Statewide Quality Collaborative As a Forum for Change: Promoting Adoption of Multiarterial Grafting in Coronary Artery Bypass Graft Surgery.

Abstract

The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative implemented a quality improvement initiative in 2016 to increase multiarterial graft (MAG) use during isolated coronary artery bypass grafting (CABG). This initiative was associated with a marked increase in MAG use compared with historical rates, from 7.4% at baseline to 21.7% in 2019. The present study provides an update on this statewide quality initiative and assesses the safety of MAG with respect to operative mortality and major morbidity as MAG increasingly becomes the default revascularization strategy. We queried the statewide database to identify adults undergoing primary CABG with the internal thoracic artery and at least 1 additional graft between January 1, 2014, and December 31, 2023. MAG was defined as the use of ≥2 arterial conduits, with or without additional venous grafts. Annual trends were analyzed using the Cochran-Armitage trend test. Postoperative outcomes, based on The Society of Thoracic Surgeons definitions, were reported as observed-to-expected ratios with bootstrapped 95% CIs. MAG use increased from 7.5% in 2014 to 39.9% in 2023 (P < .001). The observed-to-expected ratio for operative mortality after MAG was 1.11 (95% CI, 0.97-1.3), indicating no increased risk of death associated with MAG. Statewide surgeon-led collaborative quality improvement efforts continue to drive MAG adoption in isolated CABG operations in Michigan. MAG use was not associated with increased operative mortality over the past decade, supporting its safe implementation in routine practice. This statewide quality collaborative experience may serve as model to scale adoption of MAG nationally.