Title

Variability in surgeons' perioperative practices may influence the incidence of low-output failure after coronary artery bypass grafting surgery.

Document Type

Article

Publication Date

9-1-2012

Journal Title

Circ Cardiovasc Qual Outcomes

MeSH Headings

Aged, Cardiac Output, Low, Cardiopulmonary Bypass, Cardiotonic Agents, Chi-Square Distribution, Clinical Competence, Coronary Artery Bypass, Female, Heart Failure, Humans, Incidence, Intra-Aortic Balloon Pumping, Logistic Models, Male, Middle Aged, Multivariate Analysis, New England, Perioperative Care, Practice Patterns, Physicians', Prospective Studies, Registries, Reoperation, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome

Abstract

BACKGROUND: Postoperative low-output failure (LOF) is an important contributor to morbidity and mortality after coronary artery bypass grafting surgery. We sought to understand which pre- and intra-operative factors contribute to postoperative LOF and to what degree the surgeon may influence rates of LOF.

METHODS AND RESULTS: We identified 11 838 patients undergoing nonemergent, isolated coronary artery bypass grafting surgery using cardiopulmonary bypass by 32 surgeons at 8 centers in northern New England from 2001 to 2009. Our cohort included patients with preoperative ejection fractions >40%. Patients with preoperative intraaortic balloon pumps were excluded. LOF was defined as the need for ≥2 inotropes at 48 hours, an intra- or post-operative intraaortic balloon pumps, or return to cardiopulmonary bypass (for hemodynamic reasons). Case volume varied across the 32 surgeons (limits, 80-766; median, 344). The overall rate of LOF was 4.3% (return to cardiopulmonary bypass, 2.6%; intraaortic balloon pumps, 1.0%; inotrope usage, 0.8%; combination, 1.0%). The predicted risk of LOF did not differ across surgeons, P=0.79, and the observed rates varied from 1.1% to 10.2%, P

CONCLUSIONS: Rates of LOF significantly varied across surgeons and could not be explained solely by patient case mix, suggesting that variability in perioperative practices influences risk of LOF.

ISSN

1941-7705

First Page

638

Last Page

644

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