Seeking Better Outcomes in Coronary Artery Bypass Grafting

Abstract

Are we delivering the safest and most effective care? How best can we learn from our experience? For healthcare professionals who ask these questions, the article by Guru and colleagues in this issue of Circulation is essential reading.1 These Canadian investigators performed an implicit review and retrospective analysis of 347 randomly selected in-hospital deaths after coronary artery bypass grafting (CABG) surgery and determined that approximately one third might have been prevented by better care. The study offers many important lessons with implications far beyond cardiac surgery. Article p 2969 Guru and colleagues uncovered many opportunities for important improvements in a hospital system that could have been content with its successes. Their investigation was conducted in a system with no low-volume hospitals and low risk-adjusted mortality rates and involved the participation of experienced staff surgeons and division chiefs. They found remarkably high percentages of preventable deaths, defined as deaths that could have been avoided had optimal care been delivered. Optimal care was considered to be the best possible care that could be delivered if current resources were operating at peak performance in accordance with the best available evidence at the time of the hospital admission. The investigators found that as many as 107 preventable CABG-related deaths occurred in Ontario in fiscal year 2000 to 2001. These deaths occurred in every institution. In particular, the highest percentages of preventable deaths were not clustered at the institutions with the highest risk-adjusted mortality rates, indicating that even a low mortality rate should not beget complacency. Even in the hospital with the lowest risk-adjusted mortality rate, about 20% of deaths were deemed to be preventable. Guru and colleagues focused specifically on contributing causes of deaths that may have been prevented. In this way, many deaths had more than 1 potential contributing cause. In each …