Most deaths in low-risk cardiac surgery could be avoidable

Abstract It is observed that death rates in cardiac surgery has decreased, however, root causes that behave like triggers of potentially avoidable deaths (AD), especially in low-risk patients (less bias) are often unknown and underexplored, Phase of Care Mortality Analysis (POCMA) can be a valuable...

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Autores principales:	Omar Asdrúbal Vilca Mejia, Gabrielle Barbosa Borgomoni, Eduardo Gomes Lima, Gustavo Pampolha Guerreiro, Luís Roberto Dallan, Pedro de Barros e Silva, Marcelo Arruda Nakazone, Orlando Petrucci Junior, Walter José Gomes, Marco Antonio Praça de Oliveira, Alexandre Sousa, Valquíria Pelisser Campagnucci, Marcos Gradim Tiveron, Alfredo José Rodrigues, Rafael Ângelo Tineli, Roberto Rocha e Silva, Luiz Augusto Ferreira Lisboa, Fabio Biscegli Jatene
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8f79c469ae6b4df0b97f6de86a231d57
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spelling	oai:doaj.org-article:8f79c469ae6b4df0b97f6de86a231d572021-12-02T14:12:47ZMost deaths in low-risk cardiac surgery could be avoidable10.1038/s41598-020-80175-72045-2322https://doaj.org/article/8f79c469ae6b4df0b97f6de86a231d572021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-80175-7https://doaj.org/toc/2045-2322Abstract It is observed that death rates in cardiac surgery has decreased, however, root causes that behave like triggers of potentially avoidable deaths (AD), especially in low-risk patients (less bias) are often unknown and underexplored, Phase of Care Mortality Analysis (POCMA) can be a valuable tool to identify seminal events (SE), providing valuable information where it is possible to make improvements in the quality and safety of future procedures. Our results show that in São Paul State, only one third of AD in low-risk cardiac surgery was related to specific surgical problems. After a revisited analysis, 75% of deaths could have been avoided, which in the pre-operative phase, the SE was related judgment, patient evaluation and preparation. In the intra-operative phase, most occurrences could have been avoided if other surgical technique had been used. Sepsis was responsible for 75% of AD in the intensive care unit. In the ward phase, the recognition/management of clinical decompensations and sepsis were the contributing factors. Logistic regression model identified age, previous coronary stent implantation, coronary artery bypass grafting + heart valve surgery, ≥ 2 combined heart valve surgery and hospital-acquired infection as independent predictors of AD.Omar Asdrúbal Vilca MejiaGabrielle Barbosa BorgomoniEduardo Gomes LimaGustavo Pampolha GuerreiroLuís Roberto DallanPedro de Barros e SilvaMarcelo Arruda NakazoneOrlando Petrucci JuniorWalter José GomesMarco Antonio Praça de OliveiraAlexandre SousaValquíria Pelisser CampagnucciMarcos Gradim TiveronAlfredo José RodriguesRafael Ângelo TineliRoberto Rocha e SilvaLuiz Augusto Ferreira LisboaFabio Biscegli JateneNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Omar Asdrúbal Vilca Mejia Gabrielle Barbosa Borgomoni Eduardo Gomes Lima Gustavo Pampolha Guerreiro Luís Roberto Dallan Pedro de Barros e Silva Marcelo Arruda Nakazone Orlando Petrucci Junior Walter José Gomes Marco Antonio Praça de Oliveira Alexandre Sousa Valquíria Pelisser Campagnucci Marcos Gradim Tiveron Alfredo José Rodrigues Rafael Ângelo Tineli Roberto Rocha e Silva Luiz Augusto Ferreira Lisboa Fabio Biscegli Jatene Most deaths in low-risk cardiac surgery could be avoidable
description	Abstract It is observed that death rates in cardiac surgery has decreased, however, root causes that behave like triggers of potentially avoidable deaths (AD), especially in low-risk patients (less bias) are often unknown and underexplored, Phase of Care Mortality Analysis (POCMA) can be a valuable tool to identify seminal events (SE), providing valuable information where it is possible to make improvements in the quality and safety of future procedures. Our results show that in São Paul State, only one third of AD in low-risk cardiac surgery was related to specific surgical problems. After a revisited analysis, 75% of deaths could have been avoided, which in the pre-operative phase, the SE was related judgment, patient evaluation and preparation. In the intra-operative phase, most occurrences could have been avoided if other surgical technique had been used. Sepsis was responsible for 75% of AD in the intensive care unit. In the ward phase, the recognition/management of clinical decompensations and sepsis were the contributing factors. Logistic regression model identified age, previous coronary stent implantation, coronary artery bypass grafting + heart valve surgery, ≥ 2 combined heart valve surgery and hospital-acquired infection as independent predictors of AD.
format	article
author	Omar Asdrúbal Vilca Mejia Gabrielle Barbosa Borgomoni Eduardo Gomes Lima Gustavo Pampolha Guerreiro Luís Roberto Dallan Pedro de Barros e Silva Marcelo Arruda Nakazone Orlando Petrucci Junior Walter José Gomes Marco Antonio Praça de Oliveira Alexandre Sousa Valquíria Pelisser Campagnucci Marcos Gradim Tiveron Alfredo José Rodrigues Rafael Ângelo Tineli Roberto Rocha e Silva Luiz Augusto Ferreira Lisboa Fabio Biscegli Jatene
author_facet	Omar Asdrúbal Vilca Mejia Gabrielle Barbosa Borgomoni Eduardo Gomes Lima Gustavo Pampolha Guerreiro Luís Roberto Dallan Pedro de Barros e Silva Marcelo Arruda Nakazone Orlando Petrucci Junior Walter José Gomes Marco Antonio Praça de Oliveira Alexandre Sousa Valquíria Pelisser Campagnucci Marcos Gradim Tiveron Alfredo José Rodrigues Rafael Ângelo Tineli Roberto Rocha e Silva Luiz Augusto Ferreira Lisboa Fabio Biscegli Jatene
author_sort	Omar Asdrúbal Vilca Mejia
title	Most deaths in low-risk cardiac surgery could be avoidable
title_short	Most deaths in low-risk cardiac surgery could be avoidable
title_full	Most deaths in low-risk cardiac surgery could be avoidable
title_fullStr	Most deaths in low-risk cardiac surgery could be avoidable
title_full_unstemmed	Most deaths in low-risk cardiac surgery could be avoidable
title_sort	most deaths in low-risk cardiac surgery could be avoidable
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/8f79c469ae6b4df0b97f6de86a231d57
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Most deaths in low-risk cardiac surgery could be avoidable

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