The implementation of OPCAB surgery into clinical routine was accompanied by a quality
management including a standardized protocol for process management, online monitoring
and analysis of quality parameters and negative events.
Methods: The process protocol included following quality markers. Absence of: 1) death, 2)
MI, 3) TVR, 4) stroke, 5) new onset of dialysis. Markers were analyzed by means of
cummulative failure charts (CUSUM) during a periode of 8 months. Perioperative negative
events were summarized as an intraoperative disturbance score (range 0–6) and recorded
online during the process. Events are defined as: 1) significant ECG changes, new
onset of arrhythmia, significant decrease of arterial pressure, need of inotropic
medicaments.
Results: 116 Patients could be enrolled. Negative quality markers: Mortality 2/116 (1.72%)
MI 3/115 (2.58%) TVR 6/115 (5.17%) stroke 3/115 (2.58%) and dialysis 1/115 (0.86%)
(Fig. 1). Disturbance score: group I (range <1) 79/116 Patients (68%); group II (range
<4) 34/116 Patients (29%); group III (range 4 or more) 3/116 Patients (2%). The group
of patients with a disturbance score more than 1 showed a significant higher incidence
of negative events (Fig. 2). However, if compared with a matched on-pump control group
there was no significant difference regarding the chosen quality marker for outcome.
Fig. 1
Fig. 2
Conclusion: During implementation of a new surgical technique e.g. OPCAB into a institutional
program quality management is an important tool for evaluation and improvement of
outcome quality. Intraoperative workflow disturbance was strongly correlated with
negative outcome markers. Prevention from process disturbance guarentees a safe outcome
quality.
