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Improved neurologic outcome after implementing evidence-based guidelines for cardiac surgery.

OBJECTIVE
A high incidence of neurologic complications was observed in the year 2001 in cardiac surgical patients in this department. This article attempts to show the impact of changing and optimizing management protocols on the incidence of neurologic morbidity after cardiac surgery.


DESIGN
An observational study of cardiac surgical patients.


SETTING
University hospital.


PARTICIPANTS
All cardiac surgical patients treated postoperatively in the cardiac surgical ICU in 2001 (n = 1,165, control group) and in 2003 (n = 1,222, intervention group) were evaluated.


INTERVENTIONS
A quality improvement program started at the beginning of 2002, based on the Task Force Committee Guidelines, included surgical and cardiopulmonary bypass recommendations as well as peri- and postoperative care (eg, use of epiaortic echo and strict perfusion protocol, avoidance of hyperthermia and hyperglycemia, and minimization of cerebral edema).


RESULTS
The number of neurologic complications decreased from 78 (6.7%) in 2001 to 33 (2.7%) in 2003 (p < 0.01), and corresponding numbers for ICU mortality were 44 (3.8%) and 24 (2.0%) (p < 0.01). The length of ICU stay also decreased (3.2 +/- 4.5 days in 2001 v 2.9 +/- 5.5 days in 2003, p < 0.001). In 2001, patients with neurologic complications consumed 853 ICU patient days (23% of all ICU patient days) and, in 2003, 549 (15% of all ICU patient days). According to logistic regression analysis that included 11 independent variables (treatment year, EuroSCORE, diabetes mellitus, history of stroke, and 7 different types of surgery), treatment in 2003 was independently associated with decreased risk for neurologic complications (odds ratio 0.30, 95% confidence intervals 0.19-0.47, p < 0.001).


CONCLUSIONS
The occurrences of neurologic complications, mortality, and ICU resource consumption by this patient group decreased after implementation of an optimized management protocol and evidence-based guidelines.