Cardiac surgery in a small community: an eight-year experience

Area of Science:

• Cardiovascular Surgery
• Health Services Research

Background:

• National guidelines recommend high case volumes for open-heart surgery units.
• Small community hospitals may face challenges meeting these volume requirements.

Purpose of the Study:

• To evaluate the long-term outcomes of open-heart procedures in a community hospital with lower-than-guideline case volumes.
• To assess the feasibility and quality of cardiac care in resource-limited settings.

Main Methods:

• Retrospective analysis of 374 open-heart procedures over eight years.
• Long-term patient follow-up averaging 49 months.
• Analysis of hospital mortality, attrition rates, and long-term survival.

Main Results:

• Hospital mortality rates were 1.8% (non-emergency CABG), 3.3% (all bypass), and 5.1% (all cardiac operations).
• Overall long-term survival was 92%, with an attrition rate <1% annually.
• Coronary artery bypass grafting patients had 94.2% long-term survival with a 0.66% annual attrition rate.
• Average costs were $9,670 (1978) and $11,073 (1979).

Conclusions:

• Community hospitals can achieve high-quality cardiac surgical outcomes irrespective of case volume.
• Focusing on quality over quantity enables comprehensive cardiac care, particularly for underserved populations.
• These findings support flexible health policies for small communities to ensure equitable access to cardiac services.