Heart surgery carries a risk of death that can be calculated before the operation. This risk is dependent on patient factors (such as age and other illnesses) and the operation itself. After heart surgery, all patients go to the intensive care unit (ICU). Events that occur intraoperatively affect how unwell they are in ICU. Acute Risk Change (ARC) is calculated by subtracting the percentage risk of death preoperatively from the postoperative risk in ICU. If the risk goes up (high ARC) then this suggests performance may have been poor in the operation. As such, ARC is a measure of ‘unwellness’ compared to expectations. We have previously shown that ARC can identify outlier units, is associated with adverse events, morbidity and long term mortality. The basis of this project will therefore be to: 1) Determine the most appropriate ICU risk score to calculate the postoperative risk of death after cardiac surgery (ANZROD, APACHE etc) 2) Determine whether the preoperative risk score is accurate enough, or requires recalibration 3) Assess recent combined databases for surgical outliers (individuals and hospitals) This project will run in conjunction with a prospective analysis.
cardiac surgery; quality and safety; outliers; mortality risk
School of Public Health and Preventive Medicine
Alfred Centre, The Alfred Hospital