A clinical audit of the short-term outcome of cardiac surgery patients admitted to Kenyatta national hospital's intensive care unit

Abstract

Introduction. Cardiac disease is a common cause of morbidity and mortality in patients at Kenyatta National hospital. The evaluation of clinical outcome of cardiac surgery has been accepted as a first step to assessing and improving a hospital's quality of patient care (1,2). In view of the strategic importance of the hospital as a centre for cardiac surgery in this region, there was need to audit the clinical outcomes of cardiac surgery at the hospital's intensive care unit. Objective. The main objective was to conduct a clinical audit of the short-term outcome (within 7 days) of cardiac surgery patients admitted to KNH's intensive care unit. Methodology. Thiswas an observational prospective cohort study spanning the period 1st November 2006 to 6th April 2007 at KNH intensive care unit. An analysis of the outcome of 60 consecutive eligible patients who underwent cardiac surgery was done. The instrument of data collection was a questionnaire. Personal and demographic data was obtained preoperatively by interviewing the patients while still in the ward a day before the scheduled surgery. Subsequential data was then abstracted post operatively from the patient's records in the intensive care unit. Results 33 (55%) males and 27 (45%) females with a mean age 23.0 years (range of 0.4-63) were consecutively recruited. Majority 27 (45%) had a bypass time of 60-120 minutes and the average duration of ICU stay was 40.8 hours. The commonest operative diagnosis was congenital heart diseases 30 (50%). Surprisingly, there was no case of coronary artery disease that was operated on over the duration of study. There was a statistically significant mortality rate of 10 (16.7%) with a 95% Confidence Interval (CI) of 7.2 - 26% over the post surgery observation period of seven days. A statistically significant 6 (10%) cases developed acute renal failure within the period 4-72 hours post operative (95% CI - 2.4 to17.6%) and 4 (7%) had significant bleeding. A statistical association between operative mortality, the duration of bypass as well as the age of the patient was established