Evaluating Phase of Care Mortality Analysis and Failure to Rescue in a Norwegian Cardiothoracic Surgery Clinic
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Background: Publication of patient care data has long been practiced in the cardiothoracic surgical environment, but traditional endpoints such as surgeon specific mortality data have been criticized and there has been a search for new methods. Two tools to categorize and present such data, namely Phase of Care Mortality Analysis (POCMA) and Failure to Rescue (FTR) have been introduced, but they have not been tested in a Scandinavian material. We wanted to investigate whether these tools could be used in a Norwegian material and at the same time increase the understanding of why patients die after cardiac surgery in our clinic. Methods: A group consisting of one medical student, one senior consultant in anesthesiology, one junior and one senior cardiothoracic surgeon scrutinized deaths within 30 days after cardiac surgery at the Department of Cardiothoracic surgery, St Olav’s University Hospital, Norway in the time period February 2012-October 2015 in line with the POCMAmethodology. We used the clinics internal register to identify patients and used the available written information from each patient course to carry out our analyses. We tried to decide whether each death was surgeon dependent, failure to rescue or a result of a multifactorial etiology, and we also evaluated the strength of our decisions in each case as high, medium or low. Results: We identified 51 deaths out of 2037 operations in our study period, giving an unadjusted mortality of 2.5%. We felt that we had identified the correct seminal event for each death with a high degree of certainty in 78% of the cases. 9 deaths were classified as surgeon dependent, 3 as FTR and 38 as multifactorial. Our results indicate that the surgeon is in most cases not responsible for the operative mortality. We found that most deaths had a multifactorial etiology, and that very few deaths were due to failure to rescue. Conclusion: We believe that POCMA- and FTR-analyses can be carried out if clinical data is well documented. The operating surgeon is in many cases not responsible for the operative mortality in patients undergoing heart surgery, but patients often die due to a multifactorial etiology.