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Association of Volume and Outcomes in 234,556 Patients Undergoing Surgical Aortic Valve Replacement. The Annals of thoracic surgery Thourani, V. H., Brennan, J. M., Edelman, J. J., Thibault, D., Jawitz, O. K., Bavaria, J. E., Higgins, R. S., Sabik, J. F., Prager, R. L., Dearani, J. A., MacGillivray, T. E., Badhwar, V., Svensson, L. G., Reardon, M. J., Shahian, D. M., Jacobs, J. P., Ailawadi, G., Szeto, W. Y., Desai, N., Roselli, E. E., Woo, Y. J., Vemulapalli, S., Carroll, J. D., Yadav, P., Malaisrie, S. C., Russo, M., Nguyen, T. C., Kaneko, T., Tang, G., Ruel, M., Chikwe, J., Lee, R., Habib, R. H., George, I., Leon, M. B., Mack, M. J. 2021

Abstract

BACKGROUND: The relationship between institutional volume and operative mortality following SAVR remains unclear.METHODS: From 1/2013 to 6/2018, 234,556 patients underwent isolated SAVR (n=144,177) or SAVR+CABG (n=90,379) within the STS ACSD. The association between annualized SAVR volume [Group 1 (1-25 SAVR), Group 2 (26-50 SAVR), Group 3 (51-100 SAVR), and Group 4 (>100 SAVR)] and operative mortality and composite major morbidity/mortality was assessed. Random effects models were used to evaluate whether historic (2013-2015) SAVR volume or risk-adjusted outcomes explained future (2016-2018) risk-adjusted outcomes.RESULTS: The annualized median number of SAVRs per site was 35 [IQR: 22-59, isolated AVR: 20, AVR+CABG: 13]. Among isolated SAVR cases, the mean operative mortality and composite morbidity/mortality were 1.5% and 9.7%, respectively, at the highest volume sites (Group 4); with significantly higher rates among progressively lower volume groups (p-trend<0.001). After adjustment, lower volume centers experienced increased odds of operative mortality [Group 1 vs. 4 (Ref): AOR (SAVR), 2.24 (1.91-2.64); AOR (SAVR+CABG), 1.96 (1.67-2.30)] and major morbidity/mortality [AOR (SAVR), 1.53 (1.39-1.69); AOR (SAVR+CABG), 1.46 (1.32-1.61)] compared to the highest volume institutions. Substantial variation in outcomes was observed across hospitals within each volume category and prior outcomes explained a greater proportion of hospital operative outcomes than prior volume.CONCLUSIONS: Operative outcomes following SAVR±CABG is inversely associated with institutional procedure volumes; however, prior outcomes are more predictive than prior volume of future outcomes. Given excellent outcomes observed at many lower volume hospitals, procedural outcomes may be preferable to procedural volumes as a quality metric.

View details for DOI 10.1016/j.athoracsur.2021.06.095

View details for PubMedID 34785247