title: Quality improvement program decreases mortality after cardiac surgery.
abstract: OBJECTIVE
  This study investigated the effects of a quality improvement program and goal-oriented, multidisciplinary protocols on mortality after cardiac surgery.
  
  
  METHODS
  Patients were divided into two groups: those undergoing surgery (coronary artery bypass grafting, isolated valve surgery, or coronary artery bypass grafting and valve surgery) after establishment of the multidisciplinary quality improvement program (January 2005-December 2006, n = 922) and those undergoing surgery before institution of the program (January 2002-December 2003, n = 1289). Logistic regression and propensity score analysis were used to adjust for imbalances in patients' preoperative characteristics.
  
  
  RESULTS
  Operative mortality was lower in the quality improvement group (2.6% vs 5.0%, P < .01). Unadjusted odds ratio was 0.5 (95% confidence interval 0.3-0.8, P < .01); propensity score-adjusted odds ratio was 0.6 (95% confidence interval 0.4-0.99, P = .04). In multivariable analysis, diabetes (P < .01), chronic renal insufficiency (P = .05), previous cardiovascular operation (P = .04), congestive heart failure (P < .01), unstable angina (P < .01), age older than 75 years (P < .01), prolonged pump time (P < .01), and prolonged operation (P = .05) emerged as independent predictors of higher mortality after cardiac surgery, whereas quality improvement program (P < .01) and male sex (P = .03) were associated with lower mortality. Mortality decline was less pronounced in patients with than without diabetes (P = .04).
  
  
  CONCLUSIONS
  Application of goal-directed, multidisciplinary protocols and a quality improvement program were associated with lower mortality after cardiac surgery. This decline was less prominent in patients with diabetes, and focused quality improvement protocols may be required for this subset of patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Carolinas Heart Institute, Carolinas Medical Center, Charlotte, NC 28203, USA.
authors.forename: Sotiris C
authors.initials: SC
authors.lastname: Stamou
authors.forename: Sara L
authors.initials: SL
authors.lastname: Camp
authors.forename: Robert M
authors.initials: RM
authors.lastname: Stiegel
authors.forename: Mark K
authors.initials: MK
authors.lastname: Reames
authors.forename: Eric
authors.initials: E
authors.lastname: Skipper
authors.forename: Larry T
authors.initials: LT
authors.lastname: Watts
authors.forename: Marcy
authors.initials: M
authors.lastname: Nussbaum
authors.forename: Francis
authors.initials: F
authors.lastname: Robicsek
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lobdell
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000401:mortality; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006351:Heart Valves / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care