title: Outcomes after usage of a quality initiative program for off-pump coronary artery bypass surgery: a comparison with on-pump surgery.
abstract: BACKGROUND
  Off-pump coronary artery bypass (OPCAB) may be associated with improved outcomes when compared with on-pump coronary artery bypass. This study evaluates the use of a system for access and stabilization (SAS) with a coronary stabilizer as well as a clinical effectiveness quality initiative (CEQI) process regarding outcomes. This included the development of an expanded heart care team as well as standardization and refinement of perioperative care at The Lankenau Hospital (TLH). Our aim was to evaluate morbidity and mortality of on-pump coronary artery bypass grafting (CABG) compared with OPCAB surgery using SAS in addition to a CEQI initiative.
  
  
  METHODS
  A retrospective consecutive cohort study using the Society of Thoracic Surgery (STS) National Database was conducted. Three cohorts were analyzed: pre-SAS (December 1, 1999-August 31, 2000); use of SAS only (September 1, 2000-April 30, 2001), and the use of SAS + CEQI process (May 1, 2001-September 30, 2002). Morbidity and mortality for all on-pump CABG procedures performed over the time period of December 1, 1999-September 30, 2002 were compared with the SAS and SAS + CEQI groups only.
  
  
  RESULTS
  One-thousand two-hundred sixty-seven procedures were performed; 405 on-pump CABGs, 90 OPCABs pre-SAS, and 772 OPCABs with SAS, of which 552 were in the SAS + CEQI group. Statistically mortality was significantly lower in the SAS + CEQI vs the on-pump group (0.7% vs 3.0%, p < 0.01). The percentage of patients with prolonged ventilation was significantly lower statistically in the SAS + CEQI vs the on-pump group (4.2% vs 9.7%, p < 0.01). Statistically the length of stay was significantly lower in both SAS groups compared with the on-pump group (p < 0.01).
  
  
  CONCLUSIONS
  OPCAB surgery using SAS in conjunction with a CEQI initiative improves outcomes for patients compared with on-pump CABG surgery.
authors.affiliation: Department of Anesthesia, Christiana Care Health Services, Wilmington, Delaware, USA.
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Gobran
authors.forename: Scott
authors.initials: S
authors.lastname: Goldman
authors.forename: Francis
authors.initials: F
authors.lastname: Ferdinand
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Wertan
authors.forename: Candace
authors.initials: C
authors.lastname: Trace
authors.forename: Gary L
authors.initials: GL
authors.lastname: Grunkemeier
authors.forename: Yingxing
authors.initials: Y
authors.lastname: Wu
authors.forename: Francis P
authors.initials: FP
authors.lastname: Sutter
mesh_terms: D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality / Q000592:standards*; D047549:Coronary Artery Bypass, Off-Pump / Q000295:instrumentation* / Q000592:standards; D006801:Humans; D010348:Patient Care Team; D011182:Postoperative Care; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome