Quality Statements for Coronary Artery Bypass Procedures at Jefferson (CABG)

Physician Board Certification Quality Statement
A board-certified physician has completed an approved educational training program and an evaluation process including an examination designed to assess the knowledge, skills, and experience necessary to provide quality patient care in that specialty. A specialty certificate is issued by a medical specialty certifying board, which is valid nationwide.  Although certification is not required for an individual physician to practice medicine, most hospitals and managed care organizations require that at least a certain percentage of their staff be “board certified."  ABMS Member Boards.  ( American Board of Medical Specialties) 

All of Thomas Jefferson University Hospital’s board-eligible cardiothoracic surgeons are board certified in Thoracic Surgery by the American Board of Thoracic Surgery. 

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Advanced Techniques or Interventions Quality Statement
In the past decade, improvements in techniques, practices, and processes, have contributed to improved outcomes. ( Annals of Surgery, January 2004: 239(1): 110-17)

Thomas Jefferson University Hospital offers newer techniques for coronary artery bypass procedures when appropriate, including off-pump CABG, off-pump valve surgery, minimally-invasive CABG, minimally-invasive valve surgery, endoscopic procedures, transmyocardial laser revascularization (TMR).

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Internal Mammary Artery Graft Quality Statement
Veins or arteries may be used to bypass obstructed coronary arteries. A piece, or section, of a vein is usually taken from one or both legs. An artery in the chest, the internal mammary artery (IMA), may also be used. A section of other arteries may sometimes be used, such as the radial artery near the wrist.

Use of the internal mammary artery (IMA) to bypass the left anterior descending (LAD) coronary artery has been considered the “gold standard” since 1985. ( New England Journal of Medicine , January 2, 1986: 314 (1); 1-6) The National Quality Forum (NQF) includes the use of internal mammary artery grafts as a standard in its National Voluntary Consensus Standards for Hospital Care: An Initial Performance Measure Set, published in 2003.

The routine use of the left internal mammary artery (LIMA) for bypassing the left anterior descending (LAD) coronary artery (one of the main coronary arteries) with supplemental saphenous vein grafts (taken from a leg vein) to other coronary artery lesions (obstructions) is generally accepted as the standard grafting method. ( ACC/AHA GUIDELINES FOR CABG SURGERY: Journal of the American College of Cardiology:   34(4) October 1999; 1262-1347)

More recently, it has been established that the IMA may be safely used in more situations than previously thought, such as during emergency operations, in elderly patients, and in the presence of certain conditions such as severe left ventricular dysfunction (poor pumping ability of the left ventricle), chronic obstructive pulmonary disease with enlarged lungs, and an obstructed left subclavian artery (located under the collarbone). ( Circulation , January 2001: 103(4); 507-512)

Internal mammary artery grafts were used, when indicated, in 93% of all CABG procedures performed between October 2003 and March 2004 at Thomas Jefferson University Hospital.

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Antibiotic Prophylaxis Quality Statement
According to JCAHO’s Surgical Infection Prevention Core Performance Measures, patients undergoing coronary artery bypass graft (CABG) should receive a prophylactic antibiotic within one hour prior to the surgical incision being made. 

95% of Thomas Jefferson University Hospital’s surgical patients received the appropriate preoperative prophylactic antibiotics, most within one hour prior to surgical incision, during the period of October 2003 to March 2004.

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Aspirin at Discharge Quality Statement
Aspirin significantly reduces vein graft closure during the first postoperative year. ( Circulation , September 28, 1999: 100(13); 1464-1480) 

97% of coronary artery bypass graft (CABG) patients who receive vein grafts at Thomas Jefferson University Hospital have aspirin prescribed at discharge during the period of October 2003 to March 2004.   

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Inpatient Mortality Rate Quality Statement
According to the most recent national data available from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality (AHRQ) , the inpatient mortality rate for CABG was 2.3 percent.

The inpatient mortality rate for CABG at Thomas Jefferson University Hospital was 3.6% in CY 2003, which compares favorably to other academic medical centers.