Joseph S. Carey1, Joseph Parker2; 1California Society of Thoracic Surgeons, Torrance, CA; 2Office of Statewide Health Planning and Development, Sacramento, CA
Objective: Case volume in cardiac surgery has been a concern since Frank Spencer M.D. coined the term "the occasional open heart surgeon" more than thirty years ago, indicating one who performs cardiac surgery infrequently.Methods: Data collected through the California CABG Outcomes Reporting Program (CCORP) was reviewed. All CABG procedures were reported for the years 2003-2004, and risk-adjusted mortality for isolated CABG cases was determined by surgeon and by hospital. Standard STS procedure and risk factor definitions were used, but a unique risk model was calculated from clinical information for isolated CABG procedures. A total of 49,418 CABG (40,381 isolated) cases were performed by 274 surgeons at 120 hospitals.
Results: Most surgeons operated at more than one hospital. The data was analyzed by surgeon and by hospital, producing 609 surgeon-hospital pairs. Low volume surgeons (n=90) were defined as performing a total of less than one CABG (isolated or combined) procedure per week at all hospitals. High volume surgeons (n=184) performed a total of one or more cases per week. Total procedures and mortality rates for isolated CABG for low and high volume surgeons are shown in the table. High volume surgeons had the lowest risk adjusted mortality rates (RAMR) when performing more than one case per week at a hospital. However, when high volume surgeons performed less than one case per week at a hospital, their mortality rates were no better than low volume surgeons.
Conclusion: High volume surgeons performing a small volume of CABG procedures in a hospital have no better outcomes than low volume surgeons, suggesting that system factors are more important to outcomes than surgeon experience.
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