Wednesday, 21 August 2013

FIASCO - Never Events in Cardiac Surgery

The main reason why cardiac surgeons were the first to publish meaningful surgical outcomes is the ability for them to risk stratify each individual patient about to undergo heart surgery.  In other words, it is possible to state the risk of that particular patient dying or even more usefully to state what the predicted death rate for a group of patients is. This can than be compared to the actual death or mortality rate. Using this data, it is possible therefore to correct for the fact that certain surgeons operate on higher risk patients than others. In In this novel study entitled FIASCO, Nashef et al from Papworth Hospital examined the deaths of patients who had very low risk scores - i.e. they were not expected to die. As expected the mortality rate was very low and the individual circumstances surrounding each death were different from those discovered when a similar analysis was made several years ago - evidence that the team was learning.
This exercise is immensely useful to me in my cardiac surgical practice. In my opinion every death should reviewed at an M&M (Morbidity and Mortality) meeting. But what this study has added is that every death of a 'low risk' patient (and low risk is easily defined in cardiac surgery) should be classed as a never event and investigated fully with all the resources an institute has at its disposal.