Resultados Imediatos após Múltiplos Enxertos Arteriais em Cirurgia de Revascularização Miocárdica no Estado de São Paulo: Estudo de Coorte

Paredes, Raúl Armando Micalay; Borgomoni, Gabrielle Barbosa; Micalay, Anny Kátia Puchalski; Camacho, José Carlos Arteaga; Dallan, Luís Roberto Palma; Lisboa, Luiz Augusto Ferreira; Dallan, Luís Alberto Oliveira; Mejía, Omar Asdrúbal Vilca

doi:10.36660/abc.20220627

Arquivos Brasileiros De Cardiologia

2023

DOI: 10.36660/abc.20220627

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Resultados Imediatos após Múltiplos Enxertos Arteriais em Cirurgia de Revascularização Miocárdica no Estado de São Paulo: Estudo de Coorte

Raúl Armando Micalay Paredes¹,

Gabrielle Barbosa Borgomoni²,

Anny Kátia Puchalski Micalay³

et al.

Abstract: Fundamento: Os resultados a curto prazo após o uso de enxertos arteriais ainda suscitam questionamentos e dúvidas na sociedade médica. Objetivo: Comparar os resultados imediatos de pacientes submetidos à cirurgia de revascularização do miocárdio com enxerto arterial único versus enxertos arteriais múltiplos. Métodos: Estudo de coorte transversal no Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II). Os dados perioperatórios de 3122 pacientes foram agrupados pelo número de enxertos arteriais utiliza… Show more

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2024

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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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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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Resultados Imediatos após Múltiplos Enxertos Arteriais em Cirurgia de Revascularização Miocárdica no Estado de São Paulo: Estudo de Coorte

Cited by 1 publication

References 24 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

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