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[Cardiac surgery in Quebec: Do we have too many centers? Too many surgeons? Too many patients?]
1Département de Chirurgie, Institut de Cardiologie de Montréal, Québec. carrier@icm.umontreal.ca
Insights
To improve cardiac surgery care in Quebec, this study reviewed surgeon and center case loads. Findings suggest optimizing case volumes per center to maximize resource use and enhance patient care delivery.
Area of Science:
- Health Services Research
- Surgical Outcomes
- Healthcare Management
Background:
- The Quebec healthcare system faces restructuring, including budget cuts and physician salary ceilings.
- A small number of practicing cardiac surgeons necessitates defining the future of the specialty.
- Evaluating current surgeon and center case loads is crucial for improving cardiac surgical care delivery.
Purpose of the Study:
- To assess the current situation of cardiac surgery in Quebec.
- To propose changes for improved surgical care delivery.
- To analyze surgeon and center case loads in relation to patient volumes.
Main Methods:
- Retrospective study design.
- Data collected from the Province of Quebec in 1994.
- Analysis focused on patients undergoing coronary artery bypass grafting.
Main Results:
- Coronary artery bypass grafting rates in Quebec are comparable to national averages.
- Patient volumes increased by 6.5% annually, projecting 7000 procedures by 2000.
- Quebec has 12 cardiac surgery centers (1 per 600,000 population); optimal case loads suggest 9-18 centers are needed.
Conclusions:
- Cardiac surgery centers should achieve optimal case volumes.
- Maximizing resource utilization is key for patient care.
- Strategic restructuring is needed to enhance cardiac surgical services in Quebec.
Objective:
In restructuring the Quebec health care system with hospital budget cuts, salary ceiling of physicians and a small number of practising cardiac surgeons, the future of this specialty needs to be defined beyond individual self-interest. To evaluate the actual situation and to suggest changes that will improve surgical care delivery in cardiac surgery, surgeon and centre case loads in the province of Quebec were reviewed.
Design:
Retrospective study.
Setting:
Province of Quebec, 1994.
Patients:
Patients who underwent coronary artery bypass grafting in 1994.
Results:
The rate of coronary bypass grafting in Quebec was similar to that in Canada as a whole. The number of patients undergoing coronary artery bypass grafting increased at a rate of 6.5%/year during the five years preceding 1994, when operations numbered 5000. Thus, 7000 procedures will be performed in the year 2000 if the actual increase remains similar. There are 12 centres performing cardiac surgery in Quebec, with one centre/600,000 population and 3.4 surgeons/centre, compared with one centre/800,000 population and 3.7 surgeons/centre in Canada. In the year 2000, to accommodate 7000 cases, 18 centres will be required for a minimal case load per centre (300 cases/centre) or nine centres for an optimal case load per centre (700 cases).
Conclusion:
Each centre of cardiac surgery should perform an optimal volume of cases to achieve maximal use of human and physical resources devoted to the care of cardiac surgical patients in the province of Quebec.