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Widening volume and persistent outcome disparity in valve operations: New York statewide analysis, 2005-2016

Michael Shang1, Makoto Mori1, Geliang Gan1

  • 1Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn.

The Journal of Thoracic and Cardiovascular Surgery
|January 12, 2021
PubMed

Insights

High-volume hospitals in New York are performing more cardiac surgeries, especially valve operations. These centers also show better outcomes, indicating that concentrating complex cardiac procedures may improve surgical mortality.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Public Health

Background:

  • Volume concentration in noncardiac surgery is known, but its trend in cardiac surgery is unclear.
  • Understanding volume-outcome relationships is crucial for optimizing patient care in complex procedures.

Purpose of the Study:

  • To examine the relationship between volume concentration and mortality rates for valve surgery and coronary artery bypass grafting (CABG) in New York State.
  • To determine if cardiac surgical procedures are regionalizing to high-volume centers and if this impacts outcomes.

Main Methods:

  • Analysis of hospital-level case volume and risk-adjusted mortality rates (RAMRs) for isolated CABG and valve operations in New York (2005-2016).
  • Comparison of market share changes and outcomes between top- and bottom-volume quartiles.
  • Longitudinal analysis to assess temporal trends in market share and mortality.

Main Results:

  • Top-quartile hospitals increased market share for valve operations (54.4% to 59.4%) and CABG (41.4% to 44.3%).
  • High-volume centers demonstrated significant improvements in outcomes for both valve procedures and CABG over the study period.
  • No significant market share changes or outcome trends were observed for the bottom-quartile hospitals.

Conclusions:

  • Cardiac surgical volume, particularly for valve operations, is concentrating in high-volume centers in New York.
  • A persistent gap in mortality rates exists between highest- and lowest-volume hospitals.
  • Volume-based referrals for specialized cardiac procedures may lead to improved surgical mortality.
Abstract

Keywords:
CABGvalve surgeryvolume concentrationvolume–outcome relationship

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