Six years of cardiac database management: the impact on clinical practice

Abstract

Background/introduction Cardiothoracic surgery quality improvement is a core value of healthcare provision. In order to improve quality of care, information on key indicators needs to be systematically collected and maintained.In 2006, the cardiothoracic department at Aga Khan University developed an infrastructure that would enable us to answer the more challenging research queries in cardiac surgery practice. The resulting electronic cardiothoracic database is based on the European Association of Cardiothoracic Surgeons database and the Society of Thoracic Surgeons database.While, it is currently used only at Aga Khan University, it has the potential to become a multicenter database. Objective To assess the impact of database development and maintenance on clinical practice and quality of care. Methods We chose the following aspects of patient care to be included in the database form: pre-surgery patient condition and medications, anesthesia information, perfusion information, surgery information, recovery information, status of the patient at discharge, 30-days and 365-days post-surgery follow-up information. Information was collected through structured questionnaire by trained data abstractor and entered into Microsoft Access software. On the basis of research hypotheses, specific data chunk was extracted and analyzed in SPSS (Statistical Package of Social Sciences) software. Results From January 2006 to May 2011, there was 3418 open heart surgeries performed. Out of them, 69.63% were isolated coronary artery bypass grafting, 10.7% were isolated valve, 2.3% were valve and coronary artery bypass grafting, 15.9% were other cardiac procedures, and 1.46% was combination of cardiac procedures. The overall 30-day mortality was 3.6%. Post-surgery morbidity was 21.5%, which includes 3.6% reoperation for bleeding, 0.6% neurological, 0.7% dialysis, 1.3% heart failure, 0.3% septicemia, 1.8% prolonged ventilation, 8.6% multiorgan failure and 0.9% respiratory complications, 1.7% cardiac arrest, 1.1% deep sterna wound infection, 0.1% Follow up at 30-days patients alive were 91.6% death, 0.1% lost to follow-up, 3.6%and 365-days showed that alive, 93.2% death, 2.1% lost to follow up, 4.6%. Impact in clinical practice. Before this database, there was no way to monitor mortality and morbidity. Fortunately, with the development of database, post-surgery mortality and morbidity rates could easily be generated. It helped in development of strict enforcement of protocol to reduce the mortality and morbidity rates. It also helped in controlling preventable post-surgery complications. It also helps in identification of a gap in patient knowledge regarding the use of warfarin after heart valve surgery and deficiencies in laboratory capabilities,both causing catastrophic complications. As a result, we modified our practice in an effort to address these issues and reduce the complication rates after heart valve surgery. Furthermore, identification of the need to quantify the mid-term functional status of in-person and telephonic interview, resulting in the development of a questionnaire that has been added to our protocol one-year post-surgery. Way forward More meticulous record keeping, including long-term follow-up for five years will be collected. In addition to this, the development of a separate congenital/pediatrics cardiac surgery database will also be developed. Conclusion Updated and stringently maintained database helps to identify deficiencies in practice and provides a direction for future improvement.