Widening volume and persistent outcome disparity in valve operations: New York statewide analysis, 2005-2016

Shang, Michael; Mori, Makoto; Gan, Geliang; Deng, Yanhong; Brooks, Cornell; Weininger, Gabe; Sallam, Aminah; Vallabhajosyula, Prashanth; Geirsson, Arnar

doi:10.1016/j.jtcvs.2020.11.098

Cited by 9 publications

(10 citation statements)

References 22 publications

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“…The growing proportion of highly comorbid patients, the technical complexity of surgical procedures, and the rising scrutinization of outcomes combined with trainees' duty‐hour restrictions made residency programs question whether the training experience would have been compromised. Additionally, while the volume–outcome relationship has been studied extensively in cardiothoracic surgery in the past decades (including CABG, 11 valve surgery, 12,13 congenital heart operations, 14 heart transplants, 15 transcatheter interventions, 16 and thoracic surgery operations 17 ), it has not been fully investigated whether specific types of procedures in TH versus NTH are more susceptible to the volume–outcome relationship.…”

Section: Discussionmentioning

confidence: 99%

“…However, such difference became non-significant when adjusting for the interaction between teaching status and pre/post-status (p = .651). Additionally, while the volume-outcome relationship has been studied extensively in cardiothoracic surgery in the past decades (including CABG, 11 valve surgery, 12,13 congenital heart operations, 14 heart transplants, 15 transcatheter interventions, 16 and thoracic surgery operations 17 ), it has not been fully investigated whether specific types of procedures in TH versus NTH are more susceptible to the volume-outcome relationship.…”

Section: The Impact Of the 2011 Duty-hour Regulations On Outcomementioning

confidence: 99%

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The impact of trainees' working hour regulations on outcome in CABG and valve surgery in the State of New York

Amabile

Mori

Brooks

et al. 2021

Journal of Cardiac Surgery

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Background and Aim: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) restricted the first-year residents' duty-hour to less than 16-hour shifts, decreased the maximum shift duration for senior residents, and increased minimum time off after on-call duties. Whether these changes may have impacted the outcomes in cardiac surgery remains unclear. Methods: We performed a difference-in-difference analysis of the New York State Cardiac Surgery Reporting System data in 2004-2006 (before the dutyhour policies change) and 2014-2016 (after the change). We evaluated differences in 30-day risk-adjusted mortality rates (RAMR) in coronary artery bypass grafting (CABG) and valve surgeries, stratifying data by hospital type: teaching hospitals (TH) versus nonteaching hospitals (NTH). NTH served as the control not affected by the duty-hour policies.Results: (1) The overall surgical volume for CABG surgery has decreased over time (37,991), while the volume for valve surgery remained similar (20,532);(2) TH had better short-term outcomes for CABG procedures during 2014-2016 (median RAMR: 1.01% vs. 1.55% in TH vs. NTH, respectively; p = .025) as well as for valve procedures during both 2004-2006 (5.16% vs. 7.49%, p = .020) and 2014-2016 (2.59% vs. 4.09%, p = .033); (3) at difference-in-difference analysis, trainees' duty-hour regulations were not associated with worsening short-term outcomes in both CABG (p = .296) and valve (p = .651) procedures performed in TH. Conclusion:The introduction of the 2011 trainees' duty-hour regulations was not associated with worse short-term outcomes for CABG and valve surgery performed in the State of NY by TH.

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Section: Discussionmentioning

confidence: 99%

Section: The Impact Of the 2011 Duty-hour Regulations On Outcomementioning

confidence: 99%

The impact of trainees' working hour regulations on outcome in CABG and valve surgery in the State of New York

Amabile

Mori

Brooks

et al. 2021

Journal of Cardiac Surgery

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“…The number of cases performed yearly by a surgeon or by a Hospital has a huge influence not only on the repair rate, but as well on early and late mortality 5,8-10 and reoperation rate 5 . A recent report from the New York State showed that high-volume hospital increased their caseload and improved the outcome in valve surgeries 11 , reinforcing the concept that high volumes will improve results that will increase more the caseload. In South Korea, analyzing 6,041 patients undergoing MVr, 1-year mortality was higher in low-(<20 cases/year) and medium-(20-40 cases/year) volume centers if compared with high-volume (>40 cases/year) centers (10.1%, 8.7% and 4.7%).…”

mentioning

confidence: 92%

“…Badhwar et al 10 reported, in patients with primary degenerative MR, a repair rate of 80.8%, increasing from the lowest (63.8%) to the highest volume quartile (84.5%). The median hospital median repair volume was 11 cases (5-25) and the median surgeon repair volume was 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Rate of successful MVr were lower in the lowest quartile as well as 1-year mortality rate, but not reoperation rate, both for hospital and surgeon volumes.…”

mentioning

confidence: 93%

Mitral Valve Repair: Regulatory or Ethical Problem?

Fattouch

Calafiore

2022

Preprint

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The long-term outcome of patients undergoing mitral valve repair (MVr) is based on what happens during the more or less 60 minutes of aortic cross clamping necessary to transform a leaking valve in a well-functioning one. As a consequence, the experience of the surgeon performing the procedure is the only determinant of the success rate that deserves to be taken into account. It is clear from the literature that the number of cases/year is inversely related to the number of early and late deaths, of repair failures and of reoperations. However, there is no agreement on the minimum caseload/year that represents the threshold to identify surgeons that can perform or not MVr. This problem then cannot be regulated by specific guidelines of by Scientific Societies, but only by the ethical perception we have of our profession.

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“…In this issue of the Journal, Shang and colleagues 1 analyze the impact of procedural volume and market share (ie, volume concentration) on 30-day mortality after cardiac surgery. Publicly available data related to the outcomes after coronary artery bypass grafting (CABG) and/or valve surgery performed between 2005 and 2016 in hospitals in New York State are reported and analyzed.…”

mentioning

confidence: 99%