The effect of surgeon volume on mortality for off-pump coronary artery bypass grafting

The Journal of Thoracic and Cardiovascular Surgery
Damien J LaparGorav Ailawadi

Abstract

Recent trials comparing on-pump (CABG) with off-pump coronary artery bypass grafting (OPCAB) have been criticized by those who believe that surgeon inexperience may explain the apparent worse outcomes for OPCAB. However, the true effect of surgeon volume on outcomes after OPCAB remains unknown. The purpose of this study was to examine the effect of surgeon volume on risk-adjusted mortality after OPCAB. From 2003 to 2007, 709,483 patients underwent coronary artery bypass grafting operations (CABG = 439,253; OPCAB = 270,230) within the Nationwide Inpatient Sample database. Hierarchic generalized linear regression modeling with spline functions for annual individual operating surgeon volume was used to assess the relationship between annual surgeon volume and inpatient mortality, adjusted for comorbid disease and other potential confounders. OPCAB was performed in 38.1% of coronary artery bypass grafting operations. The average age for those undergoing OPCAB was 66.1 ± 11.1 years, and female patients accounted for 29.3% of operations with 1-vessel (20.4%), 2-vessel (36.6%), 3-vessel (20.5%), or 4 vessels or more (13.6%). Median surgeon volume for OPCAB was 105 (56-156) operations per year. A highly significant nonlinear relationsh...Continue Reading

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Citations

Nov 6, 2012·Interactive Cardiovascular and Thoracic Surgery·Amir H Sepehripour, Thanos Athanasiou
Sep 12, 2012·Annals of Surgery·Damien J LaParBenjamin D Kozower
Feb 26, 2013·Journal of Neurosurgery·Andrew S Little, Kristina Chapple
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