Caseload and valve surgery outcome in Australia.
Russell EA, Baker RA, Bennetts JS, Brown A, Reid CM, Tam R, Tran L, Walsh WF, Maguire GP.
Int J Cardiol. 2016;221:144-151. doi:10.1016/j.ijcard.2016.06.179
Abstract
Background: In Australia, it has been suggested that heart valve surgery, particularly for rheumatic heart disease (RHD), should be consolidated in higher volume centres. International studies of cardiac surgery suggest large volume centres have superior outcomes. However, the effect of site and surgeon caseload on longer-term outcomes for valve surgery has not been investigated.
Results: Outcomes associated with 20,116 valve procedures at 25 surgical sites and by 93 surgeons were analysed. Overall adjusted analysis showed increasing site and surgeon caseload was associated with longer ventilation, less reoperation, and more anticoagulant complications. Increasing surgeon caseload was also associated with less acute kidney injury. Adjusted 30-day mortality was not associated with the site or surgeon caseload. There was no consistent relationship between increasing site caseload and long term survival. The association between surgeon caseload and outcome demonstrated poorer adjusted survival in the highest volume surgeon group.
Conclusion: In this Australian study, the adjusted association between surgeon and site caseload was not simple or consistent. Overall larger volume sites or surgeons did not have superior outcomes. Mandating a particular site caseload level for valve surgery or a minimum number of procedures for individual surgeons, in an Australian context, cannot be supported by these findings.