TY - JOUR
T1 - Multiple Arterial Graft Use in Coronary Artery Bypass Surgery
T2 - Surgeon Perspective vs Practice
AU - Velez, Ana K.
AU - Alejo, Diane
AU - Holmes, Sari D.
AU - Fonner, Clifford E.
AU - Clement, Kathleen C.
AU - Whitman, Glenn J.
AU - Salenger, Rawn
AU - Ad, Niv
AU - Lawton, Jennifer S.
N1 - Funding Information:
The authors wish to acknowledge all members of the Maryland Cardiac Surgery Quality Initiative who made this work possible. The authors have no funding sources to disclose. The authors have no conflicts of interest to disclose.
Publisher Copyright:
© 2023 The Society of Thoracic Surgeons
PY - 2023/9
Y1 - 2023/9
N2 - Background: Despite supportive evidence and guidelines, the use of multiple arterial grafts (MAGs) in coronary artery bypass grafting remains low. We sought to determine surgeon perception of personal MAG use and compare this with actual MAG use. Methods: We conducted a statewide surgeon survey of MAG use, presence of a hospital MAG protocol, and barriers for MAG use, with a response rate of 78% (n = 25). Surgeon survey responses were compared with actual Society of Thoracic Surgeons patient data from January 1, 2017, to December 31, 2020 using χ2 or Fisher's exact tests. Results: Of 5299 patients who had first-time, nonemergent, isolated coronary artery bypass grafting (≥2 grafts) by responding surgeons, 16% received MAG (n = 825). MAG use in patients whose surgeons self-designated as “routine” MAG users was 21% vs 7% for “nonroutine” users. Surgeons with a hospital protocol for MAG use utilized MAG more often (18% vs 14%, P = .001). Surgeons who were unconvinced by the data on the benefits of MAGs used MAGs in 11% vs 22% in surgeons who were convinced. MAG use increased over time, particularly from before to after the survey (13.1% vs 30.5%, P < .001). Conclusions: Although MAG use increased over time, barriers to routine use remain. In surgeons who reported routine use, only 21% of their patients received MAGs. Hospital protocols, education, and increased awareness may reduce barriers to use and encourage evidence-based clinical practice.
AB - Background: Despite supportive evidence and guidelines, the use of multiple arterial grafts (MAGs) in coronary artery bypass grafting remains low. We sought to determine surgeon perception of personal MAG use and compare this with actual MAG use. Methods: We conducted a statewide surgeon survey of MAG use, presence of a hospital MAG protocol, and barriers for MAG use, with a response rate of 78% (n = 25). Surgeon survey responses were compared with actual Society of Thoracic Surgeons patient data from January 1, 2017, to December 31, 2020 using χ2 or Fisher's exact tests. Results: Of 5299 patients who had first-time, nonemergent, isolated coronary artery bypass grafting (≥2 grafts) by responding surgeons, 16% received MAG (n = 825). MAG use in patients whose surgeons self-designated as “routine” MAG users was 21% vs 7% for “nonroutine” users. Surgeons with a hospital protocol for MAG use utilized MAG more often (18% vs 14%, P = .001). Surgeons who were unconvinced by the data on the benefits of MAGs used MAGs in 11% vs 22% in surgeons who were convinced. MAG use increased over time, particularly from before to after the survey (13.1% vs 30.5%, P < .001). Conclusions: Although MAG use increased over time, barriers to routine use remain. In surgeons who reported routine use, only 21% of their patients received MAGs. Hospital protocols, education, and increased awareness may reduce barriers to use and encourage evidence-based clinical practice.
UR - http://www.scopus.com/inward/record.url?scp=85147229816&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147229816&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2022.11.041
DO - 10.1016/j.athoracsur.2022.11.041
M3 - Article
C2 - 36608752
AN - SCOPUS:85147229816
SN - 0003-4975
VL - 116
SP - 474
EP - 481
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -