title: Outcome improvement and cost reduction in an increasingly morbid cardiac surgery population.
abstract: Two studies assessed initiatives to improve the quality and the cost-effectiveness of cardiac surgery. The first evaluated a system for access and stabilization (SAS), with coronary stabilization, and a clinical effectiveness quality initiative (CEQI) in off-pump coronary artery bypass grafting. The SAS + CEQI cohort showed significantly lower mortality, a lower percentage of patients requiring prolonged ventilation, and a shorter mean postoperative length of hospital stay than the pre-SAS cohort who underwent on-pump coronary artery bypass grafting. The second study assessed the potential for noninvasive cerebral oximetry to reduce strokes related to all cardiac surgery by optimizing cerebral oxygen delivery. The incidence of permanent stroke was significantly lower in the cerebral oximetry group than in an earlier control group in which cerebral oximetry was not used, despite the fact that the study group had a significantly greater number of patients in New York Heart Association classes III and IV. The proportion of patients requiring prolonged ventilation was significantly lower, and the length of postoperative hospital stay was significantly shorter in the study group than in the control group. The incidence of cerebrovascular accident in the study group was 0.97%, compared with 2.03% in the controls. This translated to a potential avoidance of 12 cerebrovascular accidents and approximately $254,214 in direct costs and more than $425,000 in total costs. The results show that specific measures can improve outcomes and reduce costs in cardiac surgery. Therefore, the use of a clinical effectiveness quality initiative and cerebral oximetry in all cardiac surgery, with the SAS system for off-pump surgery, should be advocated.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Lankenau Hospital and Institute for Medical Research, Main Line Health Heart Center, Wynnewood, PA, USA. goldman@mlhs.org
authors.forename: Scott M
authors.initials: SM
authors.lastname: Goldman
authors.forename: Francis P
authors.initials: FP
authors.lastname: Sutter
authors.forename: Mary Ann C
authors.initials: MA
authors.lastname: Wertan
authors.forename: Francis D
authors.initials: FD
authors.lastname: Ferdinand
authors.forename: Candace L
authors.initials: CL
authors.lastname: Trace
authors.forename: Louis E
authors.initials: LE
authors.lastname: Samuels
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000191:economics; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D009017:Morbidity; D010092:Oximetry / Q000191:economics*; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000191:economics; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome