Tim G Coulson1, Michael Bailey2, Christopher M Reid3, Lavinia Tran3, Daniel V Mullany4, Julian A Smith5, David Pilcher6. 1. Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: timcoulson@doctors.org.uk. 2. Australian and New Zealand Intensive Care Research Centre. 3. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. 4. Critical Care Research Group, University of Queensland, Brisbane, Australia. 5. Department of Surgery, Monash University, and Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia. 6. Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; ANZICS Centre for Outcome and Resource Evaluation, Melbourne, Australia.
Abstract
BACKGROUND: Quality of cardiac surgical care may vary between institutions. Mortality is low and large numbers are required to discriminate between hospitals. Measures other than mortality may provide better comparisons. OBJECTIVES: To develop and assess the Acute Risk Change for Cardiothoracic Admissions to Intensive Care (ARCTIC) index, a new performance measure for cardiothoracic admissions to intensive care units (ICUs). METHODS: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons database and Australian and New Zealand Intensive Care Society Adult Patient Database were linked. Logistic regression was used to generate a predicted risk of death first from preoperative data using the previously validated Allprocscore and second on admission to an ICU using Acute Physiology and Chronic Health Evaluation III score. Change in risk as a percentage (ARCTIC) was calculated for each patient. The validity of ARCTIC as a marker of quality was assessed by comparison with intraoperative variables and postoperative morbidity markers. RESULTS: Sixteen thousand six hundred eighty-seven patients at 21 hospitals from 2008 to 2011 were matched. An increase in ARCTIC score was associated with prolonged cardiopulmonary bypass time (P = .001), intraoperative blood product transfusion (P < .001), reoperation (P < .0001), postoperative renal failure (P < .0001), prolonged ventilation (P < .0001), and stroke (P = .001). CONCLUSIONS: The ARCTIC index is associated with known markers of perioperative performance and postoperative morbidity. It may be used as an overall marker of quality for cardiac surgery. Further work is required to assess ARCTIC as a method to discriminate between cardiac surgical units.
BACKGROUND: Quality of cardiac surgical care may vary between institutions. Mortality is low and large numbers are required to discriminate between hospitals. Measures other than mortality may provide better comparisons. OBJECTIVES: To develop and assess the Acute Risk Change for Cardiothoracic Admissions to Intensive Care (ARCTIC) index, a new performance measure for cardiothoracic admissions to intensive care units (ICUs). METHODS: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons database and Australian and New Zealand Intensive Care Society Adult Patient Database were linked. Logistic regression was used to generate a predicted risk of death first from preoperative data using the previously validated Allprocscore and second on admission to an ICU using Acute Physiology and Chronic Health Evaluation III score. Change in risk as a percentage (ARCTIC) was calculated for each patient. The validity of ARCTIC as a marker of quality was assessed by comparison with intraoperative variables and postoperative morbidity markers. RESULTS: Sixteen thousand six hundred eighty-seven patients at 21 hospitals from 2008 to 2011 were matched. An increase in ARCTIC score was associated with prolonged cardiopulmonary bypass time (P = .001), intraoperative blood product transfusion (P < .001), reoperation (P < .0001), postoperative renal failure (P < .0001), prolonged ventilation (P < .0001), and stroke (P = .001). CONCLUSIONS: The ARCTIC index is associated with known markers of perioperative performance and postoperative morbidity. It may be used as an overall marker of quality for cardiac surgery. Further work is required to assess ARCTIC as a method to discriminate between cardiac surgical units.
Authors: Salome Dell-Kuster; Nuno V Gomes; Larsa Gawria; Soheila Aghlmandi; Maame Aduse-Poku; Ian Bissett; Catherine Blanc; Christian Brandt; Richard B Ten Broek; Heinz R Bruppacher; Cillian Clancy; Paolo Delrio; Eloy Espin; Konstantinos Galanos-Demiris; I Ethem Gecim; Shahbaz Ghaffari; Olivier Gié; Barbara Goebel; Dieter Hahnloser; Friedrich Herbst; Ioannidis Orestis; Sonja Joller; Soojin Kang; Rocio Martín; Johannes Mayr; Sonja Meier; Jothi Murugesan; Deirdre Nally; Menekse Ozcelik; Ugo Pace; Michael Passeri; Simone Rabanser; Barbara Ranter; Daniela Rega; Paul F Ridgway; Camiel Rosman; Roger Schmid; Philippe Schumacher; Alejandro Solis-Pena; Laura Villarino; Dionisios Vrochides; Alexander Engel; Greg O'Grady; Benjamin Loveday; Luzius A Steiner; Harry Van Goor; Heiner C Bucher; Pierre-Alain Clavien; Philipp Kirchhoff; Rachel Rosenthal Journal: BMJ Date: 2020-08-25