Abstract
Background: Although understanding the association between surgical volume and outcome has been the focus of much research, no study has yet reported the volume-outcome effect for thoracic aortic surgery. Methods: From the clinical database, we identified and analyzed 2875 procedures that took place across 36 centers between 2003 and 2005. The effect of hospital procedural volume was assessed for each outcome measure using a hierarchical mixed-effects logistic regression model. Clinical risk factors, procedural year, clinical processes, range of replacement, hospital volume and surgeon volume were set as fixed effects and sites were used as random intercepts. Results: The logistic regression model revealed that hospital thoracic aortic surgery volume was linked to statistically significant decreases in both 30-day mortality (p = 0.127: OR 0.988-0.999) and operative mortality (p = 0.022: 0.989-0.999). In addition, subgroup analysis showed that increased hospital volume was associated with reduced mortality rates in patients under 65 years of age (p = 0.038: 0.982-0.999) and in high-risk surgical candidates (p = 0.019: 0.989-0.999). Thoracic aortic surgery volume of surgeons, hospital adult cardiovascular surgery volume and surgeons adult cardiovascular surgery volume did not significantly impact these outcomes. Conclusions: In this study higher annual hospital thoracic aortic surgery volume of hospitals is associated with reduced mortality rates for thoracic aortic surgery. In Japan it is not the hospital general adult cardiovascular surgery volume, but the hospital specific thoracic aortic surgery volume that might be preferable for quality indicator of thoracic aortic surgery.
| Original language | English |
|---|---|
| Pages (from-to) | 517-521 |
| Number of pages | 5 |
| Journal | European Journal of Cardio-thoracic Surgery |
| Volume | 36 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 2009 Sep |
| Externally published | Yes |
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Keywords
- Cardiovascular
- Clinical database
- Public reporting
- Quality improvement
- Thoracic aortic surgery
- Volume-outcome effect
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
Cite this
Toward quality improvement of thoracic aortic surgery : estimating volume-outcome effect from nationwide survey. / Miyata, Hiroaki; Motomura, Noboru; Ueda, Yuichi; Tsukihara, Hiroyuki; Tabayashi, Koichi; Takamoto, Shinichi.
In: European Journal of Cardio-thoracic Surgery, Vol. 36, No. 3, 09.2009, p. 517-521.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Toward quality improvement of thoracic aortic surgery
T2 - estimating volume-outcome effect from nationwide survey
AU - Miyata, Hiroaki
AU - Motomura, Noboru
AU - Ueda, Yuichi
AU - Tsukihara, Hiroyuki
AU - Tabayashi, Koichi
AU - Takamoto, Shinichi
PY - 2009/9
Y1 - 2009/9
N2 - Background: Although understanding the association between surgical volume and outcome has been the focus of much research, no study has yet reported the volume-outcome effect for thoracic aortic surgery. Methods: From the clinical database, we identified and analyzed 2875 procedures that took place across 36 centers between 2003 and 2005. The effect of hospital procedural volume was assessed for each outcome measure using a hierarchical mixed-effects logistic regression model. Clinical risk factors, procedural year, clinical processes, range of replacement, hospital volume and surgeon volume were set as fixed effects and sites were used as random intercepts. Results: The logistic regression model revealed that hospital thoracic aortic surgery volume was linked to statistically significant decreases in both 30-day mortality (p = 0.127: OR 0.988-0.999) and operative mortality (p = 0.022: 0.989-0.999). In addition, subgroup analysis showed that increased hospital volume was associated with reduced mortality rates in patients under 65 years of age (p = 0.038: 0.982-0.999) and in high-risk surgical candidates (p = 0.019: 0.989-0.999). Thoracic aortic surgery volume of surgeons, hospital adult cardiovascular surgery volume and surgeons adult cardiovascular surgery volume did not significantly impact these outcomes. Conclusions: In this study higher annual hospital thoracic aortic surgery volume of hospitals is associated with reduced mortality rates for thoracic aortic surgery. In Japan it is not the hospital general adult cardiovascular surgery volume, but the hospital specific thoracic aortic surgery volume that might be preferable for quality indicator of thoracic aortic surgery.
AB - Background: Although understanding the association between surgical volume and outcome has been the focus of much research, no study has yet reported the volume-outcome effect for thoracic aortic surgery. Methods: From the clinical database, we identified and analyzed 2875 procedures that took place across 36 centers between 2003 and 2005. The effect of hospital procedural volume was assessed for each outcome measure using a hierarchical mixed-effects logistic regression model. Clinical risk factors, procedural year, clinical processes, range of replacement, hospital volume and surgeon volume were set as fixed effects and sites were used as random intercepts. Results: The logistic regression model revealed that hospital thoracic aortic surgery volume was linked to statistically significant decreases in both 30-day mortality (p = 0.127: OR 0.988-0.999) and operative mortality (p = 0.022: 0.989-0.999). In addition, subgroup analysis showed that increased hospital volume was associated with reduced mortality rates in patients under 65 years of age (p = 0.038: 0.982-0.999) and in high-risk surgical candidates (p = 0.019: 0.989-0.999). Thoracic aortic surgery volume of surgeons, hospital adult cardiovascular surgery volume and surgeons adult cardiovascular surgery volume did not significantly impact these outcomes. Conclusions: In this study higher annual hospital thoracic aortic surgery volume of hospitals is associated with reduced mortality rates for thoracic aortic surgery. In Japan it is not the hospital general adult cardiovascular surgery volume, but the hospital specific thoracic aortic surgery volume that might be preferable for quality indicator of thoracic aortic surgery.
KW - Cardiovascular
KW - Clinical database
KW - Public reporting
KW - Quality improvement
KW - Thoracic aortic surgery
KW - Volume-outcome effect
UR - http://www.scopus.com/inward/record.url?scp=68749092645&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=68749092645&partnerID=8YFLogxK
U2 - 10.1016/j.ejcts.2009.03.020
DO - 10.1016/j.ejcts.2009.03.020
M3 - Article
VL - 36
SP - 517
EP - 521
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
SN - 1010-7940
IS - 3
ER -