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U? 1=  endstream endobj 30 0 obj <>stream h21W0Pw.JM,sI,Ip220044044550V70Pׄ/pLOJUsI-LSp6U033O0nL@Q~Jir*̜7̤ĢJK=KM;;( endstream endobj 31 0 obj <>/Filter/FlateDecode/ID[<6C143DEE9D59E74AAA5CF4ACD1F3E4D5>]/Info 47 0 R/Length 138/Root 49 0 R/Size 48/Type/XRef/W[1 3 1]>>stream hbb&F% RD؀E~IFF 0= Y> v7mT 6L 2X#`g !UDmg t_`d`D22 endstream endobj startxref 116 %%EOF Cuantificación de resultados en cirugía de cardiopatía congénita 2012-2015: 4 años de experiencia con el programa colaborativo internacional de mejoría de calidad - Archivo PPCT

Cuantificación de resultados en cirugía de cardiopatía congénita 2012-2015: 4 años de experiencia con el programa colaborativo internacional de mejoría de calidad;
Quantification of Outcomes in Surgery for Congenital Heart Diseases in 2012-2015: a Four-Year Experience with the International Quality Improvement Collaborative Program

Creators:Juaneda, Ernesto, Juaneda, Ignacio, Azar, Irma, Rodríguez, Rosa, Pérez Ferrero, Julieta, Bustamante, Paola, Benedetto, Emilia, Peirone, Alejandro, Banille, Edgardo, Díaz, Héctor
2018-09-12

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Introducción: El sistema de salud experimenta un creciente interés en cruzar el abismo de calidad. La cirugía de cardiopatíascongénitas ha mejorado en resultados y calidad de vida; no obstante tiene riesgo de mortalidad e infección que requierencuantificación. El objetivo de este trabajo fue cuantificar sus resultados a través del Programa Colaborativo Internacionalpara Mejoría de Calidad en cirugía de cardiopatías congénitas para mejorar.Material y métodos: Estudio prospectivo intervencionista, en Hospital Público Terciario de Niños, Córdoba, Argentina. Seincluyeron pacientes con cirugía de cardiopatías congénitas desde el 1 de enero de 2012 al 31 de diciembre de 2015; se cuantificósexo, edad y peso en cirugía de cardiopatías congénitas, riesgo ajustado a complejidad, porcentaje no ajustado e índicesestándar de mortalidad intrahospitalaria e infección estándar (índice observado/índice esperado) con intervalos de confianzadel 95% y se comparó con el estándar del Programa Colaborativo para Mejoría de Calidad (1,0 = estándar, &lt; 1= mejoría). Comointervención se introdujeron las guías conductoras: prácticas perioperatorias seguras, control de infección y trabajo en equipo.Resultados: Se efectuaron 373 cirugías de cardiopatías congénitas en 203 varones, 170 mujeres con porcentaje con porcentajede distribución RACHS-1 : I:28,4%, II:44%, III:24,4% y IV-VI 3,2%.El porcentaje semestral de mortalidad no ajustado fue del 6%, 3%, 8%, 9%, 11%, 0%, 0% y 5%, respectivamente (estándar 4-6%).El índice estándar de mortalidad intrahospitalaria y el intervalo de confianza fueron 0,85 (0,23-2,18), 1,82 (0,79-3,59), 1,07(0,39-2,34), 0,36 (0,04-1,29), respectivamente.El porcentaje semestral de infección no ajustado fue 24%, 23%, 25%, 14%, 13%, 6%, 9% y 16%, respectivamente (estándar 5-7%).El índice de infección estándar y el intervalo de confianza fueron 1,89 (1,12-2,99), 1,87 (1,17-2,83), 2,0 (1,20-3,12), 1,22 (0,61-2,18).Conclusiones: La implementación del Programa Colaborativo para Mejoría de Calidad en cirugía de cardiopatías congénitasdel Hospital Público Terciario de Niños, Córdoba, Argentina contribuyó a cuantificar resultados e introducir la implementaciónde guías conductoras para mejorarlos. Se logró la reducción en mortalidad, en tanto la infección continúa por mejorar.

Background: The health care system is undergoing an increasing interest in crossing the quality chasm. Surgery for congenitalheart defects has improved in terms of outcomes and quality of life; however, the risk of mortality and infection requiresto be quantified. The goal of this study was to quantify the outcomes of surgery for congenital heart diseases following theInternational Quality Improvement Collaborative (IQIC) for Congenital Heart Disease program.Methods: This observational and interventional study was conducted at a tertiary children’s hospital in Cordoba, Argentina.Patients undergoing surgery for congenital heart defects between January 1, 2012, and December 31, 2015, were included.The following variables were quantified: sex, age, weight, risk-adjusted congenital heart surgery score, non-adjusted risk,standardized in-hospital mortality ratios and standardized infection ratio (observed rate/expected rate) with their corresponding95% confidence intervals. The results were compared with the IQIC for Congenital Heart Disease program standards(1.0=standardized rates, &lt;1=improvement). The IQIC guidelines based on key drivers -safe perioperative practice, reductionof infections and team-based practice- were implemented as intervention for improvement. Results: A total of 373 surgical procedures for congenital heart defects were performed on 203 male patients and 170 femalepatients assigned to the following RACHS-1 categories: I: 28.4%, II: 44%, III: 24.4% and IV-VI 3.2%. Non-adjusted mortalityrate at 6 months was of 6%, 3%, 8%, 9%, 11%, 0%, 0% and 5%, respectively (standardized rates 4-6%). Standardized in-hospitalmortality ratios and their corresponding confidence intervals were 0.85 (0.23-2.18), 1.82 (0.79-3.59), 1.07 (0.39-2.34), and0.36 (0.04-1.29), respectively. Non-adjusted infection rate at 6 months was of 4%, 23%, 25%, 14%, 13%, 6%, 9% and 16%,respectively (standardized rates 5-7%).Standardized infection ratios and their corresponding confidence intervals were 1.89 (1.12-2.99), 1.87 (1.17-2.83), 2.0 (1.20-3.12), 1.22 (0.61-2.18), respectively.Conclusion: The implementation of the International Quality Improvement Collaborative for Congenital Heart Disease programwith the use of guidelines based on key drivers in a public tertiary hospital in Cordoba, Argentina, contributed to quantifyingand improving the outcomes. While mortality decreased, the rate of infections is still to be improved.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 86, No 4 (2018); 256-261, Argentine Journal of Cardiology; Vol 86, No 4 (2018); 256-261

Citación

Juaneda, Ernesto et al., “Cuantificación de resultados en cirugía de cardiopatía congénita 2012-2015: 4 años de experiencia con el programa colaborativo internacional de mejoría de calidad,” Archivo PPCT, consulta 2 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/9495.

Dublin Core

Autor

Juaneda, Ernesto
Juaneda, Ignacio
Azar, Irma
Rodríguez, Rosa
Pérez Ferrero, Julieta
Bustamante, Paola
Benedetto, Emilia
Peirone, Alejandro
Banille, Edgardo
Díaz, Héctor

Fuente

Revista Argentina de Cardiología; Vol 86, No 4 (2018); 256-261
Argentine Journal of Cardiology; Vol 86, No 4 (2018); 256-261

Editor

Sociedad Argentina de Cardiología

Fecha

2018-09-12

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

Formato

Idioma

spa
eng

Tipo

info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion