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L. Henry Edmunds, Jr.
Robert M. Mentzer, Jr.
Shukri F. Khuri
Sidney Levitsky
Philippe Menasché
Frank W. Sellke
Richard D. Weisel
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Ann Thorac Surg 2001;72:S2267-S2270
© 2001 The Society of Thoracic Surgeons

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

Panel discussion: monitoring and improving patient safety during and following cardiac surgery

L. Henry Edmunds, Jr., MD, Robert M. Mentzer, Jr., MD, Shukri F. Khuri, MD, Sidney Levitsky, MD, Dennis T. Mangano, MD, PhD, Philippe Menasché, MD, Frank W. Sellke, MD, Richard D. Weisel, MD

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

Moderators: L. Henry Edmunds, Jr, MD, and Robert M. Mentzer, Jr, MD

Panelists: Shukri F. Khuri, MD, Sidney Levitsky, MD, Dennis T. Mangano, MD, PhD, Philippe Menasché, MD, Frank W. Sellke, MD, and Richard D. Weisel, MD

Outcomes in the assessment of myocardial injury

DR L. HENRY EDMUNDS, JR (Philadelphia, PA):

Doctor Mangano’s discussion of the presentation on outcomes left us with a lot of questions. We really don’t have good definitions of variables and outcomes. We do have a pretty good definition of death. We certainly don’t have a good definition of perioperative infarction, and variables like emergency surgery have different interpretations by different groups. In some hospitals it is "next day surgery," in other hospitals it is "any operating room now," and in others it is everything in between!

DR DENNIS MANGANO (San Francisco, CA):

Should we even be measuring nonfatal perioperative events in comparative studies, or should we be measuring more definitive end points at 6 months, such as death, the use of an intraaortic balloon pump, renal failure requiring dialysis, or hospitalization with stroke?

DR SIDNEY LEVITSKY (Boston, MA):

I think there is more or less universal agreement that operative mortality per se is not a good measure because, in good institutions, it is very low. A more meaningful measure is patient outcome at 1 year. This can be examined in Medicare patients using the federal computers in Washington, which give us a variety of important information. First, these computers allow us to assess the frequency of rehospitalization after discharge. For example, using these computers, we found at the Beth Israel Deaconess Hospital in Boston that 28% of our coronary artery bypass patients who had been discharged early had to be rehospitalized, mostly in different institutions. Rehospitalization within 1 year of surgery is easy to obtain on Medicare patients and, with the added . . . [Full Text of this Article]






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