Cardiothoracic Surgeon Management of Postoperative Cardiac Critical Care
OBJECTIVE To determine whether postoperative cardiac care by cardiothoracic surgeons in a semiclosed intensive care unit model could be distinguished from that given by intensivists who are not board certified in cardiothoracic surgery. DESIGN From January 2007 to February 2009, we retrospectively e...
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| Veröffentlicht in: | Archives of surgery (Chicago. 1960) 2011-11, Vol.146 (11), p.1253-1260 |
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| creator | Whitman, Glenn J. R Haddad, Michel Hirose, Hitoshi Allen, Jeremiah G Lusardi, Margaret Murphy, Maura A |
| description | OBJECTIVE To determine whether postoperative cardiac care by cardiothoracic surgeons in a semiclosed intensive care unit model could be distinguished from that given by intensivists who are not board certified in cardiothoracic surgery. DESIGN From January 2007 to February 2009, we retrospectively examined data on patients after cardiac operations from 2 consecutive periods during which full-time management of intensive care was changed from noncardiothoracic intensivists (period 1, 168 patients) to cardiothoracic surgeons (period 2, 272 patients). MAIN OUTCOME MEASURES Variables measured included Society of Thoracic Surgeons observed and expected mortality, central venous line infections, ventilator-acquired pneumonia, red blood cell exposure, adherence to blood glucose level target at 6 AM on the first and second postoperative days, length of stay, and intensive care unit pharmacy costs. Results were compared using a 2-sample t test or 2-tailed Fisher exact test. RESULTS In similar populations, as witnessed by equivalent Society of Thoracic Surgeons operative risk, cardiothoracic surgeons providing postoperative critical care led to a mean (SD) decrease in hospital length of stay from 13.4 (0.9) to 11.2 (0.4) days (P = .01) and decreased drug costs from $4300 (1000) to $1800 (200) (P |
| doi_str_mv | 10.1001/archsurg.2011.298 |
| format | Article |
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R ; Haddad, Michel ; Hirose, Hitoshi ; Allen, Jeremiah G ; Lusardi, Margaret ; Murphy, Maura A</creator><creatorcontrib>Whitman, Glenn J. R ; Haddad, Michel ; Hirose, Hitoshi ; Allen, Jeremiah G ; Lusardi, Margaret ; Murphy, Maura A</creatorcontrib><description>OBJECTIVE To determine whether postoperative cardiac care by cardiothoracic surgeons in a semiclosed intensive care unit model could be distinguished from that given by intensivists who are not board certified in cardiothoracic surgery. DESIGN From January 2007 to February 2009, we retrospectively examined data on patients after cardiac operations from 2 consecutive periods during which full-time management of intensive care was changed from noncardiothoracic intensivists (period 1, 168 patients) to cardiothoracic surgeons (period 2, 272 patients). MAIN OUTCOME MEASURES Variables measured included Society of Thoracic Surgeons observed and expected mortality, central venous line infections, ventilator-acquired pneumonia, red blood cell exposure, adherence to blood glucose level target at 6 AM on the first and second postoperative days, length of stay, and intensive care unit pharmacy costs. Results were compared using a 2-sample t test or 2-tailed Fisher exact test. RESULTS In similar populations, as witnessed by equivalent Society of Thoracic Surgeons operative risk, cardiothoracic surgeons providing postoperative critical care led to a mean (SD) decrease in hospital length of stay from 13.4 (0.9) to 11.2 (0.4) days (P = .01) and decreased drug costs from $4300 (1000) to $1800 (200) (P < .001). These improvements occurred without losing benefits in other quality measures. CONCLUSIONS By virtue of their cardiac-specific operative and nonoperative training, cardiothoracic surgeons may be uniquely qualified to provide postoperative cardiac critical care. In a semiclosed unit where care of the patient is codirected, the improvements noted may have been facilitated by the commonalities between surgeons and intensivists associated with similar training and experiences.</description><identifier>ISSN: 0004-0010</identifier><identifier>ISSN: 2168-6254</identifier><identifier>EISSN: 1538-3644</identifier><identifier>EISSN: 2168-6262</identifier><identifier>DOI: 10.1001/archsurg.2011.298</identifier><identifier>PMID: 22106316</identifier><identifier>CODEN: ARSUAX</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Aged ; Biological and medical sciences ; Cardiac Surgical Procedures ; Critical care ; Female ; General aspects ; Health Care Costs ; Health participants ; Heart surgery ; Humans ; Intensive care ; Intensive Care Units - organization & administration ; Length of Stay ; Male ; Medical sciences ; Postoperative Care - economics ; Postoperative Care - methods ; Postoperative Period ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Retrospective Studies ; Risk assessment ; Specialties, Surgical ; Surgeons</subject><ispartof>Archives of surgery (Chicago. 1960), 2011-11, Vol.146 (11), p.1253-1260</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright American Medical Association Nov 2011</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a419t-1679fbc4b04a3963843ba634cc2f5daf267acb9b6c2b9c1eb2d6fc49e191494d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamasurgery/articlepdf/10.1001/archsurg.2011.298$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.2011.298$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76232,76235</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24790180$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22106316$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Whitman, Glenn J. R</creatorcontrib><creatorcontrib>Haddad, Michel</creatorcontrib><creatorcontrib>Hirose, Hitoshi</creatorcontrib><creatorcontrib>Allen, Jeremiah G</creatorcontrib><creatorcontrib>Lusardi, Margaret</creatorcontrib><creatorcontrib>Murphy, Maura A</creatorcontrib><title>Cardiothoracic Surgeon Management of Postoperative Cardiac Critical Care</title><title>Archives of surgery (Chicago. 1960)</title><addtitle>Arch Surg</addtitle><description>OBJECTIVE To determine whether postoperative cardiac care by cardiothoracic surgeons in a semiclosed intensive care unit model could be distinguished from that given by intensivists who are not board certified in cardiothoracic surgery. DESIGN From January 2007 to February 2009, we retrospectively examined data on patients after cardiac operations from 2 consecutive periods during which full-time management of intensive care was changed from noncardiothoracic intensivists (period 1, 168 patients) to cardiothoracic surgeons (period 2, 272 patients). MAIN OUTCOME MEASURES Variables measured included Society of Thoracic Surgeons observed and expected mortality, central venous line infections, ventilator-acquired pneumonia, red blood cell exposure, adherence to blood glucose level target at 6 AM on the first and second postoperative days, length of stay, and intensive care unit pharmacy costs. Results were compared using a 2-sample t test or 2-tailed Fisher exact test. RESULTS In similar populations, as witnessed by equivalent Society of Thoracic Surgeons operative risk, cardiothoracic surgeons providing postoperative critical care led to a mean (SD) decrease in hospital length of stay from 13.4 (0.9) to 11.2 (0.4) days (P = .01) and decreased drug costs from $4300 (1000) to $1800 (200) (P < .001). These improvements occurred without losing benefits in other quality measures. CONCLUSIONS By virtue of their cardiac-specific operative and nonoperative training, cardiothoracic surgeons may be uniquely qualified to provide postoperative cardiac critical care. In a semiclosed unit where care of the patient is codirected, the improvements noted may have been facilitated by the commonalities between surgeons and intensivists associated with similar training and experiences.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiac Surgical Procedures</subject><subject>Critical care</subject><subject>Female</subject><subject>General aspects</subject><subject>Health Care Costs</subject><subject>Health participants</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Intensive Care Units - organization & administration</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Postoperative Care - economics</subject><subject>Postoperative Care - methods</subject><subject>Postoperative Period</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Retrospective Studies</subject><subject>Risk assessment</subject><subject>Specialties, Surgical</subject><subject>Surgeons</subject><issn>0004-0010</issn><issn>2168-6254</issn><issn>1538-3644</issn><issn>2168-6262</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkNFKwzAUhoMobk4fQC-kCOJVZ06Spc2lDHXCREG9LqdpunWszUxawbc3c5sDr3II3_-fw0fIOdAhUAq36PTcd242ZBRgyFR6QPow4mnMpRCHpE8pFXEAaY-ceL8IE0sVOyY9xoBKDrJPJmN0RWXbuXWoKx29hTpjm-gZG5yZ2jRtZMvo1frWrozDtvoy0W8EdTR2VVtpXK4_zCk5KnHpzdn2HZCPh_v38SSevjw-je-mMQpQbQwyUWWuRU4FciV5KniOkgutWTkqsGQyQZ2rXGqWKw0mZ4UstVAGFAglCj4gN5velbOfnfFtVldem-USG2M7nyk6ShOmRjKQV__Ihe1cE44LkKQJ4yIJEGwg7az3zpTZylU1uu8MaLaWnO0kZ2vJWZAcMpfb4i6vTfGX2FkNwPUWQB_8lA4bXfk9JxJFIaWBu9hwWON-L4TTgPEf47KOqA</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Whitman, Glenn J. 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Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Retrospective Studies</topic><topic>Risk assessment</topic><topic>Specialties, Surgical</topic><topic>Surgeons</topic><toplevel>online_resources</toplevel><creatorcontrib>Whitman, Glenn J. R</creatorcontrib><creatorcontrib>Haddad, Michel</creatorcontrib><creatorcontrib>Hirose, Hitoshi</creatorcontrib><creatorcontrib>Allen, Jeremiah G</creatorcontrib><creatorcontrib>Lusardi, Margaret</creatorcontrib><creatorcontrib>Murphy, Maura A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of surgery (Chicago. 1960)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Whitman, Glenn J. R</au><au>Haddad, Michel</au><au>Hirose, Hitoshi</au><au>Allen, Jeremiah G</au><au>Lusardi, Margaret</au><au>Murphy, Maura A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiothoracic Surgeon Management of Postoperative Cardiac Critical Care</atitle><jtitle>Archives of surgery (Chicago. 1960)</jtitle><addtitle>Arch Surg</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>146</volume><issue>11</issue><spage>1253</spage><epage>1260</epage><pages>1253-1260</pages><issn>0004-0010</issn><issn>2168-6254</issn><eissn>1538-3644</eissn><eissn>2168-6262</eissn><coden>ARSUAX</coden><abstract>OBJECTIVE To determine whether postoperative cardiac care by cardiothoracic surgeons in a semiclosed intensive care unit model could be distinguished from that given by intensivists who are not board certified in cardiothoracic surgery. DESIGN From January 2007 to February 2009, we retrospectively examined data on patients after cardiac operations from 2 consecutive periods during which full-time management of intensive care was changed from noncardiothoracic intensivists (period 1, 168 patients) to cardiothoracic surgeons (period 2, 272 patients). MAIN OUTCOME MEASURES Variables measured included Society of Thoracic Surgeons observed and expected mortality, central venous line infections, ventilator-acquired pneumonia, red blood cell exposure, adherence to blood glucose level target at 6 AM on the first and second postoperative days, length of stay, and intensive care unit pharmacy costs. Results were compared using a 2-sample t test or 2-tailed Fisher exact test. RESULTS In similar populations, as witnessed by equivalent Society of Thoracic Surgeons operative risk, cardiothoracic surgeons providing postoperative critical care led to a mean (SD) decrease in hospital length of stay from 13.4 (0.9) to 11.2 (0.4) days (P = .01) and decreased drug costs from $4300 (1000) to $1800 (200) (P < .001). These improvements occurred without losing benefits in other quality measures. CONCLUSIONS By virtue of their cardiac-specific operative and nonoperative training, cardiothoracic surgeons may be uniquely qualified to provide postoperative cardiac critical care. 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| subjects | Aged Biological and medical sciences Cardiac Surgical Procedures Critical care Female General aspects Health Care Costs Health participants Heart surgery Humans Intensive care Intensive Care Units - organization & administration Length of Stay Male Medical sciences Postoperative Care - economics Postoperative Care - methods Postoperative Period Public health. Hygiene Public health. Hygiene-occupational medicine Retrospective Studies Risk assessment Specialties, Surgical Surgeons |
| title | Cardiothoracic Surgeon Management of Postoperative Cardiac Critical Care |
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