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

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. This prospect...

Full description

Saved in:

Bibliographic Details
Published in:	International journal of surgery (London, England) Vol. 110; no. 5; pp. 2535 - 2544
Main Authors:	Mejia, Omar A V, Borgomoni, Gabrielle B, de Freitas, Fabiane Letícia, Furlán, Lucas S, Orlandi, Bianca Maria M, Tiveron, Marcos G, Silva, Pedro Gabriel M de B E, Nakazone, Marcelo A, Oliveira, Marco A P de, Campagnucci, Valquíria P, Normand, Sharon-Lise, Dias, Roger D, Jatene, Fábio B
Format:	Journal Article
Language:	English
Published:	United States Lippincott Williams & Wilkins 01-05-2024
Subjects:	Aged Coronary Artery Bypass - adverse effects Coronary Artery Bypass - mortality Female Humans Male Mentoring Middle Aged Original Research Postoperative Complications - epidemiology Postoperative Complications - mortality Propensity Score Prospective Studies Quality Improvement
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	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. 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. 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1743-9159 1743-9191 1743-9159
DOI:	10.1097/JS9.0000000000001153