Grand Rounds Report: Predictors of Poor Neurological Outcomes Following CABG Surgeries

by Academy of Clinical Excellence on September 30, 2009

At a recent Medical Grand Rounds, I had the privilege of hearing Dr. Guy McKhann share some of his exciting research. For many years, he had been the Chairman of Neurology at Johns Hopkins Hospital and he was introduced as a ‘giant’ whose influence in patient care, education, and research has been tremendous.
His more recent research has focused on neurological outcomes following heart bypass (CABG) surgery. He explained fewer CABGs are performed than in the prior years (largely due to coronary stents) and that patients undergoing the procedures are older, more complex, and more chronically ill. His team has been tracking outcomes for approximately 9,500 patients who have had CABGs at Johns Hopkins Hospital since 1992; with an emphasis on post-operative neurological sequelae.
According to Dr. McKhann, some of the most clinically relevant findings of the research have been the identification of risk factors that portend poor neurological outcomes following any procedural intervention, both surgical and stents.Listening to the presentation and reflecting upon how the information relates to clinical excellence, 3 thoughts came to mind:

1. The scholarly approach, taken by Dr. McKhann and his team, to caring for patients has led to significant advances in our understanding of how best to take care of older, sick patients with blockages in their coronary arteries.2. If practicing physicians are to ‘translate’ clinical research for the benefit their patients, it is imperative that they remain committed to lifelong learning and keep up with this emerging knowledge.

3. Although Dr. McKhann’s discussion did not go into the subject of communicating with our patients, I spent part of the hour imagining what would be the best approach to help a patient to understand that we need to consider both the blocked arteries in their heart and the potential neurological consequences that might arise as efforts are made to ‘unblock’ them.
A patient-centered approach emphasizing shared decision-making and understanding patient preferences seem like a reasonable starting point.

During the allotted time for discussion and questions, several people in the audience who have trained under and learned much from Dr. McKhann alluded to the great influence that he has had on their professional development.

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