Abstract 20433: Prospective Peer Review Prior to Very-High-Risk Cardiac Surgery Improves In-Hospital Survival
Introduction: Quality improvement programs often improve outcome measures to national benchmark; however, their effectiveness to improve beyond national standards is less well established. We studied whether prospective peer review (PPR) of very-high-risk cardiac surgery patients improves mortality from accepted to highest-performance levels.
Methods: Predicted mortality >20% (very-high-risk) mandated committee review <12hrs that verified appropriateness and timing of surgery and discussed optimal care strategies before, during, and after operation. Predicted mortality of 15-19% (high-risk) or emergency patients obviated prospective review but had retrospective review.
Results: No patient was denied surgery as a result of PPR; the percentage of high- and very-high-risk patients remained the same in both periods (4.22% v. 4.15%, p=NS). Cath-to-OR times in the highest-risk cohort increased from 3.5 to 5.6 days (p=0.06). Trends in overall program mortality (table) and in CABG-only patients were favorable; CABG-only mortality decreased from 1.67% to 1.05% (p=0.25) below the STS predicted rate (1.5%), due to the mortality reduction in high-risk cohorts.
Conclusion: A quality improvement program of prospective peer review and collaboration prior to high-risk surgery lowers mortality substantially below predicted rates in high-risk cohorts and trends overall program mortality favorably. Longer cath-to-OR time suggests enhanced pre-op management is associated with the improved outcomes.
- © 2010 by American Heart Association, Inc.