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Practice makes perfect? Institutional coronary artery bypass case volumes and outcomes

Thomas A Schwann1, Milo Engoren2, Mario F Gaudino3

  • 1University of Massachusetts-Baystate, Springfield, MA, USA.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|October 9, 2023
PubMed

Insights

Coronary artery bypass grafting (CABG) outcomes improve with higher hospital case volumes. Even a weak correlation suggests potential reductions in mortality and complications if CABG procedures are concentrated at high-volume centers.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Quality Improvement

Background:

  • Conflicting results exist regarding the association between coronary artery bypass grafting (CABG) institutional case volumes and patient outcomes.
  • Contemporary surgical practices and outcomes require updated analysis, particularly given advancements in cardiac surgery.

Purpose of the Study:

  • To investigate the relationship between institutional case volumes and outcomes for isolated primary CABG in current American surgical practice.
  • To assess the impact of hospital case volume on operative mortality (OM), mortality/major morbidity (MM), and deep sternal wound infections (DSWI).

Main Methods:

  • Analysis of the 2018-2019 isolated primary CABG data from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database.
  • Utilized Generalized Estimating Equations to model the association between institutional CABG volumes and outcomes.
  • Employed observed-to-expected ratios based on STS risk models to evaluate risk-adjusted outcomes (OM, MM, DSWI) relative to institutional volume.

Main Results:

  • A total of 241,902 isolated primary CABG cases from 1014 hospitals were analyzed.
  • A weak negative correlation was observed between institutional case volumes and operative mortality (R² -0.0272), mortality/major morbidity (R² -0.1213), and deep sternal wound infections (R² -0.003).
  • Institutions performing fewer than 100 cases represented 23% of the total, while 9% performed over 500 cases per study period.

Conclusions:

  • Coronary artery bypass grafting outcomes demonstrate a general improvement trend with increasing institutional case volumes.
  • Concentrating CABG procedures at higher-volume institutions could lead to significant reductions in operative mortality, major morbidity, and deep sternal wound infections nationally.
  • Further research into additional hospital and surgeon-specific factors is recommended to identify further quality improvement opportunities in CABG care.
Abstract

Keywords:
Coronary artery bypass grafting institutional case volumesOutcomesQuality

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