AI Article Synopsis
- A significant drop in neurologic complications in cardiac surgery patients was observed after the implementation of new management protocols in 2003, following a high incidence in 2001.
- The quality improvement program included updated surgical guidelines and better postoperative care to enhance patient outcomes.
- As a result, not only did neurologic complications and ICU mortality rates decrease, but the length of ICU stays also shortened, showcasing the effectiveness of these interventions.
Article Abstract
Objective: A high incidence of neurologic complications was observed in the year 2001 in cardiac surgical patients in this department. This article attempts to show the impact of changing and optimizing management protocols on the incidence of neurologic morbidity after cardiac surgery.
Design: An observational study of cardiac surgical patients.
Setting: University hospital.
Participants: All cardiac surgical patients treated postoperatively in the cardiac surgical ICU in 2001 (n = 1,165, control group) and in 2003 (n = 1,222, intervention group) were evaluated.
Interventions: A quality improvement program started at the beginning of 2002, based on the Task Force Committee Guidelines, included surgical and cardiopulmonary bypass recommendations as well as peri- and postoperative care (eg, use of epiaortic echo and strict perfusion protocol, avoidance of hyperthermia and hyperglycemia, and minimization of cerebral edema).
Results: The number of neurologic complications decreased from 78 (6.7%) in 2001 to 33 (2.7%) in 2003 (p < 0.01), and corresponding numbers for ICU mortality were 44 (3.8%) and 24 (2.0%) (p < 0.01). The length of ICU stay also decreased (3.2 +/- 4.5 days in 2001 v 2.9 +/- 5.5 days in 2003, p < 0.001). In 2001, patients with neurologic complications consumed 853 ICU patient days (23% of all ICU patient days) and, in 2003, 549 (15% of all ICU patient days). According to logistic regression analysis that included 11 independent variables (treatment year, EuroSCORE, diabetes mellitus, history of stroke, and 7 different types of surgery), treatment in 2003 was independently associated with decreased risk for neurologic complications (odds ratio 0.30, 95% confidence intervals 0.19-0.47, p < 0.001).
Conclusions: The occurrences of neurologic complications, mortality, and ICU resource consumption by this patient group decreased after implementation of an optimized management protocol and evidence-based guidelines.
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| http://dx.doi.org/10.1053/j.jvca.2006.12.019 | DOI Listing |
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