Novel Assessments of Technical and Nontechnical Cardiac Surgery Quality: Protocol for a Mixed Methods Study

Area of Science:

• Cardiovascular Surgery
• Surgical Quality Improvement
• Health Services Research

Background:

• Coronary artery bypass grafting (CABG) complications affect 35% of 150,000 annual patients, increasing mortality and costs.
• Hospital variations in complications are poorly explained by patient risk or operative approach.
• The intraoperative phase is an understudied source of variation in CABG outcomes.

Purpose of the Study:

• To investigate the link between peer-assessed intraoperative technical and nontechnical skills and risk-adjusted complication rates.
• To assess the feasibility of using computer-based metrics for automated evaluation of surgical skills and practices.

Main Methods:

• Multicenter study utilizing video recordings, peer assessments, EHR data, and computer vision.
• Analyzing relationships between surgeon technical skills, team nontechnical practices, and patient adverse events.
• Exploring objective, data-driven methods for automating the assessment of intraoperative determinants of complications.

Main Results:

• The project is funded by the National Heart, Lung and Blood Institute (R01HL146619).
• Preliminary Institutional Review Board approvals are in place at the University of Michigan.

Conclusions:

• This research will enhance the assessment of factors influencing complication rate variations in cardiac surgery.
• Findings are expected to identify targets for trials and quality improvement initiatives to improve patient care safety and quality.