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Title: Procedure-specific cardiac surgeon volume associated with patient outcome following valve surgery but not isolated CABG Surgery
Epworth Authors: Ch'ng, Stephanie
Other Authors: Cochrane, Andrew
Wolfe, Rory
Reid, Christopher
Smith, Catherine
Smith, Julian
Keywords: Adult cardiac surgery
Valve surgery
Coronary artery bypass
Australian and New Zealand Society of Cardiac and Thoracic Surgeons
Isolated CABG surgery
Epworth HealthCare, Melbourne, Australia
Issue Date: Jun-2015
Publisher: Elsevier
Citation: Heart Lung Circ. 2015 Jun;24(6):583-9
Abstract: PURPOSE: Trends towards surgical sub-specialisation to improve patient-outcomes are well-documented and largely supported by evidence. However few studies have examined whether this benefit exists within adult-cardiac surgery. To answer whether sub-specialisation within adult-cardiac surgery improves patient-outcomes, this study assessed the relationship between procedure-specific and total-cardiac surgeon-volume and mortality and morbidity in cardiac-valve and coronary artery bypass grafting (CABG) surgery. METHODS: Data came from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registry from 2001 to 2010 and included 23 hospitals, 109 surgeons, 20,619 patients with isolated-CABG-surgery and 11,536 patients with a valve-procedure. Hierarchical logistic regression using generalised estimating equations was used to analyse outcomes. Measures included operative-mortality and occurrence of a complication (deep sternal wound infection, new stroke, acute kidney injury). RESULTS: Crude operative mortality (and complication rates) were 1.7% (4.9%) and 4% (11%) in the isolated-CABG and valve-surgical populations respectively. A greater procedure-specific surgeon volume was associated with reduced mortality and complication rates in valve-surgery but not isolated-CABG. There was a 33% decrease in odds of dying for every additional 50 valve procedures performed [OR 0.67, p=0.003]. Conversely, greater total-cardiac surgical volume for individual surgeons did not result in improved outcomes, for both isolated-CABG and valve populations. CONCLUSIONS: Our finding of an association between increased valve-specific surgeon volumes with improved valve-surgery outcomes, and absence of an association between these outcomes and annual total-cardiac surgical experience supports the case for sub-specialisation specifically within the field of valve surgery.
DOI: 10.1016/j.hlc.2014.11.014
PubMed URL:
ISSN: 1443 9506
Journal Title: Heart Lung and Circulation
Type: Journal Article
Affiliated Organisations: Monash Medical Centre, Melbourne Australia
School of Public Health and Preventive Medicine, Monash University, Melbourne Australia.
Type of Clinical Study or Trial: Retrospective studies
Appears in Collections:Cardiac Sciences

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