An audit of 545 consecutive cases of anaesthesia for
elective cardiac surgery was conducted for the purpose of quality assurance.
This comprised all elective cases up until the end of 2014 in which I was the
primary anaesthetist.
Outcomes of interest include the scope of operations for
which anaesthesia was provided, the usage of and complications from
trans-oesophageal echocardiography (TOE), and adverse outcomes, both major and
minor.
Scope of
surgery
Operation type
|
Freq.
|
Percent
|
|
|
|
Cabg
|
329
|
60.37
|
Avr +/- cabg
|
128
|
23.49
|
Mitral +/-cabg
|
36
|
6.61
|
Opcab
|
11
|
2.02
|
Other
|
12
|
2.20
|
Other valve
|
8
|
1.47
|
Redo cabg
|
9
|
1.65
|
Redo valve
|
12
|
2.20
|
|
|
|
Total
|
545
|
100.00
|
Other valve cases included tricusip and multiple valve
surgery. Other non valve cases included ASD closure, atrial myxoma and lipoma,
HOCM surgery, pericardiectomy on bypass, aortic root replacement and Bentall
procedure. Arrhythmia ablation was performed concomitantly in 3 cases.
Not included in this review are emergency cases for cabg or
dissection, cases such as pericardial window which did not use bypass,
take-backs, or combined AAA/cabg surgery. The cases that are included are those
which provide useful information for prospective patients about to undergo
elective cardiac surgery.
Adverse
outcomes
Death: Death within 24 hours of anaesthesia is a definition
which fails to capture the majority of anaesthesia-related deaths, so was not
used. Death within 30 days of surgery is a standard measure, but data for this
is not available to me. Failure to leave ICU alive was the most inclusive
definition for which I have reliable data. There were two cases – a patient who
died in ICU 4 days post-operatively with an IABP that had been placed before
surgery. A second patient also died in ICU more than 24 hours after surgery.
Other: There were no major airway, TOE, CVL or other
problems complications.
Summary
An audit of 545 consecutive cases of anaesthesia for
elective cardiac surgery was conducted for the purpose of quality assurance. This
information can be used to inform prospective patients about the performance of
this particular surgical unit. The audit is to be repeated once a total of 750 patients is reached.