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Institutional case volume and mortality after aortic and mitral valve replacement: a nationwide study in two Korean

Karam Nam1, Eun Jin Jang2, Jun Woo Jo3

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

Journal of Cardiothoracic Surgery
|August 20, 2022
PubMed

Insights

Higher heart valve surgery volume is linked to better patient survival. This study found lower mortality rates in high-volume centers for aortic valve replacement (AVR) and mitral valve replacement (MVR).

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Outcomes Research

Background:

  • Limited research exists on the volume-outcome relationship in heart valve surgery.
  • This study investigates the association between hospital case volume and mortality for aortic valve replacement (AVR) and mitral valve replacement (MVR).

Purpose of the Study:

  • To determine if higher institutional case volumes correlate with lower in-hospital mortality rates after AVR and MVR.
  • To inform discussions on centralizing cardiac valve replacement procedures.

Main Methods:

  • Analysis of a Korean healthcare insurance database (2009-2016) for adult AVR and MVR cases.
  • Hospitals categorized into low, medium, and high volume based on annual case numbers for AVR and MVR.
  • Comparison of in-hospital mortality rates across different volume groups.

Main Results:

  • Higher in-hospital mortality observed in low- and medium-volume centers for both AVR and MVR compared to high-volume centers.
  • Adjusted risk of mortality was significantly higher in lower-volume centers for both procedures.
  • AVR: Low-volume (8.3%), Medium-volume (4.0%), High-volume (2.6%). MVR: Low-volume (9.3%), Medium-volume (6.3%), High-volume (2.9%).

Conclusions:

  • Lower institutional case volume is associated with increased in-hospital mortality after AVR and MVR.
  • Findings suggest potential benefits of regionalizing or centralizing cardiac valve replacement surgeries.
  • Optimizing patient outcomes may be achieved through strategic centralization of these procedures.
Abstract

Keywords:
Aortic valve replacementCase volumeMitral valve replacementSurgical prognosisVolume-outcome relationship

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