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Good at One or Good at All? Variability of Coronary and Valve Operation Outcomes Within Centers

Lily E Johnston1, Emily A Downs1, Robert Hawkins1

  • 1Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.

The Annals of Thoracic Surgery
|February 1, 2018
PubMed

Insights

Center performance in coronary artery bypass grafting (CABG) and heart valve surgery outcomes do not correlate for mortality. However, morbidity rates show a strong correlation, suggesting postoperative care impacts both procedures.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Health Services Research

Background:

  • Technical expertise for coronary artery bypass grafting (CABG) and structural heart valve disease treatment differs.
  • A correlation between center-specific mortality rates for CABG and valve operations has not been established.
  • This study investigated whether risk-adjusted outcomes for coronary and valve procedures correlate within institutions.

Purpose of the Study:

  • To test the hypothesis that risk-adjusted outcomes between coronary artery bypass grafting (CABG) and heart valve operations do not correlate within medical centers.
  • To analyze the relationship between institutional performance in CABG and valve procedures.
  • To identify potential determinants of patient outcomes in cardiac surgery.

Main Methods:

  • Utilized a multi-institutional Society of Thoracic Surgeons (STS) database (2008-2015) including isolated CABG, aortic valve replacement (AVR), and mitral valve replacement (MVR) procedures.
  • Calculated observed-to-expected (O/E) ratios for morbidity and mortality based on STS predicted risks for each institution and procedure.
  • Employed linear regression models to assess the relationship between institutional performance in CABG and valve operations.

Main Results:

  • Analyzed 22,258 procedures (17,026 CABG, 3,238 AVR, 1,994 MVR) across 18 institutions.
  • Weak correlation coefficients were observed for mortality: 0.22 (AVR vs. CABG) and 0.26 (MVR vs. CABG).
  • A strong relationship was found for morbidity O/E ratios: 1.03 (AVR) and 0.97 (MVR), indicating a nearly 1:1 correlation between institutional morbidity for CABG and valve operations.

Conclusions:

  • Institutions with low CABG mortality rates may not exhibit similarly low valve operation mortality rates.
  • A striking, nearly identical O/E ratio for morbidity was observed for CABG and valve operations at each center.
  • These findings suggest that postoperative care is a significant determinant of morbidity following cardiac operations.
Abstract

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