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Inconsistent correlation between procedural volume and publicly reported outcomes in adult cardiac operations

Valentino Bianco1, Edgar Aranda-Michel1, Ibrahim Sultan1

  • 1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh and Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Journal of Cardiac Surgery
|September 4, 2019
PubMed

Insights

Public reporting of surgical outcomes is common, but this study found no consistent link between the number of adult cardiac surgeries performed and patient mortality or readmission rates. Procedural volume does not reliably predict outcomes in publicly reported data.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Public Health

Background:

  • Statewide public reporting initiatives aim to increase transparency in surgical outcomes.
  • Evaluating the relationship between procedural volume and reported outcomes is crucial for quality assessment.

Purpose of the Study:

  • To assess the correlation between procedural volume and publicly reported outcomes in adult cardiac surgery.
  • To determine if surgeon or hospital volume predicts observed-to-expected (OE) mortality and readmission rates.

Main Methods:

  • Analysis of the Pennsylvania Health Care Cost Containment Council (PHC4) database for adult cardiac surgeries (2014-2016).
  • Included isolated coronary artery bypass grafting (CABG), isolated valve surgery, and combined CABG-valve procedures.
  • Correlated procedural volume with operative mortality and 30-day readmission using observed-to-expected (OE) ratios and weighted linear regression.

Main Results:

  • The study analyzed 29,578 adult cardiac operations performed by 182 surgeons at 60 hospitals.
  • An inconsistent correlation was observed between surgeon/hospital volume and OE operative mortality or 30-day readmission for all included procedures.
  • Expected mortality and readmission rates were calculated for surgeons and hospitals across different surgery types.

Conclusions:

  • No consistent association was found between surgeon or hospital procedural volume and publicly reported outcomes (mortality, readmission) in adult cardiac surgery.
  • These findings suggest that procedural volume is not a reliable predictor of surgeon or hospital-level outcomes in publicly available data.
  • Further research may be needed to identify more robust predictors of quality in cardiac surgery outcomes.
Abstract

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