Dashboard of Short-Term Postoperative Patient Outcomes for Anesthesiologists: Development and Preliminary Evaluation.

BACKGROUND: Anesthesiologists require an understanding of their patients' outcomes to evaluate their performance and improve their practice. Traditionally, anesthesiologists had limited information about their surgical outpatients' outcomes due to minimal contact post discharge. Leveraging digital health innovations for analyzing personal and population outcomes may improve perioperative care. BC Children's Hospital's postoperative follow-up registry for outpatient surgeries collects short-term outcomes such as pain, nausea, and vomiting. Yet, these data were previously not available to anesthesiologists. OBJECTIVE: This quality improvement study aimed to visualize postoperative outcome data to allow anesthesiologists to reflect on their care and compare their performance with their peers. METHODS: The postoperative follow-up registry contains nurse-reported postoperative outcomes, including opioid and antiemetic administration in the postanesthetic care unit (PACU), and family-reported outcomes, including pain, nausea, and vomiting, within 24 hours post discharge. Dashboards were iteratively co-designed with 5 anesthesiologists, and a department-wide usability survey gathered anesthesiologists' feedback on the dashboards, allowing further design improvements. A final dashboard version has been deployed, with data updated weekly. RESULTS: The dashboard contains three sections: (1) 24-hour outcomes, (2) PACU outcomes, and (3) a practice profile containing individual anesthesiologist's case mix, grouped by age groups, sex, and surgical service. At the time of evaluation, the dashboard included 24-hour data from 7877 cases collected from September 2020 to February 2023 and PACU data from 8716 cases collected from April 2021 to February 2023. The co-design process and usability evaluation indicated that anesthesiologists preferred simpler designs for data summaries but also required the ability to explore details of specific outcomes and cases if needed. Anesthesiologists considered security and confidentiality to be key features of the design and most deemed the dashboard information useful and potentially beneficial for their practice. CONCLUSIONS: We designed and deployed a dynamic, personalized dashboard for anesthesiologists to review their outpatients' short-term postoperative outcomes. This dashboard facilitates personal reflection on individual practice in the context of peer and departmental performance and, hence, the opportunity to evaluate iterative practice changes. Further work is required to establish their effect on improving individual and department performance and patient outcomes.

Infant repair of massive aortic aneurysm with prosthetic valved conduit.

A 4-month-old child with severe infantile Marfan syndrome underwent successful repair of an extremely dilated aortic root and severe aortic valve insufficiency using a prosthetic valved conduit.

Does troponin-I measurement predict low cardiac output syndrome following cardiac surgery in children?

OBJECTIVE: To determine whether serum troponin I (TnI), measured 4 hours after surgery for congenital heart disease, is a predictor of myocardial dysfunction and low cardiac output syndrome (LCOS). DESIGN: Prospective, observational study. SETTING: Paediatric intensive care unit in a tertiary care academic children's hospital, 1 June 2003 to 12 May 2004. PATIENTS: 99 consecutive eligible children who underwent a variety of surgical procedures for congenital heart disease, using cardiopulmonary bypass. All patients were cared for by a consistent perioperative care team. INTERVENTIONS: Measurement of TnI preoperatively, and at 0, 4, 8, 12, 24 and 36 hours after ICU admission. RESULTS: Patient demographics and outcome (as median and 25th-75th percentile) were as follows: age, 23.9 (4.6- 65.9) months; cardiopulmonary bypass time, 135 (98-178) minutes; aortic cross-clamp time, 65 (28-85) minutes; preoperative TnI level, 0.02 (0.01-0.03) ng/mL; 4h TnI, 10.6 (3.0-23.4) ng/mL; highest 24 h TnI, 11.7 (3.9-29.5) ng/mL; time to discontinuation of inotropes, 43.9 (18.7-92.9) hours; maximal inotrope score, 10.0 (5.0-16.3); time to extubation, 42.4 (19.8-137.5) hours; and time to ICU discharge 91.8 (45.7-169.7) hours. Twenty-three patients developed LCOS. A 4h TnI level > 13 ng/mL predicted LCOS with a sensitivity of 0.78 (95% CI, 0.56-0.93), and a specificity of 0.72 (95% CI, 0.61-0.82). The area under the receiver operating characteristic curve for TnI as a predictor of LCOS was 0.75 (95% CI, 0.63-0.88). TnI was the only predictive variable associated with LCOS in multivariate logistic regression analysis, with an odds ratio of 1.45 (95% CI, 1.05-2.01) for developing LCOS with each 10 ng/mL increase in 4h TnI. Linear regression analysis showed TnI to be significantly correlated with increased time to discontinuation of inotropes, maximal inotrope administration, time to extubation, and time to ICU discharge. CONCLUSIONS: Measurement of early postoperative levels of TnI may aid in the early identification of children who will develop LCOS.