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Veena Guru
Stephen E. Fremes
Frederick L. Grover
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J Thorac Cardiovasc Surg 2005;130:1257
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

The identification and development of Canadian coronary artery bypass graft surgery quality indicators

Veena Guru, MD a , * , Geoffrey M. Anderson a , Stephen E. Fremes, MD a , Gerald T. O'Connor, PhD b , Frederick L. Grover, MD c , Jack V. Tu, MD, PhD a Canadian CABG Surgery Quality Indicator Consensus Panel

a Institute For Clinical Evaluative Sciences and Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Canada
b Professor, Medicine, Community and Family Medicine, Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH
c Division of Cardiovascular Surgery, University of Colorado, Denver, Colo

Received for publication March 25, 2005; revisions received May 2, 2005; accepted for publication July 22, 2005.

* Address for reprints: Veena Guru, MD, Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G106, Toronto, Ontario M4N 3M5, Canada (Email: veena.guru{at}utoronto.ca).

OBJECTIVE: The study objective was to develop quality indicators for coronary artery bypass graft surgery that relate to quality of care, associate with preventable death, and could be reported on performance reports.

METHODS: A comprehensive list of quality indicators was collected from quality improvement organizations including the Society For Thoracic Surgery, Northern New England Cardiovascular Disease Study Group, and Veteran's Affairs System. Indicators were collated from practice guidelines from the American College of Cardiology and the American Heart Association. A MEDLINE search using the keywords "quality indicators" and "coronary bypass" was completed. A 17-member multidisciplinary international expert panel was assembled, who voted using a 2-step Delphi process regarding association with quality of care, risk adjustment, association with preventable death, and inclusion on performance reports.

RESULTS: A total of 149 quality indicators were examined. This list was distilled to 33 indicators related to quality of care, 10 indicators that could be adequately risk adjusted, 34 indicators related to preventable death, and 18 indicators to be included on performance reports. These selected indicators consisted of 19 outcome variables, 23 process of care variables, and 4 structure variables. The quality indicators believed to be useful on a Canadian institutional coronary artery bypass graft surgery report card included the following: 30-day mortality, in-hospital mortality, electrocardiographic myocardial infarction, red cell transfusion, allogeneic blood product transfusion, deep sternal wound infection, postoperative stroke, postoperative dialysis, intensive care unit readmission, intensive care unit length of stay, ventilation time, repeat cardiac operation, repeat surgery with cardiopulmonary bypass, repeat revascularization, waiting time to surgery, completion of surgery within a recommended waiting time, use of left internal thoracic artery graft, and institutional volume.

CONCLUSIONS: This set of consensus quality indicators can be used as a standard list to be monitored by providers of coronary artery bypass graft surgery in an effort to continuously evaluate and improve their performance.

Abbreviations and Acronyms CABG = coronary artery bypass graft; ECG = electrocardiogram (electrocardiographic); ICU = intensive care unit; NQF = National Quality Forum




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