 796, 44.8%), and obese (BMI > 30 kg/m2; N = 430, 24.2%). In‐hospital outcomes were compared and independent predictors of infection were obtained through multiple Poisson regression with a robust variation. Results Independent predictors of any infection morbidity were female sex (relative ratio [RR], 1.47; p = .002), age > 60 years (RR, 1.85; p < .0001), cardiopulmonary bypass > 120 min (RR, 1.89; p = .0007), preoperative myocardial infarction < 30 days (RR, 1.37; p = .01), diabetes mellitus (RR, 1.59; p = .0003), ejection fraction < 48% (RR, 2.12; p < .0001), and blood transfusion (RR, 1.55; p = .0008). Among other variables, obesity, as well as diabetes mellitus, were independent predictors of superficial and deep sternal wound infection. Conclusions Other factors rather than the anthropometric profile are more important in determining the occurrence of any infection after CABG. However, surgical site infection has occurred more frequently in obese patients. Appropriate patient selection, control of modifiable factors, and application of surgical bundles would minimize this important complication.
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