Mohamad Bashir1, Amer Harky2, Matthew Fok3, Matthew Shaw4, Graeme L Hickey5, Stuart W Grant6, Rakesh Uppal2, Aung Oo7. 1. Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom. Electronic address: drmbashir@mail.com. 2. Department of Cardiac Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom. 3. School of BUILT Environment, Liverpool John Moore University, Liverpool, United Kingdom. 4. Research and Development, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom. 5. Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom; University of Manchester, Manchester Academic Health Science Centre, Academic Surgery Unit, University Hospital of South Manchester, Department of Cardiothoracic Surgery, Manchester, United Kingdom; University College London, National Institute for Cardiovascular Outcomes Research (NICOR), London, United Kingdom. 6. University of Manchester, Manchester Academic Health Science Centre, Academic Surgery Unit, University Hospital of South Manchester, Department of Cardiothoracic Surgery, Manchester, United Kingdom; University College London, National Institute for Cardiovascular Outcomes Research (NICOR), London, United Kingdom; Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom. 7. Aortic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
Abstract
OBJECTIVES: Surgery for acute type A aortic dissection (ATAD) carries a high risk of operative mortality. We examined the surgeon volume-outcome relation with respect to in-hospital mortality for patients presenting with this pathology in the United Kingdom. METHOD: Between April 2007 and March 2013, 1550 ATAD procedures were identified from the National Institute for Cardiovascular Outcomes Research database. A total of 249 responsible consultant cardiac surgeons from the United Kingdom recorded 1 or more of these procedures in their surgical activity over this period. We describe the patient population and mortality rates, focusing on the relationship between surgeon volume and in-hospital mortality. RESULTS: The mean annual volume of procedures per surgeon during the 6-year period ranged from 1 to 6.6. The overall in-hospital mortality rate was 18.3% (283/1550). A mortality improvement at the 95% level was observed with a risk-adjusted mean annual volume >4.5. Surgeons with a mean annual volume <4 over the study period had significantly higher in-hospital mortality rates in comparison with surgeons with a mean annual volume ≥4 (19.3% vs 12.6%; P = .015). CONCLUSIONS: Patients with ATAD who are operated on by lower-volume surgeons experience higher levels of in-hospital mortality. Directing these patients to higher-volume surgeons may be a strategy to reduce in-hospital mortality.
OBJECTIVES: Surgery for acute type A aortic dissection (ATAD) carries a high risk of operative mortality. We examined the surgeon volume-outcome relation with respect to in-hospital mortality for patients presenting with this pathology in the United Kingdom. METHOD: Between April 2007 and March 2013, 1550 ATAD procedures were identified from the National Institute for Cardiovascular Outcomes Research database. A total of 249 responsible consultant cardiac surgeons from the United Kingdom recorded 1 or more of these procedures in their surgical activity over this period. We describe the patient population and mortality rates, focusing on the relationship between surgeon volume and in-hospital mortality. RESULTS: The mean annual volume of procedures per surgeon during the 6-year period ranged from 1 to 6.6. The overall in-hospital mortality rate was 18.3% (283/1550). A mortality improvement at the 95% level was observed with a risk-adjusted mean annual volume >4.5. Surgeons with a mean annual volume <4 over the study period had significantly higher in-hospital mortality rates in comparison with surgeons with a mean annual volume ≥4 (19.3% vs 12.6%; P = .015). CONCLUSIONS:Patients with ATAD who are operated on by lower-volume surgeons experience higher levels of in-hospital mortality. Directing these patients to higher-volume surgeons may be a strategy to reduce in-hospital mortality.
Authors: Amine Mazine; Rodolfo V Rocha; Ismail El-Hamamsy; Maral Ouzounian; Bobby Yanagawa; Deepak L Bhatt; Subodh Verma; Jan O Friedrich Journal: JAMA Cardiol Date: 2018-10-01 Impact factor: 14.676
Authors: Alexander A Brescia; Himanshu J Patel; Donald S Likosky; Tessa M F Watt; Xiaoting Wu; Raymond J Strobel; Karen M Kim; Shinichi Fukuhara; Bo Yang; G Michael Deeb; Michael P Thompson Journal: Ann Thorac Surg Date: 2019-08-07 Impact factor: 4.330