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    Procedure-specific Cardiac Surgeon Volume associated with Patient outcome following Valve Surgery, but not Isolated CABG Surgery

    Access Status
    Fulltext not available
    Authors
    Ch'ng, S.
    Cochrane, A.
    Wolfe, R.
    Reid, Christopher
    Smith, C.
    Smith, J.
    Date
    2015
    Type
    Journal Article
    
    Metadata
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    Citation
    Ch'ng, S. and Cochrane, A. and Wolfe, R. and Reid, C. and Smith, C. and Smith, J. 2015. Procedure-specific Cardiac Surgeon Volume associated with Patient outcome following Valve Surgery, but not Isolated CABG Surgery. Heart, Lung and Circulation. 24 (6): pp. 583-589.
    Source Title
    Heart, Lung and Circulation
    DOI
    10.1016/j.hlc.2014.11.014
    ISSN
    14439506
    URI
    http://hdl.handle.net/20.500.11937/32571
    Collection
    • Curtin Research Publications
    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.

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