Abstract
BACKGROUND: We report a custom-designed visual feedback tool integrated into a comprehensive quality improvement (QI) program to drive accelerated, real-time advances in coronary artery bypass grafting (CABG) surgery. METHODS: The Society of Thoracic Surgeons (STS) risk profiles of 977 consecutive patients who underwent CABG between January 1, 2021, and December 31, 2024 risk profiles were analyzed. For 2021-2022, the mortality observed-to-expected ratio (O/E) was 2.5. In 2023, we started a real-time, rapid cycle process improvement program. We designed a QI tool to calculate in real time the O/Es for death, stroke, renal failure, prolonged ventilation, reoperation, deep sternal wound infection, prolonged length of stay, and failure of left internal mammary artery (LIMA) use or medication compliance. We developed a final composite score in which we assigned 80% to mortality, 7% to LIMA use, 3% to medications, and 10% to nonfatal STS adverse outcomes as a rough estimate of the STS 3-star CABG construct. For a final composite grade, we assigned "good" (O/E < 0.65), "fair" (O/E = 0.65-1.0), or "poor" (O/E > 1.0) for each adverse outcome. RESULTS: The CABG mortality O/E improved from 1.5 in 2021-2022 to 0.25 in 2023-2024 (P < .0001; z = 327,991). The final composite O/E for 2023-2024 was 0.55 ("good"). This resulted in a final composite grade of "good," coinciding with our 3-star STS status for isolated CABG. CONCLUSIONS: Our custom-designed QI tool enabled rapid improvement of our CABG outcomes (P < .0001). This report is unique because it uses the publicly available STS risk calculator for real-time rapid cycle process improvement, integrated into a comprehensive QI program.