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Influence of Surgeon Volume on Outcomes With Aortic Valve Replacement.
MedLine Citation:
PMID:  22226491     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: A volume-outcome association has been shown for cardiovascular procedures such as coronary artery bypass grafting. The association of a volume-outcome relationship for aortic valve replacement procedures, however, has not been clearly defined. We evaluated the influence of surgeon volume on operative outcomes with isolated aortic valve replacement and aortic valve replacement with concomitant coronary artery bypass grafting. METHODS: One thousand six hundred thirty-five patients were identified as having either isolated aortic valve replacement or aortic valve replacement plus coronary artery bypass grafting between January 1, 2000, and December 31, 2009. Patients were divided into three equal terciles using their Society of Thoracic Surgery Predicted Risk of Mortality scores. Data were retrieved on 14 surgeons with complete data records in our Society of Thoracic Surgery database covering a minimum 5-year period (mean, 8.9 ± 1.5 years; median, 10 years). RESULTS: Clinically significant increases are seen in operative mortality, permanent stroke, renal failure, prolonged ventilation, and hospital and intensive care unit lengths of stay in the high-risk compared with low-risk groups. The low-risk patient group has the smallest observed to expected ratio, less than 50%, whereas in the high-risk group the ratio is greater than 1. Odds ratios demonstrate that as surgeon volume increases, outcomes improve correspondingly (ie, odds ratio <1). In low-risk patients, five of ten major complications demonstrated improved outcomes with increased surgeon volume; in medium and high-risk groups eight of ten were improved. CONCLUSIONS: Surgeon volumes have a significant influence on operative outcomes in high-risk patients undergoing aortic valve replacement or aortic valve replacement with coronary artery bypass grafting.
Authors:
Todd M Dewey; Morley A Herbert; William H Ryan; William T Brinkman; Robert Smith; Syma L Prince; Michael J Mack
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-1-5
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  -     ISSN:  1552-6259     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-1-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Affiliation:
Medical City Dallas Hospital, Dallas, Texas.
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