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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Annual case volume on mortality after coronary artery bypass grafting: a dose-response meta-analysis
Hong-Tao Tie1, Rui Shi2, Quan Zhou3
1Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
Higher hospital and surgeon case volumes for coronary artery bypass grafting (CABG) are linked to reduced patient mortality. This inverse relationship between volume and mortality persists over time, indicating consistent benefits.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Surgical Outcomes
Background:
- Patient outcomes after coronary artery bypass grafting (CABG) can be influenced by various factors.
- Understanding the impact of procedural volume on mortality is crucial for quality improvement in cardiac surgery.
Purpose of the Study:
- To evaluate the association between hospital and surgeon annual case volumes and patient mortality following CABG.
- To determine if this association has changed over time.
Main Methods:
- A systematic review and meta-analysis of clinical studies identified through PubMed and Embase.
- Inclusion of studies reporting operative, in-hospital, or 30-day mortality following CABG.
- Pooled estimation of the odds ratio (OR) for mortality based on hospital and surgeon case volumes.
Main Results:
- Both higher hospital and surgeon annual case volumes were significantly inversely associated with mortality after CABG (OR for hospital: 0.62; OR for surgeon: 0.51).
- High heterogeneity was observed in the pooled estimates.
- Meta-regression and dose-response analyses indicated a robust, non-linear, and unattenuated negative association between volume and mortality over time.
Conclusions:
- Increased hospital and surgeon annual case volumes are associated with lower mortality rates in CABG patients.
- The beneficial effect of higher procedural volumes on mortality remains consistent and is not diminished over time.
Objectives:
This study evaluated the effect of both hospital and surgeon annual case volumes on patient mortality following coronary artery bypass grafting (CABG).
Methods:
PubMed and Embase databases were searched for clinical studies on CABG. The outcome was mortality, including operative mortality, in-hospital mortality and 30-day mortality.
Results:
Twenty-five studies involving 3 492 101 participants and 143 951 deaths were included for hospital volume, and 4 studies involving 108 356 participants and 2811 deaths were included for surgeon volume. The pooled estimate revealed that both hospital and surgeon annual case volumes were inversely associated with mortality in patients after CABG [odds ratio (OR) for hospital: 0.62, 95% confidence interval (CI) 0.56-0.69; P < 0.001; OR for surgeon: 0.51, 95% CI 0.31- 0.83; P < 0.001] with high heterogeneity (hospital: I2 = 90.6%, Pheterogeneity < 0.001; surgeon: I2 = 86.8%, Pheterogeneity < 0.001). The relationship remained consistent and robust in most subgroup and sensitivity analyses. Our meta-regression analysis of time suggested that the strength of the negative associations between volume and mortality for both hospitals and surgeons remained unattenuated over time even though the CABG mortality gradually decreased over time. The dose-response analysis suggested a non-linear relationship between both hospital and surgeon annual case volumes and mortality (both Pnon-linearity = 0.001).
Conclusions:
Both higher hospital and surgeon annual case volumes are associated with lower mortality in patients undergoing CABG, and the negative associations remain unattenuated over time.
Clinical Registration Number:
The study was registered at PROSPERO as CRD42017067912.
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