Summary

A large variation in clinical outcomes and cost has been observed in the many CABG procedures performed annually. A Clinical Practice Improvement study was conducted at 15 hospitals throughout the US to determine areas of significant improvement in the management of CABG patients. Results show that, after controlling for severity of illness, several treatments were associated with longer length of stay, higher cost, greater increase of severity of illness from admission (first 24 hours) to maximum during the hospital stay, and more post-operative infections.

Primary Objectives

1. Determine which patient variables, e.g., demographics, comorbidities, smoking history, baseline weight, albumin level, body mass index, number previous PCTAs, failed PCTAs, and percent occlusion, are associated with better or worse outcomes.
   

2. Determine which process variables, e.g., intraoperative dosing and drugs used, duration of anesthesia and anesthesia agents used, ventricular assistive device used, cross-clamp time, and number of bypass grafts, are associated with better or worse outcomes.

Methods

1. Data were collected on 850 separate variables from 3,000 CABG patients.
   

2. Outcome variables included several complications: transfusion reaction, bleeding problems, lower respiratory infections, wound infections, pulmonary emboli, edema, arrythmias, post-operative return to surgery, myocardial infarction, cardiac or respiratory arrest, CVA, length of stay, and cost.
   

3. Multivariate analyses were performed on all data.

Results

Preliminary Findings (Further analyses in progress.)

1. Wound infection was associated with low serum albumin level during hospitalization (< 2.7 g/dl), only internal mammary veins used, crystalloid for cardioplegia > 1250 cc during surgery, higher body mass index, and elevated blood glucose 4 days post surgery
   

2. Myocardial infarction (peri- or post-operative) was associated with a larger amount of crystalloid for cardioplegia and extra for pump during surgery, and more previous angioplasties.
   

3. Post-operative respiratory infection was associated with low serum albumin level during hospitalization (2.5-2.99 g/dl), post-operative antiemetic use, a larger amount of crystalloid for cardioplegia during surgery, a longer time until first post-op eating, and having smoked within the last 3 months.
   

4. Longer length of stay and mortality were associated with lower serum level during hospitalization, older age, confusion, and longer time until first post-op feeding.

Impact

Further analyses are in progress.