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

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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


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.



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