Surgeon Reports

The Impact of SPY on Cardiovascular

Service Line Quality, Safety, Outcomes and Economics

Every provider, patient and payer is concerned about patient quality, safety and outcomes. Hospital economies reflect the institution’s commitment to patient care and evidence has shown that hospital’s that invest wisely in quality and safety are also the most profitable. Cardiovascular services offer a primary example of the relationship between best care practice and hospital economics.

Quality and Cardiovascular Service Line Economics

The introduction of SPY imaging into the Operating Room environment represents a paradigm shift for providers. For surgeons, SPY Imaging provides an additional resource of information about the patient and the procedure that they are actively engaged in performing; that is, real-time imaging feedback. Opportunities to perform intra-operative vascular imaging have been limited by the lack of hybrid OR/Cath Lab facilities and by the low fidelity of portable fluoroscopic imaging techniques. In every instance in cardiovascular disease management where imaging has been added to patient care, it has resulted in significant improvement in quality of care (cardiac cath, nuclear, echo, and possibly CTA) by supplying additional information that was not previously available. Furthermore, to have this information at the point of care provides a real-time opportunity to impact disease progression and patient outcome.

SPY intra-operative angiography is used to improve the quality and sustainability of a variety of operations that involve vascular flow and tissue perfusion including Coronary Artery Bypass Graft surgery. In the recently published PREVENT IV study of over 3000 patients undergoing CABG at >100 major centers in the US, the one-year graft failure rate was demonstrated by follow-up angiography to be greater than 27%, much higher than had been anticipated. In contrast, the 30-day mortality outcomes were excellent in the trial; however, the subgroup with graft failure had a higher rate of perioperative Myocardial Infarction (MI) and, in turn, diminished long-term survival. For facilities performing CABG, perioperative MI leads to significantly increased costs of care and length of stay. In another recently published retrospective review of hospital billing data of 2100 CABG patients from the PRIMO-CABG Trial, periop MI increased ICU length of stay by 50%, overall length of stay by 48% and facility cost of care for CABG by 43%. Early data from the VICTORIA Registry demonstrate that excellent outcomes are reproducible in centers that use SPY Imaging with coronary artery bypass surgery.

Intuitively, the presence of intra-operative imaging to guide and confirm success at the point of care would be expected to improve the overall quality of the grafts and the revascularization procedure while addressing technical problems that can be fixed at the time of the operation. This in turn would drive down the long-term graft failure rate, increase overall efficacy and benefit of CABG with imaging as compared to CABG without imaging. Recent studies testing the efficacy of SPY imaging have demonstrated a significant decrease in perioperative MIs and improved long-term graft patency in SPY patients compared to those in whom SPY was not used. SPY Imaging, when used in CABG, has been shown to decrease short- and long-term morbidity metrics. Some of these metrics are known to impact directly on mortality, hospital length of stay and overall costs.

Patient Safety

The ability to perform confirmatory imaging following procedural interventions has consistently been associated with improved outcomes. The ability to have confirmatory documentation and information that will help guide technical and therapeutic maneuvers during procedures has led to direct improvements in patient safety. SPY Intra-operative imaging makes both of these quality and safety opportunities available to surgeons and their patients at point of care during the cardiac surgical procedures.

SPY Quantified Success

SPY angiograms provide valuable vascular flow and tissue perfusion data that is used by the operating surgeon to ensure a successful operation and more optimal surgical result. With quantifiable intra-operative assessment of myocardial perfusion, surgeons can determine whether revisions or additional therapies are needed to achieve a durable revascularization. They can also compare perfusion post-grafting to the pre-grafting state, thereby quantifying the degree of regional perfusion improvement achieved by surgical revascularization.

Return on Facility Investment

Institutions that invest in CABG quality and provide the most effective treatment for multi-vessel coronary disease provide the best care and are more profitable.
- Dr. T. Bruce Ferguson Jr., FACC, FAHA, FACS

Dr. Ferguson is the Professor and Chairman of Department of Cardiovascular Sciences The Brody School Medicine at East Carolina University. He served as the founding Chair of the Society of Thoracic Surgeons Council on Quality, Research, Patient Safety overseeing the STS National Database Registry and two pivotal studies in cardiac surgery quality improvement funded by the AHRQ. Currently Dr. Ferguson serves as a Center PI for the NHLBI funded Cardiac Surgery Network, and is a member of the ACC Quality Strategic Directions Committee and the ACC Surgeon Council. He received his training in general and cardiothoracic surgery at Duke University Medical Center. Dr. Ferguson has published extensively in the arena of cardiac surgical quality and safety.