Teams, Rapid Recovery Protocols and Technology to Resume Cardiac Surgery in the COVID-19 Era

Lima, Mariana Kabakura do Amaral; Borgomoni, Gabrielle Barbosa; Mejía, Omar Asdrúbal Vilca

doi:10.21470/1678-9741-2021-0035

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Given the budgetary restriction imposed by the pandemics, a significant backlog on the waiting list for cardiac surgery is expected in the near-to-medium term and with the potential for increased mortality in this population [ 25 ] .…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

Gomes¹,

Rocco²,

Pimentel³

et al. 2021

Braz J Cardiovasc Surg

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Introduction We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

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Section: Discussionmentioning

confidence: 99%

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

Gomes¹,

Rocco²,

Pimentel³

et al. 2021

Braz J Cardiovasc Surg

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“…The second REPLICCAR project had two objectives: upgrading our data collection for a quality registry 16 and creating training strategies for better surgical outcomes based on the data collected during the before-implementation phase. Based on the data, the committee decided to provide training to hospital teams in nontechnical subjects: root cause analysis of mortality with POCMA 41 , glycemic control 19 , blood management 36 , 37 , 42 , ERAS protocol timing optimization 22 , 43 , 44 , reduction of failure to rescue 45 , 46 , and orientation based on surgical coaching for artery dissection and use of arterial grafts 47 – 49 .…”

Section: Discussionmentioning

confidence: 99%

Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study

Mejia,

Borgomoni,

de Freitas

et al. 2024

International Journal of Surgery

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Background: The impact of quality improvement initiatives Program (QIP) on coronary artery bypass grafting surgery (CABG) remains scarce, despite improved outcomes in other surgical areas. This study aims to evaluate the impact of a package of QIP on mortality rates among patients undergoing CABG. Materials and methods: This prospective cohort study utilized data from the multicenter database Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II), spanning from July 2017 to June 2019. Data from 4,018 isolated CABG adult patients were collected and analyzed in three phases: before-implementation, implementation, and after-implementation of the intervention (which comprised QIP training for the hospital team). Propensity Score Matching was used to balance the groups of 2,170 patients each for a comparative analysis of the following outcomes: reoperation, deep sternal wound infection/mediastinitis ≤ 30 days, cerebrovascular accident, acute kidney injury, ventilation time>24 hours, length of stay<6 days, length of stay>14 days, morbidity and mortality, and operative mortality. A multiple regression model was constructed to predict mortality outcomes. Results: Following implementation, there was a significant reduction of operative mortality (61.7%, P=0.046), as well as deep sternal wound infection/mediastinitis (P<0.001), sepsis (P=0.002), ventilation time in hours (P<0.001), prolonged ventilation time (P=0.009), postoperative peak blood glucose (P<0.001), total length of hospital stay (P<0.001). Additionally, there was a greater use of arterial grafts, including internal thoracic (P<0.001) and radial (P=0.038), along with a higher rate of skeletonized dissection of the internal thoracic artery. Conclusions: QIP was associated with a 61.7% reduction in operative mortality following CABG. Although not all complications exhibited a decline, the reduction in mortality suggests a possible decrease in failure to rescue during the after-implementation period.

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Ambulatory Electrocardiography Monitoring for Early Discharge After Minimally Invasive Valve Surgery

Laraia,

Pepe,

Sabatino

et al. 2023

Journal of Surgical Research

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Teams, Rapid Recovery Protocols and Technology to Resume Cardiac Surgery in the COVID-19 Era

Cited by 3 publications

References 13 publications

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience

Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study

Ambulatory Electrocardiography Monitoring for Early Discharge After Minimally Invasive Valve Surgery

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