Abstract 4147882: Multiple Arterial Graft Use: Sustained Quality Improvement Following a Targeted Assessment and Programmatic Intervention

Introduction/Background: Multiple arterial grafting (MAG) provides superior outcomes compared to single arterial grafting in coronary artery bypass graft (CABG) patients. Studies and meta-analyses demonstrate MAG's association with improved survival, reduced major adverse cardiac events, and lower repeat revascularization rates. Despite strong evidence and guidelines, MAG utilization remains low nationally, ranging from 4-11%. Surgeons cite concerns such as advanced age, diabetes, and high body mass index (BMI) for not employing MAG. An educational and quality improvement initiative raised MAG usage from 11% to over 30% at one academic institution. This study reassesses MAG adoption trends and barriers three years later at the same institution. Research Question/Hypothesis: We investigated whether the increased adoption of MAG after a quality improvement initiative was sustained three years later. We hypothesized that MAG utilization would remain elevated due to the lasting impact of initial educational efforts, though some barriers might persist. Methods/Approach: We assessed MAG utilization and surgeons' reasons for not using MAG in isolated CABG procedures with two or more grafts over a four-month period. This evaluation aimed to determine if the previous quality improvement initiative's adoption of MAG was sustained post-implementation. The study analyzed MAG use frequency and surgeons' justifications for alternative methods, including patient outcomes, surgeon preferences, and institutional practices. Results: A total of 92 patients were included, with MAG used in 28 cases (30.4%). The MAG use rate three years earlier following the quality initiative was 30.5%. Predominant reasons for not using MAG were age > 65 (29.9%), diabetes (18.8%), BMI ≥35 (14.1%), and non-critical disease (9.4%), similar to concerns from three years prior: age >75 (30.8%), diabetes (23.1%), and BMI > 35 (22.9%) (Figure 1). Conclusions: The sustained adoption rate of MAG among cardiac surgeons at one institution highlights the complexities of changing surgical practices, even with targeted educational efforts. Continuous support and educational initiatives led by surgeon-champions are crucial for enhancing long-term adoption of evidence-based practices like MAG, ultimately improving patient care. Dedicated mentoring and regular training updates significantly influence the integration of advanced surgical techniques into routine practice, advancing patient treatment quality.