title: Towards excellence in cardiac surgery: experience from a developing country.
abstract: OBJECTIVE
  The objective of this study is an attempt to measure the performance in terms of comparing results with a large internationally recognized database used as a benchmark.
  
  
  METHODS
  Cross-sectional (prospectively collected data analysed and compared retrospectively).
  
  
  METHODS
  Aga Khan University Hospital, Karachi, Pakistan.
  
  
  METHODS
  From January 2006 to December 2010, information of the 2198 CABGs performed at Aga Khan University Hospital (AKU) was collected prospectively. This included patient characteristics and specific intra- and post-operative outcomes and compared with findings from the American Society of Thoracic Surgeons' National Cardiac Database (STS-NCD).
  
  
  RESULTS
  There were more male patients in the AKU cohort and more diabetics. In AKU, more cases involved three or more grafts (85 vs. 78%), and in both groups, an internal mammary artery graft was used over 90% of the time. The overall 30-day mortality was 2.7% at AKU, compared with 1.5% in the STS-NCD data. AKU had a lower incidence of permanent stroke (0.5 vs. 1.2%), prolonged ventilation (10.5 vs. 11.0%), deep sternal wound infection (0.2 vs. 0.4%) and reoperation (4.0 vs. 4.7%). It had more cases of renal failure (5.4 vs. 3.6%). Readmission rates within 30 days were also less in AKU (3.9 vs. 9.1%).
  
  
  CONCLUSIONS
  The outcomes of this study compare very favourably with the benchmark (STS). This demonstrates that high level of quality care can be achieved in this part of the world.
authors.affiliation: Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Aamir
authors.initials: A
authors.lastname: Saifuddin
authors.affiliation: Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Syed
authors.initials: S
authors.lastname: Shahabuddin
authors.affiliation: Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Shazia
authors.initials: S
authors.lastname: Perveen
authors.affiliation: Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Shumaila
authors.initials: S
authors.lastname: Furnaz
authors.affiliation: Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Hasanat
authors.initials: H
authors.lastname: Sharif
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome
keywords: cardiac surgery; database; patient outcomes; quality improvement