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摘要
Objectives: Precursor events are undesirable events that can lead to a subsequent adverse event and have been associated with postoperative mortality. The purpose of the present study was to determine whether precursor events are associated with a composite endpoint of major adverse cardiac events (MACE) (death, acute renal failure, stroke, infection) in a low- to medium-risk coronary artery bypass grafting, valve, and valve plus coronary artery bypass grafting population. These events might be targets for strategies aimed at quality improvement. %26lt;br%26gt;Methods: The present study was a retrospective cohort design performed at the Queen Elizabeth Health Science Centre. Low-to medium-risk patients who had experienced postoperative MACE were matched 1:1 with patients who had not experienced postoperative MACE. The operative notes, for both groups, were scored by 5 surgeons to determine the frequency of 4 precursor events: bleeding, difficulty weaning from cardiopulmonary bypass, repair or regrafting, and incomplete revascularization or repair. A univariate comparison of %26gt;= 1 precursor events in the matched groups was performed. %26lt;br%26gt;Results: A total of 311 MACE patients (98.4%) were matched. The primary outcome occurred more frequently in the MACE group than in the non-MACE group (33% vs 24%; P = .015). The incidence of the individual events of bleeding and difficulty weaning from cardiopulmonary bypass was significantly higher in the MACE group. Those patients with a precursor event in the absence of MACE also appeared to have a greater prevalence of other important postoperative outcomes. %26lt;br%26gt;Conclusions: Patients undergoing cardiac surgery who are exposed to intraoperative precursor events were more likely to experience a postoperative MACE. Quality improvement techniques aimed at mitigating the consequences of precursor events might improve the surgical outcomes for cardiac surgical patients.
- 出版日期2014-5
