Center-Level CABG and Valve Operative Outcomes and Volume-outcome Relationships in New York State

Abstract

Background: We analyzed center-level outcome correlations between valve surgery and coronary artery bypass graft (CABG) in New York (NY) State and how volume-outcome effect differ between case types. Methods: We used the 2014-2016 NY cardiac surgery outcomes report. Center-level observedto-expected (O/E) ratio for operative mortality provided risk-adjusted operative outcomes for isolated CABG and valve operations. Correlation coefficient characterized the concordance in center-level outcomes

Commentary: Correlation of coronary and valve procedure outcomes between centers

“…While the authors report a positive correlation between mortality outcomes following CABG and valve surgery in the state of New York, the correlation is modest with a correlation coefficient of only 0.31 1 . As reported, our group previously examined center specific morbidity and mortality outcomes following CABG and valve surgery within 18 institutions in Virginia between 2008 and 2015 and found a weak correlation in terms of mortality with a correlation coefficient of .22 for aortic valve replacement and CABG as well as .26 for mitral valve replacement and CABG 2 .…”

“…These centers had better than expected CABG outcomes and worse than expected valve outcomes 1 . There was no discordance identified in centers with better than expected valve outcomes 1 . They concluded that while good outcomes following valve surgery may translate to improved outcomes following CABG, the opposite may not be true.…”

“…While Brooks et al 1 found modest correlation between CABG and valve surgery, they identified two centers with discordant outcomes. These centers had better than expected CABG outcomes and worse than expected valve outcomes 1 . There was no discordance identified in centers with better than expected valve outcomes 1 .…”

“…Due to the high number performed annually, coronary artery bypass grafting (CABG) outcomes make up much of the data available to patients deciding where to pursue operative consultation, but how well does this correlate with outcomes following other types of cardiac surgery? In a recent article by Brooks and colleagues in the Journal of Cardiac Surgery , they evaluated center‐level outcome correlation between CABG and valve surgery in New York State from 2014 to 2016 1 . On the center level, they found modest mortality outcome correlation between CABG and valve surgery.…”

“…In the increasingly subspecialized field of cardiac surgery, we feel that center outcomes in one procedure do not necessarily translate to others. This is highlighted by an important work from Brooks et al 1 who report that “favorable valve outcomes may indicate good CABG outcomes but good CABG outcomes may not ensure valve outcomes.” Continued research in this area is critical to ensure patients are adequately equipped to make decisions about where to pursue consultation.…”