Single versus Multi-Center Surgeons' Risk-Adjusted Coronary Artery Bypass Graft Procedural Outcomes.
Single versus Multi-Center Surgeons' Risk-Adjusted Coronary Artery Bypass Graft Procedural Outcomes.
- 2018
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Since 2010, 460+ hospital mergers have occurred in the United States rerouting historical coronary artery bypass graft [CABG] referral patterns. The goals of this study were: 1) to compare risk-adjusted CABG outcomes between single-center versus multi-center surgeons; and 2) for multi-center surgeons, to evaluate the risk-adjusted outcomes between their home (primary) versus satellite (secondary) hospitals. CONCLUSIONS: Single-center surgeons performing CABG had lower risk-adjusted outcome rates as compared to multi-center surgeons, who performed better at their home versus satellite hospitals. To improve future quality of care, surgeons, health care networks, and health policy makers should now more closely scrutinize their single versus multi-center performance. Copyright (c) 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. METHODS: Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, non-emergent, first-time CABG procedures (n = 543,403) performed in the United States between 2011 and 2014 were extracted across 1,120 centers and for 2,676 surgeons. Surgeons were classified as multi-center if they performed operations at two separate hospitals for >= 2 consecutive quarters; their home hospital was identified as their highest volume center. Observed-to-expected [O/E] outcome ratios were reported using approved multivariable risk models for 30-day operative mortality and major morbidity. RESULTS: Of 2,676 cardiac surgeons, 668 (25.0%) operated at multiple centers. The O/E mortality ratios were 1.06 (95% CI: 1.01, 1.12) and 0.97 (95% CI: 0.94, 1.00) for multi- and single-center surgeons (p < 0.001). For multi-center surgeons, the O/E mortality ratios were 1.17 (95% CI: 1.09, 1.27) vs 1.01 (95% CI: 0.96, 1.07), p < 0.001, for their satellite versus home facilities respectively.
English
0003-4975
10.1016/j.athoracsur.2018.01.023 [doi] S0003-4975(18)30138-3 [pii]
*Coronary Artery Bypass/ae [Adverse Effects]
*Organizational Affiliation
*Postoperative Complications/ep [Epidemiology]
*Professional Practice Location
Aged
Female
Hospital Mortality
Humans
Male
Middle Aged
Practice Patterns, Physicians'
Risk Assessment
United States
MedStar Heart & Vascular Institute
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Since 2010, 460+ hospital mergers have occurred in the United States rerouting historical coronary artery bypass graft [CABG] referral patterns. The goals of this study were: 1) to compare risk-adjusted CABG outcomes between single-center versus multi-center surgeons; and 2) for multi-center surgeons, to evaluate the risk-adjusted outcomes between their home (primary) versus satellite (secondary) hospitals. CONCLUSIONS: Single-center surgeons performing CABG had lower risk-adjusted outcome rates as compared to multi-center surgeons, who performed better at their home versus satellite hospitals. To improve future quality of care, surgeons, health care networks, and health policy makers should now more closely scrutinize their single versus multi-center performance. Copyright (c) 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. METHODS: Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, non-emergent, first-time CABG procedures (n = 543,403) performed in the United States between 2011 and 2014 were extracted across 1,120 centers and for 2,676 surgeons. Surgeons were classified as multi-center if they performed operations at two separate hospitals for >= 2 consecutive quarters; their home hospital was identified as their highest volume center. Observed-to-expected [O/E] outcome ratios were reported using approved multivariable risk models for 30-day operative mortality and major morbidity. RESULTS: Of 2,676 cardiac surgeons, 668 (25.0%) operated at multiple centers. The O/E mortality ratios were 1.06 (95% CI: 1.01, 1.12) and 0.97 (95% CI: 0.94, 1.00) for multi- and single-center surgeons (p < 0.001). For multi-center surgeons, the O/E mortality ratios were 1.17 (95% CI: 1.09, 1.27) vs 1.01 (95% CI: 0.96, 1.07), p < 0.001, for their satellite versus home facilities respectively.
English
0003-4975
10.1016/j.athoracsur.2018.01.023 [doi] S0003-4975(18)30138-3 [pii]
*Coronary Artery Bypass/ae [Adverse Effects]
*Organizational Affiliation
*Postoperative Complications/ep [Epidemiology]
*Professional Practice Location
Aged
Female
Hospital Mortality
Humans
Male
Middle Aged
Practice Patterns, Physicians'
Risk Assessment
United States
MedStar Heart & Vascular Institute
Journal Article