An audit of 545 consecutive cases of anaesthesia for elective cardiac surgery

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.