Robich Michael P, Krafcik Brianna M, Shah Nishant K, Farber Alik, Rybin Denis, Siracuse Jeffrey J
Division of Cardiothoracic Surgery, Cardiovascular Institute, Maine Medical Center, Portland, ME, USA.
Department of Surgery Boston University, School of Medicine, Boston, MA, USA.
J Cardiovasc Surg (Torino). 2017 Oct;58(5):755-762. doi: 10.23736/S0021-9509.17.09866-4. Epub 2017 Mar 16.
This study was conducted to determine the risk factors, nature, and outcomes of "never events" following open adult cardiac surgical procedures. Understanding of these events can reduce their occurrence, and thereby improve patient care, quality metrics, and cost reduction.
"Never events" for patients included in the Nationwide Inpatient Sample who underwent coronary artery bypass graft, heart valve repair/replacement, or thoracic aneurysm repair between 2003-2011 were documented. These events included air embolism, catheter-based urinary tract infection (UTI), pressure ulcer, falls/trauma, blood incompatibility, vascular catheter infection, poor glucose control, foreign object retention, wrong site surgery and mediastinitis. Analysis included characterization of preoperative demographics, comorbidities and outcomes for patients sustaining never events, and multivariate analysis of predictive risk factors and outcomes.
A total of 588,417 patients meeting inclusion criteria were identified. Of these, never events occurred in 4377 cases. The majority of events were in-hospital falls, vascular catheter infections, and complications of poor glucose control. Rates of falls, catheter based UTIs, and glucose control complications increased between 2009-2011 as compared to 2003-2008. Analysis revealed increased hospital length of stay, hospital charges, and mortality in patients who suffered a never event as compared to those that did not.
This study establishes a baseline never event rate after cardiac surgery. Adverse patient outcomes and increased resource utilization resulting from never events emphasizes the need for quality improvement surrounding them. A better understanding of individual patient characteristics for those at risk can help in developing protocols to decrease occurrence rates.
本研究旨在确定成人心脏直视手术后“绝不允许发生的事件”的风险因素、性质和结果。了解这些事件可减少其发生，从而改善患者护理、质量指标并降低成本。
记录2003年至2011年间在全国住院患者样本中接受冠状动脉搭桥术、心脏瓣膜修复/置换或胸主动脉瘤修复的患者发生的“绝不允许发生的事件”。这些事件包括空气栓塞、导管相关性尿路感染（UTI）、压疮、跌倒/创伤、血型不合、血管导管感染、血糖控制不佳、异物残留、手术部位错误和纵隔炎。分析包括对发生“绝不允许发生的事件”的患者的术前人口统计学特征、合并症和结果进行描述，以及对预测风险因素和结果进行多变量分析。
共确定了588417名符合纳入标准的患者。其中，4377例发生了“绝不允许发生的事件”。大多数事件为院内跌倒、血管导管感染和血糖控制不佳的并发症。与2003年至2008年相比，2009年至2011年期间跌倒、导管相关性UTI和血糖控制并发症的发生率有所增加。分析显示，发生“绝不允许发生的事件”的患者与未发生此类事件的患者相比，住院时间延长、住院费用增加且死亡率更高。
本研究确定了心脏手术后“绝不允许发生的事件”的基线发生率。“绝不允许发生的事件”导致的不良患者结局和资源利用增加强调了围绕这些事件进行质量改进的必要性。更好地了解高危患者的个体特征有助于制定降低发生率的方案。
