STS National Database Plays Key Role in New HAI Study

STS News, Winter 2014 -- STS is partnering with the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC) and the University of Michigan to study ways of preventing health care-acquired infections (HAIs) after cardiac surgery. The Agency for Healthcare Research and Quality has awarded a grant of nearly $1.6 million over a 4-year period for the project.

The grant was secured with the help of the STS Research Center, and Richard L. Prager, MD, Head of Adult Cardiac Surgery at the University of Michigan and Chair of the STS Task Force on Quality Initiatives, will be the principal investigator (PI) for the Society. The project PI is STS Associate Member Donald S. Likosky, PhD, Head of the Section of Health Services Research and Quality in the Department of Cardiac Surgery at the University of Michigan.

The first goal of the project is to identify patient risk factors and clinical practices that are associated with HAIs after cardiac surgery. Examples of HAIs in this setting include postoperative pneumonia and sepsis/septicemia, as well as surgical site infections (i.e., deep sternal wounds, thoracotomy, and harvest/cannulation site infections). To accomplish this, the project team will analyze data within the MSTCVS-QC, which includes center-specific data from the STS National Database, and conduct surveys and site visits at each of the 33 institutions throughout Michigan that perform cardiac surgery.

“Health care-acquired conditions elevate a patient’s risk of morbidity and mortality. Such infections also increase overall health care and societal costs,” said Dr. Likosky. “What we want to do through this grant is understand what the sites that do really well are doing that the other sites are not. By doing that, we’ll hopefully be able to implement best practices and reduce the overall rate of infection.”

Finally, the team will evaluate the effectiveness of these best practices by assessing how HAI rates at participating institutions have changed over time. The rates will also be compared to national data on HAIs from the Adult Cardiac Surgery Database component of the STS National Database.

“The STS data will be vital because we want to leverage our experience within the state to the national experience. We not only want to see if our rates improve over time, but also how the Michigan rates relate to the national experience,” Dr. Likosky said.

“Infectious complications are thankfully uncommon, but that also makes it difficult to obtain sufficient data to study the complications. With the STS National Database, however, there are huge numbers of patient records. The large volume provides an excellent source of information to examine patient characteristics and outcomes that are relatively uncommon so we can obtain a clear picture of even rare events,” said Fred H. Edwards, MD, Director of the STS Research Center.

The hope is that the study will identify a set of best practices that all cardiac surgeons across the country can implement in their own institutions.

“As cardiac surgeons, our goal is to avoid infection in any patient we operate on. Recognizing, however, that this does occur, a study such as this may be a major step in clarifying our understanding of HAIs and creating opportunities for improved practices for our entire profession,” Dr. Prager said.

Dr. Likosky said the project team hopes to complete the risk factor analysis by the second quarter of 2014.