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