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The Effect of Center Volume on In-Hospital Mortality After Aortic and Mitral Valve Surgical Procedures: A

Jeffrey Shuhaiber1, Abby J Isaacs2, Art Sedrakyan2

  • 1Department of Surgery, Swedish American Health System, Rockford, Illinois.

The Annals of Thoracic Surgery
|July 21, 2015
PubMed

Insights

Higher hospital volume for combined aortic and mitral valve surgery is linked to better patient survival. Centers performing over eight such procedures annually show superior outcomes compared to lower-volume centers.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Outcomes Research

Background:

  • Assessing the impact of hospital volume on outcomes for complex cardiac procedures.
  • Investigating the relationship between center volume and patient mortality in dual valve surgery.

Purpose of the Study:

  • To determine the association between hospital volume and the use of dual aortic and mitral valve surgical procedures.
  • To evaluate in-hospital outcomes based on annual center volume for multiple-heart valve operations.

Main Methods:

  • Utilized the Nationwide Inpatient Sample (NIS) to identify patients undergoing combined aortic and mitral valve repair or replacement.
  • Compared patient characteristics and outcomes across low (1-8), medium (9-18), and high (19+) annual volume centers.
  • Employed chi-squared tests and adjusted hierarchical logistic regression for statistical analysis.

Main Results:

  • Analyzed 87,675 procedures from 1998-2011; high-volume centers treated older patients with CAD and performed more tricuspid valve operations.
  • Low-volume centers more frequently used mechanical valves for concomitant aortic and mitral valve replacement (66.1% vs. 45.5%).
  • Risk-adjusted in-hospital mortality was significantly lower at medium (OR 0.85) and high-volume (OR 0.66) centers compared to low-volume centers.

Conclusions:

  • Hospital volume is a critical determinant of risk-adjusted mortality following combined aortic and mitral valve surgery.
  • Centers performing >8 dual valve operations annually demonstrate statistically superior hospital survival.
  • Quality improvement initiatives targeting low-volume centers could reduce mortality in valve surgery.
Abstract

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