Single versus Multi-Center Surgeons' Risk-Adjusted Coronary Artery Bypass Graft Procedural Outcomes.

MedStar author(s):
Citation: Annals of Thoracic Surgery. 105(5):1308-1314, 2018 05.PMID: 29427617Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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 StatesYear: 2018Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0003-4975
Name of journal: The Annals of thoracic surgeryAbstract: 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.All authors: Bilfinger TV, Bishawi M, Gioia WE, Gulack BC, O'Brien SM, Shroyer ALW, Thourani VH, Wallace AS, Xian YFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2018-02-20
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29427617 Available 29427617

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.

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