Quantification of operational learning in off-pump coronary bypass.
OBJECTIVE
The use of off-pump coronary artery bypass grafting (OPCAB) has been associated with similar or even worse results vs on-pump coronary artery bypass graft (CABG). Different production processes demand re-engineering, operational learning and quality loops to study and reduce negative learning curves. This analysis studies and quantifies the impact of these processes on the early mortality of continued re-engineering and quality loops within the OPCAB patient group.


METHODS
We re-engineered CABG towards OPCAB in October 1999. A consecutive cohort of 3054 patients, representing 92.3% (ranging from 90% in 2000 to 99% in 2001 and later) of all primary and redo isolated CABG from that same period, was divided into three consecutive cohorts of 1018 patients. An anniversary follow-up at 3 months was complete for 100% of the patients. The 1- and 3-month survivals are studied using saturated propensity score matching and stratification for cohort variability (area under the curve = 0.82).


RESULTS
Despite a progressively worsening risk profile (history of vascular disease, stroke and diabetes; main stem stenosis; left ventricular dysfunction), a survival improvement was shown between the consecutive cohorts. This improvement remained valid after the propensity stratification and propensity matching at 1 (97.6 vs 99.3%, P < 0.001) and at 3 months (96.7 vs 98.8%, P < 0.001).


CONCLUSIONS
OPCAB re-engineering, followed by operational learning, improved the early survival even in the presence of a worsening risk profile.
Department of Cardiac Surgery, University Hospital Leuven, Leuven, Belgium. matteo.pettinari@uzleuven.be
Matteo
M
Pettinari
Paul
P
Sergeant
Bart
B
Meuris
D000368:Aged; D001530:Belgium / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000193:education* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors