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R H Dal Col

Publications and source records attributed to R H Dal Col.

4 recordsLinked to original sources
PubMed1994

How a New York cardiac surgery program uses outcomes data.

In New York State, a risk-adjusted outcomes system has been used by the Department of Health to monitor all cardiac operations since January 1989. Hospital-specific and physician-specific results are published annually. In this report we describe the experience of one hospital in New York State whose results showed a higher than expected surgical mortality. Staff reactions were initially skeptical, and case reviews found no quality-of-care problems. However, a different approach using statistical analysis of the detailed case-specific outcomes data was more revealing. The excess mortality was localized to patients having high-acuity, emergency coronary artery bypass grafting, particularly those who had suffered a preoperative acute myocardial infarction less than 6 hours before, those who were in shock, or those who were in a hemodynamically unstable condition. The staff responded with a focused effort to optimize the management of these patients, resulting in zero mortality for emergency coronary artery bypass grafting during the following year. In the process, staff from all departments joined together in a more collaborative approach to the cardiac surgery program. Outcomes data can be useful for effecting program improvement if comparable norms and open access for flexible analysis are available.

Cardiac Surgical Procedures↗
PubMed1993

Alternative conduits for coronary revascularization: a novel approach for harvest of the lesser saphenous vein.

Previous use of the greater saphenous vein limits the subsequent availability of conduit for coronary artery bypass grafting (CABG). One readily available alternative conduit is the lesser saphenous vein (LSV). During a 4-year period, 34 LSVs were explored in 23 patients using a novel surgical approach. The incision used for LSV harvest was carried through and deep into the muscular fascia, posterior to the tibia, along the length of the leg, developing a fascial-cutaneous flap. The LSV in all patients was imaged before operation by venous duplex scanning. Important anatomic details were mapped on the patient's leg before surgery using indelible ink. Findings at operation correlated well with the duplex imaging results. Of the 34 LSVs explored 31 were judged usable by the operating surgeon. In eight patients bilateral LSVs were used and in two this vein was the only conduit available. Among patients undergoing LSV harvest there was no operative mortality and minimal operative morbidity related to harvesting. Only one wound infection developed at the incision site. There were no documented cases of deep vein thrombosis. A case-control study was performed in which a control group of 25 patients undergoing CABG without use of the LSV were compared with the 23 who had LSVs harvested; patients in both groups underwent preoperative venous duplex studies. There were no significant differences in operative mortality or morbidity rate between groups (statistical power > 0.8 for these negative observations), suggesting that harvest of the LSV is usually successful when used in conjunction with preoperative venous duplex scanning.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Donor-specific cytotoxicity testing: an advance in detecting pulmonary allograft rejection.

Ten beagle dogs underwent left unilateral lung transplantation and were treated with cyclosporine and azathioprine. After three days, cyclosporine administration was discontinued and azathioprine administration was maintained at a suboptimal dose to allow a graded response to the pulmonary allograft. Dogs were monitored by chest roentgenogram, bronchoalveolar lavage (BAL), and sampling of peripheral blood lymphocytes at weekly intervals. Open lung biopsies also were performed at weekly intervals in 5 of the dogs. Lymphocytes from the BAL and peripheral blood and those grown in culture from open and transbronchial biopsy specimens were tested for donor-specific cytotoxicity (DSC) by testing their responsiveness to lymphocytes from their donor. Rejection was confirmed in all animals. Donor-specific cytotoxicity became detectable in all animals in either the BAL fluid or biopsy specimens. An abnormal chest roentgenogram developed in 9 dogs, but not until after DSC was detected in the BAL in 7. In the open biopsy specimens tested for DSC, all exhibited DSC synchronous with the first changes noted on chest roentgenogram. Donor-specific cytotoxicity was sensitive for detecting rejection in 8 of 9 dogs in the BAL and in 5 of 5 dogs in the open biopsy specimens. Based on these results, 3 additional dogs were maintained on cyclosporine. Two of these dogs did not reject their transplants and had no evidence of DSC. We conclude that donor-specific functional assays provide an advance over less sensitive clinical techniques.

Animals↗