Phase of Care Mortality Analysis

A Unique Method for Comparing Mortality Differences Among Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Patients

Todd C. Crawford, J. Trent Magruder, Joshua C. Grimm, Kaushik Mandal, Joel Price, Jon Resar, Matthew Chacko, Rani K. Hasan, Glenn Whitman, John Conte

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The objective of this study is based on the phase of care mortality analysis (POCMA), an effective tool to evaluate the root cause of in-hospital mortality in cardiac surgery patients. POCMA has not been used to compare operative mortalities among transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) populations, and may provide insight that could affect patient safety initiatives and improve outcomes in aortic valve surgery. We included patients who underwent TAVR or isolated SAVR between 2011 and March 31, 2015 and did not survive the index hospitalization. A multidisciplinary heart team made POCMA assignments as part of the weekly morbidity and mortality conference, pinpointing the phase of care and subcategory that directly caused or had the greatest effect on each mortality. During the study period, 240 patients underwent TAVR and 530 underwent SAVR. Unadjusted mortality rates were significantly higher in the TAVR group, 5.0% (n = 12) compared with SAVR, 1.9% (n = 10) (P = 0.016). TAVR deaths by phase of care are as follows: 0 for preoperative, 9 (72.8%) for intraoperative, 2 (18.2%) for postoperative intensive care unit, and 1 (9.1%) for postoperative floor. By comparison, 4 (40%) SAVR deaths had a root cause in the preoperative phase, 1 (10%) in the intraoperative phase, and 5 (50%) in the postoperative intensive care unit phase. POCMA is a novel method of categorizing in-hospital mortalities. Our single institution review revealed that patients who underwent TAVR more often expired because of intraoperative technical issues, whereas SAVR deaths were typically the result of patient selection or postoperative complications.

Original languageEnglish (US)
Pages (from-to)245-252
Number of pages8
JournalSeminars in Thoracic and Cardiovascular Surgery
Volume28
Issue number2
DOIs
StatePublished - Feb 2 2016

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Aortic Valve
Surgical Instruments
Mortality
Postoperative Care
Hospital Mortality
Intensive Care Units
Transcatheter Aortic Valve Replacement
Population Dynamics
Patient Safety
Patient Selection
Thoracic Surgery
Hospitalization
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Crawford, Todd C. ; Magruder, J. Trent ; Grimm, Joshua C. ; Mandal, Kaushik ; Price, Joel ; Resar, Jon ; Chacko, Matthew ; Hasan, Rani K. ; Whitman, Glenn ; Conte, John. / Phase of Care Mortality Analysis : A Unique Method for Comparing Mortality Differences Among Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Patients. In: Seminars in Thoracic and Cardiovascular Surgery. 2016 ; Vol. 28, No. 2. pp. 245-252.
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Phase of Care Mortality Analysis : A Unique Method for Comparing Mortality Differences Among Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Patients. / Crawford, Todd C.; Magruder, J. Trent; Grimm, Joshua C.; Mandal, Kaushik; Price, Joel; Resar, Jon; Chacko, Matthew; Hasan, Rani K.; Whitman, Glenn; Conte, John.

In: Seminars in Thoracic and Cardiovascular Surgery, Vol. 28, No. 2, 02.02.2016, p. 245-252.

Research output: Contribution to journalArticle

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