TY - JOUR
T1 - Association of Volume and Outcomes in 234 556 Patients Undergoing Surgical Aortic Valve Replacement
AU - Thourani, Vinod H.
AU - Brennan, James M.
AU - Edelman, J. James
AU - Thibault, Dylan
AU - Jawitz, Oliver K.
AU - Bavaria, Joseph E.
AU - Higgins, Robert S.D.
AU - Sabik, Joseph F.
AU - Prager, Richard L.
AU - Dearani, Joseph A.
AU - MacGillivray, Thomas E.
AU - Badhwar, Vinay
AU - Svensson, Lars G.
AU - Reardon, Michael J.
AU - Shahian, David M.
AU - Jacobs, Jeffrey P.
AU - Ailawadi, Gorav
AU - Szeto, Wilson Y.
AU - Desai, Nimesh
AU - Roselli, Eric E.
AU - Woo, Y. Joseph
AU - Vemulapalli, Sreek
AU - Carroll, John D.
AU - Yadav, Pradeep
AU - Malaisrie, S. Chris
AU - Russo, Mark
AU - Nguyen, Tom C.
AU - Kaneko, Tsuyoshi
AU - Tang, Gilbert
AU - Ruel, Marc
AU - Chikwe, Joanna
AU - Lee, Richard
AU - Habib, Robert H.
AU - George, Isaac
AU - Leon, Martin B.
AU - Mack, Michael J.
N1 - Publisher Copyright:
© 2022 The Society of Thoracic Surgeons
PY - 2022/10
Y1 - 2022/10
N2 - Background: The relationship between institutional volume and operative mortality after surgical aortic valve replacement (SAVR) remains unclear. Methods: From January 2013 to June 2018, 234 556 patients underwent isolated SAVR (n = 144 177) or SAVR with coronary artery bypass grafting (CABG) (n = 90 379) within the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The association between annualized SAVR volume (group 1 [1-25 SAVRs], group 2 [26-50 SAVRs], group 3 [51-100 SAVRs], and group 4 [>100 SAVRs]) and operative mortality and composite major morbidity or mortality was assessed. Random effects models were used to evaluate whether historical (2013-2015) SAVR volume or risk-adjusted outcomes explained future (2016-2018) risk-adjusted outcomes. Results: The annualized median number of SAVRs per site was 35 (interquartile range, 22-59; isolated aortic valve replacement [AVR], 20; AVR with CABG, 13). Among isolated SAVR cases, the mean operative mortality and composite morbidity or mortality were 1.5% and 9.7%, respectively, at the highest-volume sites (group 4), with significantly higher rates among progressively lower-volume groups (P trend < .001). After adjustment, lower-volume centers had increased odds of operative mortality (group 1 vs group 4 [reference]: adjusted odds ratio [AOR] for SAVR, 2.24 [95% CI, 1.91-2.64]; AOR for SAVR with CABG, 1.96 [95% CI, 1.67-2.30]) and major morbidity or mortality (AOR for SAVR, 1.53 [95% CI, 1.39-1.69]; AOR for SAVR with CABG, 1.46 [95% CI, 1.32-1.61]) compared with the highest-volume institutions. Substantial variation in outcomes was observed across hospitals within each volume category, and prior outcomes explained a greater proportion of hospital operative outcomes than did prior volume. Conclusions: Operative outcomes after SAVR with or without CABG is inversely associated with institutional procedure volumes; however, prior outcomes are more predictive of future outcomes than is prior volume. Given the excellent outcomes observed at many lower-volume hospitals, procedural outcomes may be preferable to procedural volumes as a quality metric.
AB - Background: The relationship between institutional volume and operative mortality after surgical aortic valve replacement (SAVR) remains unclear. Methods: From January 2013 to June 2018, 234 556 patients underwent isolated SAVR (n = 144 177) or SAVR with coronary artery bypass grafting (CABG) (n = 90 379) within the Society of Thoracic Surgeons Adult Cardiac Surgery Database. The association between annualized SAVR volume (group 1 [1-25 SAVRs], group 2 [26-50 SAVRs], group 3 [51-100 SAVRs], and group 4 [>100 SAVRs]) and operative mortality and composite major morbidity or mortality was assessed. Random effects models were used to evaluate whether historical (2013-2015) SAVR volume or risk-adjusted outcomes explained future (2016-2018) risk-adjusted outcomes. Results: The annualized median number of SAVRs per site was 35 (interquartile range, 22-59; isolated aortic valve replacement [AVR], 20; AVR with CABG, 13). Among isolated SAVR cases, the mean operative mortality and composite morbidity or mortality were 1.5% and 9.7%, respectively, at the highest-volume sites (group 4), with significantly higher rates among progressively lower-volume groups (P trend < .001). After adjustment, lower-volume centers had increased odds of operative mortality (group 1 vs group 4 [reference]: adjusted odds ratio [AOR] for SAVR, 2.24 [95% CI, 1.91-2.64]; AOR for SAVR with CABG, 1.96 [95% CI, 1.67-2.30]) and major morbidity or mortality (AOR for SAVR, 1.53 [95% CI, 1.39-1.69]; AOR for SAVR with CABG, 1.46 [95% CI, 1.32-1.61]) compared with the highest-volume institutions. Substantial variation in outcomes was observed across hospitals within each volume category, and prior outcomes explained a greater proportion of hospital operative outcomes than did prior volume. Conclusions: Operative outcomes after SAVR with or without CABG is inversely associated with institutional procedure volumes; however, prior outcomes are more predictive of future outcomes than is prior volume. Given the excellent outcomes observed at many lower-volume hospitals, procedural outcomes may be preferable to procedural volumes as a quality metric.
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U2 - 10.1016/j.athoracsur.2021.06.095
DO - 10.1016/j.athoracsur.2021.06.095
M3 - Article
C2 - 34785247
AN - SCOPUS:85119068126
SN - 0003-4975
VL - 114
SP - 1299
EP - 1306
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -