- 作者：Frederic Jacques ; MD ; MSc ; FRCSC ; Vijay Anand ; MD ; Edward J. Hickey ; MD ; Yasuhiro Kotani ; MD ; PhD ; Mrinal Yadava ; MBBS ; Abdullah Alghamdi ; MSc ; MD ; Christopher A. Caldarone ; MD ; Andrew N. Redington ; MD ; Steven Schwartz ; MD ; Glen S. Van Arsdell ; MD ; glen.vanarsdell@sickkids.ca
- 关键词：HLHS ; hypoplastic left heart syndrome ; ICU ; intensive care unit ; PE ; postoperative error
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：2013
- 出版时间：June, 2013
- 年：2013
- 卷：145
- 期：6
- 页码：1465-1475
- 全文大小：584 K
Background
The frequency and impact of medical errors during staged palliation are unknown.Methods
All patients with hypoplastic left heart syndrome and physiologic equivalents (N?=?191) who underwent staged palliation (2001-2011) were studied. Stage 1, interstage, and stage 2 were reviewed to identify diagnostic, technical, judgment, and management errors. The impact of errors on transplant-free survival was examined by parametric competing risks and risk-adjusted regressions using bootstrapping.
Results
Stage 1 (N?=?191) errors (n?=?111, 58 % ) were common and predominantly intraoperative (n?=?84, 44 % ) or postoperative (n?=?43, 23 % ). Postoperative errors were determinants of death/transplant (hazard ratio, 1.7; P?=?.01), whereas technical errors (n?=?65, 34 % ) were not, but they delayed recovery and discharge (extra 24 days approximately, P?=?.0024). Postoperative stage 1 errors led to decrements in total strategy success of approximately 30 % (78 % vs 48 % , P?=?.004). Stage 2 (N?=?134) errors (n?=?66, 49 % ) were common. Intraoperative errors were the most prevalent (n?=?61, 46 % ) but did not compromise survival. Postoperative errors (n?=?11, 8 % ) were determinants of death/transplant (hazard ratio, 2.4; P?<?.0001). Interstage errors (n?=?21, 16 % ) led to twice the intensive care unit stay (16 vs 7 days, P?<?.0001) and hospital stay (30 vs 17 days, P?<?.02) after stage 2. Overall, a child presenting with ideal morphology and managed with no postoperative errors at stage 1 or 2 would have a predicted late survival in excess of 80 % .
Conclusions
Technical errors are common and delay recovery. Their effects on survival are mitigated. Intraoperative judgment errors are associated with strategy failure in a univariate model and lead to increased postoperative errors in a multivariate model. Postoperative errors are independently associated with a decrease in univentricular strategy survival.