Case load and valve surgery outcome in Australia

Area of Science:

• Cardiovascular Surgery
• Health Services Research

Background:

• Recommendations exist in Australia to consolidate heart valve surgery, especially for rheumatic heart disease (RHD), in high-volume centers.
• International cardiac surgery data suggest higher volume centers yield better outcomes.
• The impact of site and surgeon caseload on long-term heart valve surgery outcomes remains under-investigated.

Purpose of the Study:

• To investigate the association between average annual site and surgeon caseload and short-term complications.
• To determine the relationship between caseload and both short-term and long-term survival after heart valve surgery.

Main Methods:

• Analysis of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database.
• Adjusted analysis of 20,116 heart valve procedures across 25 sites and 93 surgeons.
• Examination of associations between caseload and outcomes including ventilation time, reoperation, anticoagulant complications, acute kidney injury, 30-day mortality, and long-term survival.

Main Results:

• Increasing site and surgeon caseload correlated with longer ventilation, reduced reoperation, and more anticoagulant complications.
• Higher surgeon caseload was linked to less acute kidney injury.
• No significant association was found between caseload and adjusted 30-day mortality.
• No consistent relationship between site caseload and long-term survival was observed.
• The highest volume surgeons showed poorer adjusted long-term survival.

Conclusions:

• The association between surgeon/site caseload and heart valve surgery outcomes in Australia is complex and inconsistent.
• Larger volume centers or surgeons did not demonstrate superior overall outcomes.
• Findings do not support mandating specific site caseloads or minimum procedure numbers for surgeons in the Australian context.