HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Shukri F. Khuri Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Khuri, S. F. Search for Related Content PubMed PubMed Citation Articles by Khuri, S. F. Related Collections Myocardial protection

Ann Thorac Surg 2001;72:S2205-S2207
© 2001 The Society of Thoracic Surgeons

---

Supplement: Monitoring and improving patient safety during and following cardiac surgery

Evidence, sources, and assessment of injury during and following cardiac surgery

^a VA Boston Healthcare System, West Roxbury, Massachusetts, USA

* Address reprint requests to Dr Khuri, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
e-mail: shukri.khuri@med.va.gov

Presented at Monitoring and Improving Patient Safety During and Following Cardiac Surgery, San Diego, CA, May 5, 2001.

In health care today, there is increasing concern about patient safety, particularly in light of the report published in 1999 by the National Academy of Science’s Institute of Medicine [1]. The report estimated that iatrogenic injury in the United States accounted for more than 98,000 deaths per year—more than suicides, highway accidents, breast cancer, or AIDS. Safety has been defined in the dictionary as "the state of being safe; freedom from danger or injury." Cardiac surgery is a major potential source of injury because of its complexity and the wide variation in severity of illness of the patients who undergo it.

Evidence of patient injury in cardiac surgery

Many cardiac surgeons have lulled themselves into believing that they perform safe surgery because the 30-day postoperative mortality rate in a large subset of their patients is very low. A live patient brought to cardiac surgery should come out of it at least in the same condition that he or she was brought into it. The mere fact that an operative mortality or morbidity is encountered in such a patient is an indication that some form of injury had been sustained in the course of the operation. In fact there are many indications that cardiac surgery is a major potential cause of patient injury, as discussed below.

First, despite relatively low 30-day mortality rates following cardiac surgery in general, the mortality and morbidity rates remain unacceptably high in relatively large subsets of patients undergoing cardiac surgery. The Platelet Glycoprotein IIb–IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial, which comprised 10,948 patients, recently reported the outcomes of 1,558 study patients who underwent in-hospital coronary artery bypass grafting (CABG) because of non–ST-segment elevation acute coronary syndrome. The 30-day postoperative mortality in the 692 patients who comprised the placebo group was 5.8%. The rate of 30-day postoperative myocardial . . . [Full Text of this Article]

This article has been cited by other articles:

				E. Gongora and T. M. Sundt III Myocardial Revascularization with Cardiopulmonary Bypass Card. Surg. Adult, January 1, 2008; 3(2008): 599 - 632. [Full Text]

				S. Matsushita, Y. Sakakibara, T. Imazuru, M. Noma, Y. Hiramatsu, O. Shigeta, T. Jikuya, and T. Mitsui High-frequency QRS potentials as a marker of myocardial dysfunction after cardiac surgery Ann. Thorac. Surg., April 1, 2004; 77(4): 1293 - 1297. [Abstract] [Full Text] [PDF]

				H. S. Thatte, J.-H. Rhee, S. E. Zagarins, P. R. Treanor, V. Birjiniuk, M. D. Crittenden, and S. F. Khuri Acidosis-induced apoptosis in human and porcine heart Ann. Thorac. Surg., April 1, 2004; 77(4): 1376 - 1383. [Abstract] [Full Text] [PDF]