More than 400,000 coronary artery bypass grafting (CABG) procedures are performed every year in the United States (U.S.). Patients undergoing CABG surgery are at risk for a number of adverse sequelae, many of which impact survival and contribute to overall health-care costs. Healthcare-acquired infections (HAIs), including pneumonia and superficial and deep sternal wound infections, occur among 16% of CABG patients and elevate a patient's risk of mortality and add excess upfront and long-term expenditures to the health care system. A number of barriers prevent wide-scale improvements in HAI rates within the setting of CABG surgery. While a number of HAI prophylaxis measures have been developed, these measures do not fully encompass the set of practices that may impact a patient's risk of HAI. Identifying cardiac surgery specific risk factors would serve as th foundation for targeted quality improvement strategies. In the absence of definitive data concerning best practices, HAI prophylaxis is variable across surgeons and institutions, resulting in unnecessary morbidity and cost. Prior work has shown the value of implementing evidence-based protocols in the general intensive care unit setting. To what extent the implementation of cardiac surgery specific standardized practices results in lower HAI rates is uncertain. An understanding of the effectiveness of this approach would certainly assist surgeons and institutions in providing safer care to their patient populations. Rates of HAIs vary from 0-26% across the 33 institutions performing CABG surgery in Michigan. This application seeks to reduce this rate by identifying and subsequently implementing standardized practices, and evaluating their impact on HAI rates. This study will be based on the prospective data and regional quality improvement activities and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). We will evaluate the effectiveness of these standardized practices in reducing HAIs regionally and relative to national rates during the same time period.

Public Health Relevance

Healthcare-acquired infections (HAIs), while potentially avoidable, are major contributors to morbidity and mortality in the setting of cardiac surgery. In the absence of well-grounded evidence regarding prophylaxis, practices and outcomes vary. The goal of this project is to reduce HAIs among Michigan hospitals, with the overarching goal of improving the quality and safety of care.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
Project #
Application #
Study Section
Program Officer
Gray, Darryl T
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
Zip Code
Brescia, Alexander A; Rankin, J Scott; Cyr, Derek D et al. (2018) Determinants of Variation in Pneumonia Rates After Coronary Artery Bypass Grafting. Ann Thorac Surg 105:513-520
Likosky, Donald S; Harrington, Steven D; Cabrera, Lourdes et al. (2018) Collaborative Quality Improvement Reduces Postoperative Pneumonia After Isolated Coronary Artery Bypass Grafting Surgery. Circ Cardiovasc Qual Outcomes 11:e004756
Likosky, Donald S; Baker, Robert A; Newland, Richard F et al. (2018) Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer? J Extra Corpor Technol 50:225-230
Liang, Qixing; Ward, Sarah; Pagani, Francis D et al. (2018) Linkage of Medicare Records to the Interagency Registry of Mechanically Assisted Circulatory Support. Ann Thorac Surg 105:1397-1402
Camaj, Anton; Zahuranec, Darin B; Paone, Gaetano et al. (2017) Organizational Contributors to the Variation in Red Blood Cell Transfusion Practices in Cardiac Surgery: Survey Results From the State of Michigan. Anesth Analg 125:975-980
Strobel, Raymond J; Liang, Qixing; Zhang, Min et al. (2016) A Preoperative Risk Model for Postoperative Pneumonia After Coronary Artery Bypass Grafting. Ann Thorac Surg 102:1213-9
Ellis, Michelle C; Paugh, Theron A; Dickinson, Timothy A et al. (2015) Nadir Hematocrit on Bypass and Rates of Acute Kidney Injury: Does Sex Matter? Ann Thorac Surg 100:1549-54; discussion 1554-5
Likosky, Donald S; Wallace, Amelia S; Prager, Richard L et al. (2015) Sources of Variation in Hospital-Level Infection Rates After Coronary Artery Bypass Grafting: An Analysis of The Society of Thoracic Surgeons Adult Heart Surgery Database. Ann Thorac Surg 100:1570-5; discussion 1575-6
Goldberg, Joshua; Paugh, Theron A; Dickinson, Timothy A et al. (2015) Greater Volume of Acute Normovolemic Hemodilution May Aid in Reducing Blood Transfusions After Cardiac Surgery. Ann Thorac Surg 100:1581-7; discussion 1587
Likosky, Donald S; Paone, Gaetano; Zhang, Min et al. (2015) Red Blood Cell Transfusions Impact Pneumonia Rates After Coronary Artery Bypass Grafting. Ann Thorac Surg 100:794-800; discussion 801

Showing the most recent 10 out of 11 publications