The Pursuit Of Cabg Excellence: Improvement In Sts Isolated Cabg Star Ranking Following Implementation Of Program And Surgeon Specialization.
A. Claire Watkins, Mehrdad Ghoreishi, Nathan L. Massel, Brody Wehman, Filiz Constantini, Bartley P. Griffith, James S. Gammie, Bradley S. Taylor.
University of Maryland, Baltimore, MD, USA.
OBJECTIVE: Clinical outcomes for isolated CABG are publically reported, compared across institutions and designated as one, two or three star programs according to performance by the STS. With the goal of improving our clinical outcomes and STS star rating, our institution developed and implemented a subspecialized coronary surgery program.
METHODS: The STS database entries for all isolated CABG operations, as well as STS star rankings, for a single institution were retrospectively before and after the implementation of subspecialized center dedicated to coronary surgery in 2013. Policies implemented in the coronary program included appointed leadership and specialization of a program director, standardization of surgical technique and postoperative care, and monthly multidisciplinary quality review (Figure (A)). Outcomes were collected and compared.
RESULTS: CABGs done following specialization had shorter bypass and clamps times, increased use of bilateral internal mammary arteries (IMA), decreased blood transfusion, permanent stroke and prolonged ventilation. Operative mortality (2.7% vs 1.4%, p value=0.02) was significantly reduced. Prior to subspecialization in CABG, the institution was a 1-star program, performing at the 12th percentile. In the subsequent 4 years, the programís ranking had improved to a 2-star program, performing at the 58th percentile (Figure (B)).
CONCLUSIONS: Subspecialization in CABG and development of dedicated coronary surgery programs may improve clinical outcomes following isolated CABG, and serve to steadily improve a programís STS star rating for isolated CABG. Despite improvements in process measures and quality metrics a 3-star ranking remains elusive.
*A portion of this data was presented at the AATS 2017 Centennial Meeting and is submitted for publication in the Journal of Thoracic and Cardiovascular Surgery.
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