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Abstract presentation - Bleeding and patient satisfaction

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Abstract presentation given at a national surgical society about the influence of surgical bleeding on patient satisfaction and willingness to recommend the hospital.

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Abstract presentation - Bleeding and patient satisfaction

  1. 1. Bleeding During Robotic CABG Leads to a Poor Patient Experience Robert Poston, MD Chair, Dept. of Cardiothoracic Surgery St. Francis Medical Center
  2. 2. Bleeding and Transfusions after CABG • Periop transfusions • On-pump CABG 63% • OPCAB 50% • Robotic CABG 24-44% NEJM 2012; 366: 1489-97
  3. 3. Therapeutic misconception • Inaccurate website marketing • Orthopedics1 • TAVI2 • Robotic cardiac surgery3 • Suboptimal informed consent4 1. RS Labovitch, KJ Bozic, E Hansen. An evaluation of information available on the internet regarding minimally invasive hip arthroplasty. The Journal of Arthroplasty, 2006 2. Kincaid M, Neuman M Presentation on US Hospital Websites of Risks and Benefits of Transcatheter Aortic Valve Replacement Procedures. JAMA 2015 3. Poston, et al. Marketing of Low Volume Robotic Cardiac Surgery Programs via the Internet and Public Reporting Avenues. Abstract, ISMICS 2014 4. S Ryan, V Chirumamilla, RA Bello et al., How informed is “informed consent” for robotic cardiac surgery? Innovations 2009
  4. 4. Does bleeding and transfusion after r-CABG increase the risk of unmet expectations and dissatisfaction?
  5. 5. Methods Robotic CABG – hemostat group (n=62) Robotic CABG – control group (n=131) Hemostatic into port sites routinely Hemostatic into port sites as needed Primary OUTCOMES: • 30 day clinical outcomes • Patient satisfaction • HCAHPS score: Items #5-7; 22 • Unmet expectations: • Size of the incision • Speed of recovery
  6. 6. Methods: Patient satisfaction Physician Communication
  7. 7. Clinical outcomes Outcome Hemostat group (n=62) Control group (n=131) p value RBC transfusion - % transfused 24.2% 40.8% 0.026 - Units received 0.44 U 1.39 U 0.024 Discharge Hct 32.4±5.7 27.2±6.5 0.001 Chest tube output (cc/24 hr) 529±112 cc 594±133 cc NS Reoperation 3.2% 3.0% NS Length of stay (d) 3.5±0.6 3.8±0.9 NS Composite M&M (O/E) 0.81±0.12 0.95±0.14 NS
  8. 8. Satisfaction outcomes Outcome Hemostat group (n=62) Control group (n=131) p value HCAHPS survey - Physician communication (percentile) 98% 85% 0.001 - Willing to recommend (% definitely yes) 91% 83% 0.02 Unmet expectations - Size of the incisions 3 out of 58 respondents (5.2%) 7 out of 125 respondents (5.6%) NS - Recovery time 2* out of 58 respondents (3.4%) 17* out of 125 respondents (13.6%) 0.03 *18 out of 19 respondents with unmet expectations about recovery time received ≥1 U PRCs.
  9. 9. Baseline Port placement Wound closureSurgeon at robotic console Baseline 60% of baseline (severe stress) HEART RATE VARIABILITY SURGICAL STAGE SURGEON HEART RATE VARIABILITY DURING ROBOTIC SURGERY Abstract, SRS 2014
  10. 10. Baseline Port placement Wound closureSurgeon at robotic console on bypass mitral repair LA closure repair of bleeding remove cardio- plegia cannula Baseline 60% of baseline (severe stress) HEART RATE VARIABILITY SURGICAL STAGE SURGEON HEART RATE VARIABILITY DURING ROBOTIC SURGERY Abstract, SRS 2014
  11. 11. Conclusion Bleeding and transfusion after r-CABG Unmet expectations about recovery time Dissatisfied patient
  12. 12. Conclusion Bleeding and transfusion after r-CABG Unmet expectations about recovery time Dissatisfied patient Topical hemostatics Manage expectations

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