Safer cardiac surgery.

Safety in cardiac surgery should be evaluated in the context of the other elements of quality in healthcare (timeliness, effectiveness, efficiency, equity, and most importantly, patient-centeredness). Mortality alone is not an adequate index of safety: Stroke is particularly feared by patients and prolonged periods of hospitalization can be very difficult for families to cope with. Advances in knowledge, technology, and medications have improved outcomes, but pharmacological means of reducing cerebral dysfunction after cardiopulmonary bypass remain elusive. Clear differences can be demonstrated between the results of different surgeons and also between different anesthesiologists. The World Health Organization's recently introduced Surgical Safety Checklist provides a validated and inexpensive cognitive aid to reduce human error and improve teamwork and communication in the operating room. Patient selection is very important, and patients should be given clear information on the relative merits of alternative treatments (for example, coronary surgery, percutaneous intervention, and medical treatment in the case of coronary artery disease). In the end, outcomes that the patients themselves desire are the most meaningful endpoint of the pursuit of safer cardiac surgery.