Foundation Program Sites

COAP Quality Indicators

Cardiovascular Surgery COAP Quality Indicators

Level

Outcome

Definition

 

 

 

I

Operative Mortality CABG All in-hospital deaths, even if after 30 days post surgery, and all deaths occurring after discharge but before the end of the 30th postoperative day
AVR
MVRR
Post-Operative Stroke Postoperative stroke, defined as any confirmed neurological deficit of abrupt onset caused by a disturbance in blood supply to the brain, that did not resolve within 24 hours
New Onset Renal Failure

Acute renal failure or worsening renal function resulting in ONE or BOTH of the following:

1) Increase in serum creatinine level 3.0 x greater than baseline, or serum creatinine level ≥ 4 mg/dL. Acute rise must be at least 0.5 mg/dL.

2) New requirement for dialysis

LIMA Use Left IMA used
 

 

 

ll

Deep Sternal Wound Infection Within 30 days postoperatively, patient had a deep sternal infection involving muscle, bone, and/or mediastinum requiring operative intervention
Any Unplanned Return to OR Return to OR for bleeding/tamponade, graft occlusion, valvular dysfunction, or other cardiac

Early Extubation

Initial vent hours <6
RBC Transfusion Any intra- or post-op RBC units
30 Day Readmission Readmission to an acute care facility as an in-patient within 30 days from the date of initial surgery for ANY reason
 

 

 

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Long Length of Stay LOS surgery – discharge >14 days
 

Prolonged Ventilation

Postop vent hours >24; vent time includes OR exit until extubation plus any additional hours following reintubation
Short Length of Stay LOS surgery – discharge <6 days
Multi-Arterial Grafting Rate of surgeries with >1 arterial grafts
Mitral Valve Repair Isolated

Rate of mitral valve repairs vs replacements

Concomitant

Procedure

Cardiac Rehab Referral Discussion conducted/advice given regarding the importance of joining a cardiac rehabilitation program, or an appointment made
Smoking Cessation Counseling Prior to discharge, patient received smoking cessation counseling.  NA for patients who are non-smokers > 1 year

PCI COAP Quality Indicators

Level 

Outcomes 

Definition 

 

 

Mortality  STEMI  Any death during hospitalization 
N-STEMI 
Non-Acute 
Door to Balloon Time  STEMI  > 90% of patients meeting door to balloon time < 90 minutes 
 

 

 

 

 

 

 

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Appropriate Use  Non-Acute 

% of Non-Acute PCI classified as Rarely Appropriate; % of Non-Acute PCI Unclassifiable 

Exclusion: sites with < 10 Non-Acute PCIs  

 

Bleeding Event w/in 72 hours  All PCIs 

Suspected or confirmed bleeding event observed and documented in the medical record that was associated with any of the following: 

1)Hemoglobin drop of ≥ 3g/dL 

2) Transfusion of whole blood or packed red blood cells 

3) Procedural intervention/surgery at the bleeding site to reverse/stop or correct the bleeding 

 

Unplanned CABG  All PCIs  Unplanned coronary artery bypass graft (CABG) surgery 

Post Procedure Cardiogenic Shock 

 

 

Non-Acute 

New onset or acute recurrence of cardiogenic shock. 

Sustained (>30 minutes) episode of systolic blood pressure <90 mm Hg, and/or cardiac index <2.2 L/min/m2 determined to be secondary to cardiac dysfunction, and/or the requirement for parenteral inotropic or vasopressor agents or mechanical support to maintain blood pressure and cardiac index.   

NOTE: Transient episodes of hypotension reversed with IV fluid or atropine do not constitute cardiogenic shock. The hemodynamic compromise (with or without extraordinary supportive therapy) must persist for at least 30 min. 

 

Radial Artery Use  STEMI 

PCI performed via radial access 

 

RBC/Whole Blood Transfusion  

 

  Post-PCI transfusion 

 

Level  Outcomes  Definition 
 

 

 

 

 

 

  

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Stroke   All PCIs  Any post procedure stroke (ischemic, hemmorhagic, other) 
Tamponade  All PCIs 
Fluid in the pericardial space compromising cardiac filling and requiring intervention. Tamponade should be documented by either: 1) echocardiogram showing pericardial fluid and signs of tamponade such as right heart compromise, or 2) Systemic Hypotension due to pericardial fluid compromising cardiafunction

Acute Kidney Injury 

 

 

All PCIs 

Acute Kidney Injury Network (AKIN) stage 1 or greater or a new requirement for dialysis following PCI, excluding those on dialysis prior to procedure, those undergoing multiple PCI procedures within the same admission, those without both a pre-post procedure creatinine, and those with same day discharges:  

1. % missing pre/post creatinine  

2. Stage 1 is defined as an absolute increase of ≥ 0.3 mg/dL or a relative increase of 50% in serum creatinine (Cr)  

3. Stage 2 is defined as an increase in serum Cr to more than 200% to 300% (>2-to 3- fold) from baseline,  

4. Stage 3 is defined as increase in serum Cr to more than 300% (>3-fold) from baseline (or serum Cr of more than or equal to 4.0 mg/dl with an acute increase of at least 0.5 mg/dl 

Fluoro Dose  All PCIs 

Mean fluoro dose 

 

Contrast Volume  All PCIs  Mean contrast dose