La monitorización continua de la calidad de los resultados de la cirugía cardíaca / Continuous monitoring of cardiac surgery quality indicators

ABSTRACT

BACKGROUND AND OBJECTIVE: Although usage of variable life-adjusted display (VLAD) in medicine was proposed a decade ago, there is only little experience in mortality and morbidity monitoring with this method. The work objective was to study the utility of VLAD for continuous monitoring of cardiac surgery quality indicators. METHODS: A continuous monitoring of morbidity and mortality with VLADs, was performed in a prospective series of 502 cardiac surgeries. VLAD plots for mortality, reopening for bleeding, deep sternal wound infection, stroke, myocardial infarction and need for postoperative dialysis were done. Mortality was risk-adjusted with Euro-SCORE, while postoperative complications were adjusted with a morbidity risk score. Additionally, internal thoracic artery graft usage in coronary surgery was plotted. RESULTS: VLADs based on risk-adjusted morbidities and mortality could identify several clusters of adverse results, occurring at different periods of time, as well as its temporal relations. In the same way, it could be determined along the series, the net lives saved, the complications avoided and the internal thoracic artery graft usage. CONCLUSIONS: Continuous monitoring with VLAD plots would provide on-line control of cardiac surgery outcomes. This method would be, not only useful for mortality supervision, but to check risk-adjusted morbidity and to control other quality indicators, such as internal thoracic artery usage.