Abstract 10802: Surgeon Volume is Associated With Operative Mortality After Congenital Cardiac Surgery
Introduction: While relationships between hospital volume and mortality related to congenital cardiac surgery have been established, the influence of surgeon volume is less certain. Hypothesis: Surgeon volume is associated with mortality, after accounting for hospital volume.
Methods: We identified congenital cardiac operations performed from 2005-2010 on patients ≤18 years of age in the Society of Thoracic Surgeons Congenital Heart Surgery Database (71,745 operations, 197 surgeons at 84 hospitals). Hospitals were grouped by annual congenital cardiac surgical volume (low, <150; medium, 150-249; high, ≥250 cases per year). Surgeons were similarly categorized (low, <75; medium, 75-124; high, ≥125 cases per year). We used nested logistic regression to examine the relationships between in-hospital mortality and annual surgeon and hospital volume adjusting for patient characteristics and case complexity.
Results: Overall unadjusted mortality in the cohort was 3.7%. When analyzed individually, both surgeon and hospital volume were inversely associated with mortality (p<0.0001 for overall surgeon volume trend, OR for low vs. high volume surgeons 1.6, 95% CI 1.3-1.9; p=0.0001 for overall hospital volume trend, OR for low vs. high volume hospitals 1.4, 95% CI 1.2-1.8). This relationship was consistent across low and high risk operations. When analyzed together, the addition of surgeon volume to the hospital volume models attenuated, but did not completely mitigate, the association of hospital volume with mortality (relative attenuation of OR 53% in low and 22% in medium volume hospitals). Low volume surgeons had higher adjusted mortality rates regardless of the surgical volume of the hospital in which they operated. (Figure)
Conclusions: Both hospital and surgeon volume were associated with in-hospital mortality after congenital cardiac surgery. Initiatives to improve patient outcomes must acknowledge these relationships.
- © 2012 by American Heart Association, Inc.