CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 7, August 2013
250
AFRICA
In our study, the mortality rate (0.93%) was higher than in both
the above studies. Most importantly, the incidence of preventable
death was found to have occurred in 11 patients (45.8%) in the
group. Therefore we argue that reduction of technical surgical
errors and system errors will improve the outcomes of this
low-risk patient group. The main areas for improvement are seen
as: (1) meticulous LIMA harvesting, (2) improvement in surgical
technique for haemostasis during the surgical procedure, and (3)
established protocols for patient care in the ICU and ward.
There were two limitations of the study; one was that the
number of deaths in this group (24/2 570) still constitutes a
relatively small number of patients from which to determine the
real risk factors influencing mortality. A larger patient group or
the pooling of patients through collaboration between hospitals
will yield valuable data on this subject. The second major
limitation of our study was the lack of an objective definition
of preventable and non-preventable causes of death. In order to
categorise a death as preventable or non-preventable, we had to
rely on consensus between the authors and an expert external to
the study, while searching for similar studies in the literature.
10,11
Conclusion
This study was conducted because there is insufficient data
on the causes of preventable deaths in the low-risk group of
patients undergoing isolated CABG. A structured analysis of the
events preceding an unexpected fatality in patients with no or
minimal risk factors should reveal potentially correctable issues.
Furthermore, the correction of technical and system errors,
such as LIMA harvesting and haemostasis during surgery, as
well as the establishment of protocols for transferring patients
from the ward to the intensive care unit will eventually lead to
improvement in the quality of care and surgical outcomes.
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