070 Validity and use of postoperative measurement of IC Troponine as an indicator of the result of preventive strategies for post-operative cardiac complications
| العنوان: | 070 Validity and use of postoperative measurement of IC Troponine as an indicator of the result of preventive strategies for post-operative cardiac complications |
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| المؤلفون: | Vichard Albin, Lenoir Bernard, Pele De Saint Maurice Guillaume, Boutonnet Mathieu, Ausset Sylvain, Dubost Clément |
| المصدر: | BMJ Quality & Safety. 19:A104-A105 |
| بيانات النشر: | BMJ, 2010. |
| سنة النشر: | 2010 |
| مصطلحات موضوعية: | Gynecology, medicine.medical_specialty, biology, business.industry, Health Policy, Incidence (epidemiology), Baseline data, Troponin, Quality enhancement, Surgery, biology.protein, medicine, Post operative, Quality of care, business, Hospital stay, Mace |
| الوصف: | Background Perioperative myocardial ischaemia (PMI) is a major health burden correlated with long-term cardiovascular outcome.1 Furthermore, its incidence is correlated with quality of care2 The aim of this study performed in patients undergoing major orthopaedic surgery (MOS) was to assess the impact of changes in practice on both the incidence of PMI detected by serial measurements of troponin-Ic (TnIc) and long-term cardiovascular outcome. Methods During a 3-year period, TnIc was measured on the first three postoperative days after MOS in a multidisciplinary hospital. After 16 months of study, postoperative care was improved according to the results of a Failure Mode, Effects, and Criticality Analysis (FMCA). Cardiac death, myocardial infarction and cardiac failure were considered major adverse cardiac events (MACE) and recorded during hospital stay and the first postoperative year. The incidence of PMI and MACE was used as result indicators for quality of care and compared before (P1) and after (P2) quality enhancement. Results 378 MOS procedures were included, 123 for P1, 255 for P2. Incidences of PMI and MACE were 8.9% versus 3.9 (p=0.0458) and 8.1% versus 1.9 (p=0.004) for P1 and P2 respectively. Using a multivariate Cox regression analysis adjusted for baseline data, independent factors associated with the occurrence of a MACE were phase P1 (HR=4.5—IC 95: 1.4–14.3) and postoperative PMI (HR=6.4—IC 95: 1.9–21.5). Conclusions Quality of postoperative care after MOS strongly impacts both short term (ie, PMI incidence with TnIc release) and long-term cardiac outcome. TnIc measurements after MOS can therefore be used as a result indicator of quality of care. Introduction L’elevation de la troponine Ic (TnIc) apres chirurgie orthopedique majeure est associee a une frequence accrue de complications perioperatoires et de complications cardiaques tardives (CCT).1 Son incidence est de plus correlee a la qualite des soins postoperatoires.2 Le but de cette etude etait de verifier si la baisse de l9incidence de l’elevation de TnIc associee a l9amelioration des soins est correlee a une baisse de la frequence des CCT. Methodes Pendant 3 ans, la TnIc a ete dosee durant les 3 premiers jours postoperatoires chez les patients beneficiant d9une chirurgie orthopedique lourde dans un hopital pluridisciplinaire. Apres 16 mois d9enquete, les soins postoperatoires ont ete ameliores au cours apres une analyse des modes de defaillance et de leur criticite (AMDEC). Les incidences des CCT un an apres l9intervention ont ete mesurees et comparees selon la phase de l’etude: Avant (P1) ou apres (P2) demarche qualite. Les CCT collectees etaient les deces de cause cardiaque, les infarctus et les poussees d9insuffisance cardiaque. Resultats 387 patients ont ete inclus, 130 pour P1 et 257 pour P2. L9incidence des elevations de TnIc et des CCT etaient de 8,9 vs 3,9% (p=0,0458) et de 8,1 vs 1,9% (p=0,0004) pour P1 et P2 respectivement. Dans une analyse multivariee utilisant un modele de Cox incluant l9age, le sexe, le score de Lee, la classe ASA, la type de chirurgie et l’elevation de la TnIc les seules variables statistiquement associees avec la survenue d9une CCT etaient l’elevation postoperatoire de la TnIc (HR=6,4 -IC 95: 1,9 - 21,5) et la phase P1 (HR=4,5 -IC 95: 1,4 - 14,3). Discussion La qualite des soins postoperatoires apres chirurgie orthopedique majeure est fortement correlee a la morbidite cardiovasculaire tardive comme a l’elevation postoperatoire de TnIc. La mesure de TnIc apres chirurgie orthopedique majeure peut donc etre utilisee comme indicateur de resultats. |
| تدمد: | 2044-5423 2044-5415 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_________::1a83329c06bf06e92694bce0e56a2b38Test https://doi.org/10.1136/qshc.2010.041624.57Test |
| رقم الانضمام: | edsair.doi...........1a83329c06bf06e92694bce0e56a2b38 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 20445423 20445415 |
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