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

Mejía, Omar Asdrúbal Vilca; Borgomoni, Gabrielle Barbosa; Dallan, Luís Roberto Palma; Mioto, Bruno Mahler; Accorsi, Tarso Augusto Duenhas; Lima, Eduardo Gomes; Soeiro, Alexandre de Matos; Lima, Felipe Gallego; Brandão, Carlos Manuel de Almeida; Pomerantzeff, Pablo Maria Alberto; Dallan, Luís Alberto; Lisboa, Luiz Augusto Ferreira; Jatene, Fábio Biscegli

doi:10.1016/j.ijsu.2022.106931

Cited by 6 publications

(5 citation statements)

References 35 publications

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“…Our research group collaborated in establishing the pioneering REPLICCAR database 34 , 35 in Brazil. This initiative has brought the first reports on the implementation of quality initiatives in our setting 36 – 39 . Participating centers in REPLICCAR embraced quality programs, including the largest public hospital for cardiac surgeries in a developing country, which achieved a significant reduction in mortality, and a private hospital that achieved a significant reduction in hospitalization times 28 , 40 .…”

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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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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“…227 • Em um estudo para avaliar o impacto de um programa de melhoria da qualidade na mortalidade hospitalar em um centro de cirurgia cardiovascular em São Paulo, com pacientes operados antes e depois da implementação do programa (858 em cada grupo), entre outros benefícios, houve redução na FA no pós-operatório de 4,4% para 1,5%, p<0,0001. 228 Fibrilação atrial e doença de Chagas…”

Section: Fibrilação Atrial Peroperatória E Cirurgia Cardiovascularunclassified

“…•In a study to assess the impact of a quality improvement program on in-hospital mortality in a cardiovascular surgery center in São Paulo, with patients operated before and after the implementation of that program (858 patients in each group), among other benefits, there was a reduction in postoperative AF from 4.4% to 1.5%, p<0.0001. 228 …”

Section: Chapter 6 – Atrial Fibrillation and Atrial Fluttermentioning

confidence: 99%

Estatística Cardiovascular – Brasil 2023

Oliveira,

Brant,

Polanczyk

et al. 2024

Arquivos Brasileiros De Cardiologia

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“…14 Exemplos mais recentes, como o modelo do cuidado perfeito "Perfect Care" mostrou redução de 37% do custo, mantendo a qualidade do atendimento, quanto mais aderência às métricas de geração de valor. 15 Na América Latina, exemplos iniciais de geração de valor em cirurgia cardiovascular mostraram uma redução da mortalidade, após o estabelecimento de métricas e a formação de núcleos de excêlencia 16 e, por outro lado, uma diminuição significativa dos tempos de internação de forma segura e efetiva. 17 Dentro disto, a diretriz do ERAS (Enhanced Recovery After Surgery) para cirurgia cardíaca publicada em 2019, 18 consolidou um novo conceito que se fortificou após a chegada da COVID-19.…”

Section: Lily Tomlinunclassified

“…14 More recent examples, such as the Perfect Care approach, showed a 37% cost reduction, maintaining the quality of care when adherence to value creation metrics was higher. 15 In Latin America, initial examples of value creation in cardiovascular surgery showed a reduction in mortality after establishing metrics and forming centers of excellence 16 and, simultaneously, a significant decrease in the length of hospital stay in a safe and effective way. 17 …”

mentioning

confidence: 99%

Do Volume para a Geração de Valor em Cirurgia Cardíaca: O que Falta para Dar a Largada no Brasil?

Mejía¹,

Jatene²

2023

Arquivos Brasileiros De Cardiologia

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

Cited by 6 publications

References 35 publications

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

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

Estatística Cardiovascular – Brasil 2023

Do Volume para a Geração de Valor em Cirurgia Cardíaca: O que Falta para Dar a Largada no Brasil?

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