# Novel Assessments of Technical and Non-Technical Cardiac Surgery Quality

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2021 · $692,365

## Abstract

Project Summary/Abstract
Of the 150,000 patients annually undergoing coronary artery bypass grafting surgery, 35% develop
complications that increase mortality 5-fold and expenditures by 50%. Differences in patient risk and operative
approach explain only 2% of hospital variation in some complications. The intraoperative phase remains
understudied as a source of variation, despite its complexity and amenability to improvement.
Unfortunately, little is known about the multitude of factors impacting optimal cardiac surgical outcomes. Within
non-cardiac surgery, peer rater assessments of a surgeon’s technical skills (e.g., instrument handling) are
correlated with complications. Beyond technical skills, the cardiac surgical team uniquely relies on carefully
orchestrated non-technical practices (e.g., teamwork, communication, situational awareness, leadership) to
deliver care, including ensuring the patient’s hemodynamic stability across phase transitions involving
extracorporeal cardiopulmonary bypass. Most research to date has focused on technical skills and non-
technical practices in simulated environments with subjective human raters, thus lacking the medical and
psychological fidelity of real-world surgery required to identify relevant improvement targets. High-dimensional
computer-based assessments of video recordings, including capabilities for recognizing and tracking human
activity (video understanding), may offer unparalleled capabilities for providing an objective, non-simulation-
based platform for assessing technical skills and non-technical practices of surgical outcomes.
Our long-term goal is to reduce surgical complications by identifying and promoting adoption of evidence-
based surgical practices. The objectives of this proposal are to: (i) investigate the relationship between peer
rater assessments of intraoperative technical skills and non-technical practices with risk-adjusted complication
rates and (ii) to evaluate the feasibility of automating computer-based assessments to identify important
intraoperative technical skills and non-technical practices. This multi-center study leverages two mature
physician collaboratives providing detailed intraoperative data merged with The Society of Thoracic Surgeons
outcomes data. We have the following aims: (1) To investigate the relationship between peer rater
assessments of surgeon technical skills and variability in risk-adjusted patient complications; (2) To investigate
the relationship between peer rater assessments of intraoperative team-based non-technical practices and
variability in risk-adjusted patient complications; (3) To explore the feasibility of using objective, data-driven
computer-based assessments to automate the identification and tracking of significant, intraoperative
determinants of risk-adjusted patient complications. This study, which aligns with NHLBI’s priorities by
leveraging a multidisciplinary team to identify modifiable determinants of surgical performance, is...

## Key facts

- **NIH application ID:** 10071198
- **Project number:** 5R01HL146619-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** DONALD S LIKOSKY
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $692,365
- **Award type:** 5
- **Project period:** 2019-12-15 → 2024-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10071198

## Citation

> US National Institutes of Health, RePORTER application 10071198, Novel Assessments of Technical and Non-Technical Cardiac Surgery Quality (5R01HL146619-02). Retrieved via AI Analytics 2026-06-14 from https://api.ai-analytics.org/grant/nih/10071198. Licensed CC0.

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