Collaborative quality improvement may reduce post-CABG pneumonia

SAN DIEGO – Participation in a collaborative quality improvement program appears to be associated with a significant reduction in pneumonia following isolated coronary artery bypass grafting surgery, according to findings presented at the 38th Annual Cardiothoracic Surgery Symposium.

Donald S. Likosky, PhD, associate professor of cardiac surgery at the University of Michigan, discussed the value of the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS). The STS provides a system for the compiling and evaluation of clinical data for surgical teams. At present, almost 100% of US cardiac surgeons submit data to the STS for this purpose. In addition to participating in the STS, some surgical programs also participate in collaborative learning, Likosky said.

“This collaborative learning process is one in which physicians come together, along with other cardiac circle team members, and they share data about their practice and outcomes,” he said. “They seek to learn about their practices, and to learn from what other cardiac surgical teams are doing, and they take that learning back to their institutions to make targeted changes in their practice.”

Only about 10% of cardiac surgical programs in the US participate in collaborative learning, Likoski said, adding that participation in collaborative learning seems to result in reduced morbidity and mortality in participating programs.

Likoski described a study undertaken by the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) in conjunction with the STS, to assess the value of the collaborative learning process in reducing postoperative pneumonia. Pneumonia is the most prevalent infection seen in coronary artery bypass grafting (CABG).

The study assessed a cohort of 1.7 million patients who underwent surgery at 1,198 hospitals between July 2011 and June 2017. Patients who didn’t receive isolated CABG surgery, or who had active or treated endocarditis were excluded, leaving approximately 900,000 surgeries at almost 1,200 centers.

“We then divided the cohort into a pre-intervention period and an intervention period,” Likoski said. “Then we spread out each one of those cohorts into centers that participated in our statewide collaborative in Michigan versus the rest of the country.”

The study intervention was collaborative learning, and the outcome was postoperative pneumonia. In the first phase of the study, the researchers used multivariable logistic aggression to account for factors possibly associated with pneumonia and postoperative outcomes. In the second phase of the study, the researchers assessed the enhancements of implementation support.

The researchers conducted interviews with high-performing hospitals and lower-performing hospitals, gathering information on how these institutions identified patients at risk for postoperative pneumonia, as well as their perioperative and postoperative care approaches to these patients. The data collected were presented to the MSTCVS-QC, which used the information to develop state-wide recommendations.

They found that the STS non-Michigan hospitals demonstrated a 1.96 adjusted decreased odds of postoperative pneumonia over the course of the study. Sites that participated in the collaborative learning intervention showed a decrease in pneumonia rates of more than 3%.

“In the 18 hospitals that agreed to track each of our recommendations and received implementation support, there’s a 10% reduction in the odds of postoperative pneumonia,” Likoski said.

In terms of major morbidity and mortality, the STS non-Michigan hospitals achieved a 10.9% reduction in the odds of these outcomes, while the collaborative learning hospitals had a 14.1% reduction in the odds of major morbidity and mortality.

“I’m not saying that participating in STS doesn’t help you – that’s not the goal of this,” Likoski said. “There was a reduction. However, getting together, talking about your data, and receiving support about making targeted improvements in your program was associated with a significant, further reduction in pneumonia relative to the rest of the country.” -- by Jennifer Byrne

Reference:
Likosky DS. Collaborative quality improvement reduces post-operative pneumonia following isolated coronary artery bypass grafting surgery. Presented at: The Annual Cardiothoracic Surgery Symposium; Sept. 6-9, 2018; San Diego.

Disclosure: Likoski reports no relevant disclosures.