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Multicenter Study
. 2024 May 1;110(5):2535-2544.
doi: 10.1097/JS9.0000000000001153.

Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study

Omar A V Mejia  1   2   3 , Gabrielle B Borgomoni  1   2   3 , Fabiane Letícia de Freitas  1 , Lucas S Furlán  1 , Bianca Maria M Orlandi  1 , Marcos G Tiveron  4 , Pedro Gabriel M de B E Silva  2 , Marcelo A Nakazone  5 , Marco A P de Oliveira  6 , Valquíria P Campagnucci  7 , Sharon-Lise Normand  8 , Roger D Dias  9 , Fábio B Jatene  1 ; REPLICCAR Study Group
Affiliations
Multicenter Study

Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study

Omar A V Mejia et al. Int J Surg. .

Abstract

Background: The impact of quality improvement initiatives program (QIP) on coronary artery bypass grafting surgery (CABG) remains scarce, despite improved outcomes in other surgical areas. This study aims to evaluate the impact of a package of QIP on mortality rates among patients undergoing CABG.

Materials and methods: This prospective cohort study utilized data from the multicenter database Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II), spanning from July 2017 to June 2019. Data from 4018 isolated CABG adult patients were collected and analyzed in three phases: before-implementation, implementation, and after-implementation of the intervention (which comprised QIP training for the hospital team). Propensity Score Matching was used to balance the groups of 2170 patients each for a comparative analysis of the following outcomes: reoperation, deep sternal wound infection/mediastinitis ≤30 days, cerebrovascular accident, acute kidney injury, ventilation time >24 h, length of stay <6 days, length of stay >14 days, morbidity and mortality, and operative mortality. A multiple regression model was constructed to predict mortality outcomes.

Results: Following implementation, there was a significant reduction of operative mortality (61.7%, P =0.046), as well as deep sternal wound infection/mediastinitis ( P <0.001), sepsis ( P =0.002), ventilation time in hours ( P <0.001), prolonged ventilation time ( P =0.009), postoperative peak blood glucose ( P <0.001), total length of hospital stay ( P <0.001). Additionally, there was a greater use of arterial grafts, including internal thoracic ( P <0.001) and radial ( P =0.038), along with a higher rate of skeletonized dissection of the internal thoracic artery.

Conclusions: QIP was associated with a 61.7% reduction in operative mortality following CABG. Although not all complications exhibited a decline, the reduction in mortality suggests a possible decrease in failure to rescue during the after-implementation period.

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Conflict of interest statement

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Figures

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Graphical abstract
Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Methodology used for implementing a package of measures focusing on quality improvement initiatives.
Figure 3
Figure 3
ROC curve of the model.
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See this image and copyright information in PMC

References

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