Abstract P314: The Impact of Hospital Cardiac Specialization on Outcomes After Coronary Artery Bypass Graft Surgery: Analysis of Medicare Claims Data

Background Hospital volume has been widely embraced as a proxy for hospital quality; little attention has been focused on an alternative quality metric - hospital specialization. While specialization occurs on a continuum, prior studies of specialization have largely focused on a small number of highly specialized ( specialty) hospitals. Studies on the broad relationship between hospital specialization and outcomes after cardiac surgery are lacking. Methods We used Medicare data to identify 705084 patients who underwent CABG at 1130 hospitals during 2001-2005. We stratified hospitals into quintiles of cardiac specialization based on the relative proportion of all Medicare discharges at each hospital classified as Major Disease Category 5 - diseases of cardiovascular system. We obtained hospital characteristics from the 2001-2005 AHA survey. We used multivariable hierarchical regression to examine the association of cardiac specialization with risk of 30-day mortality adjusting for patient characteristics & CABG volume. Results The mean age of CABG recipients was 75 years, 65% were men, 92% were white. Patient demographic & comorbidity was generally similar between quintiles of hospital specialization. The median cardiac specialization was 29.7% for all hospitals (mean cardiac specialization in lowest quintile of hospital specialization was 23.2% vs. 45.2% for highest quintile). Compared to the highest quintile, hospitals in the lowest quintile had fewer beds (296 vs. 314, p < .01), were less likely to be teaching hospitals (22% vs. 26%, p < .01) and had lower CABG volume (63 vs. 239, p < .01). They also admitted less transfer patients (8.3% vs. 17.5%, p < .01) and performed less concurrent valve surgery (13% vs. 15%, p < .01). Unadjusted 30-day mortality was higher at least specialized hospitals compared to most specialized hospitals (4.9% vs. 4.3%, p < .01). Odds of mortality remained higher at these hospitals after adjustment for patient characteristics (OR 1.15 95% CI [1.07 - 1.24] p trend < .01) but was similar after further adjustment for CABG volume (OR 1.05 95% CI [0.97 - 1.15] p trend 0.65). Conclusion After accounting for hospital volume, hospitals with greater cardiac specialization did not have better CABG outcomes than less specialized hospitals.

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Limitations of Hospital Volume as a Measure of Quality of Care for Coronary Artery Bypass Graft Surgery

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2005.05.017 ◽

2005 ◽

Vol 80 (6) ◽

pp. 2114-2119 ◽

Cited By ~ 29

Author(s):

Karl F. Welke ◽

Mitchell J. Barnett ◽

Mary S. Vaughan Sarrazin ◽

Gary E. Rosenthal

Keyword(s):

Quality Of Care ◽

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Hospital Volume ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft

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Impact of atrial fibrillation on in-hospital outcomes among hospitalizations for cardiac surgery: an analysis of the National Inpatient Sample

Journal of Investigative Medicine ◽

10.1136/jim-2021-001864 ◽

2022 ◽

pp. jim-2021-001864

Author(s):

Kanishk Agnihotri ◽

Paris Charilaou ◽

Dinesh Voruganti ◽

Kulothungan Gunasekaran ◽

Jawahar Mehta ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Valve Replacement ◽

Failure Time ◽

Artery Bypass ◽

Bypass Graft ◽

National Inpatient Sample ◽

Inpatient Mortality ◽

Hospitalization Costs ◽

The Impact

The short-term impact of atrial fibrillation (AF) on cardiac surgery hospitalizations has been previously reported in cohorts of various sizes, but results have been variable. Using the 2005–2014 National Inpatient Sample, we identified all adult hospitalizations for cardiac surgery using the International Classification of Diseases, Ninth Revision, Clinical Modification as any procedure code and AF as any diagnosis code. We estimated the impact of AF on inpatient mortality, length of stay (LOS), and cost of hospitalization using survey-weighted, multivariable logistic, accelerated failure-time log-normal, and log-transformed linear regressions, respectively. Additionally, we exact-matched AF to non-AF hospitalizations on various confounders for the same outcomes. A total of 1,269,414 hospitalizations were noted for cardiac surgery during the study period. Coexistent AF was found in 44.9% of these hospitalizations. Overall mean age was 65.6 years, 40.9% were female, mean LOS was 11.6 days, and inpatient mortality was 4.5%. Stroke rate was lower in AF hospitalizations (1.8% vs 2.1%, p<0.001). Mortality was lower in the AF (3.9%) versus the non-AF (5%) group (exact-matched OR or emOR=0.48, 95% CI 0.29 to 0.80, p<0.001; 987 matched pairs, n=2423), with similar results after procedural stratification: isolated valve replacement/repair (emOR=0.38, p<0.001), isolated coronary artery bypass graft (CABG) (emOR=0.33, p<0.001), and CABG with valve replacement/repair (emOR=0.55, p<0.001). A 12% increase was seen in LOS in the AF subgroup (exact-matched time ratio=1.12, 95% CI 1.10 to 1.14, p<0.001) among hospitalizations which underwent valve replacement/repair with or without CABG. Hospitalizations for cardiac surgery which had coexistent AF were found to have lower inpatient mortality risk and stroke prevalence but higher LOS and hospitalization costs compared with hospitalizations without AF.

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The impact of minimal invasive extracorporeal circulation on postoperative kidney function

Perfusion ◽

10.1177/0267659120954601 ◽

2020 ◽

pp. 026765912095460

Author(s):

Ara Shwan Media ◽

Peter Juhl-Olsen ◽

Nils Erik Magnusson ◽

Ivy Susanne Modrau

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Kidney Function ◽

Extracorporeal Circulation ◽

Artery Bypass ◽

Bypass Graft ◽

Kidney Injury ◽

Minimal Invasive ◽

Mortality And Morbidity ◽

The Impact

Introduction: Acute kidney injury following cardiac surgery is a frequent complication associated with increased mortality and morbidity. Minimal invasive extracorporeal circulation is suggested to preserve postoperative renal function. The aim of this study was to assess the impact of minimal invasive versus conventional extracorporeal circulation on early postoperative kidney function. Methods: Randomized controlled trail including 60 patients undergoing elective stand-alone coronary artery bypass graft surgery and allocated in a 1:1 ratio to either minimal invasive (n = 30) or conventional extracorporeal circulation (n = 30). Postoperative kidney injury was assessed by elevation of plasma neutrophil gelatinase-associated lipocalin (NGAL), a sensitive tubular injury biomarker. In addition, we assessed changes in estimated glomerular filtration rate (eGFR), and the incidence of acute kidney injury according to the Acute Kidney Injury Network (AKIN) classification. Results: We observed no differences between groups regarding increase of plasma NGAL (p = 0.31) or decline of eGFR (p = 0.82). In both groups, 6/30 patients developed acute kidney injury according to the AKIN classification, all regaining preoperative renal function within 30 days. Conclusion: Our findings challenge the superiority of minimal invasive compared to conventional extracorporeal circulation in terms of preservation of renal function following low-risk coronary surgery.

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Mortality and Revascularization among Myocardial Infarction Patients with Schizophrenia: A Population-Based Cohort Study

The Canadian Journal of Psychiatry ◽

10.1177/0706743720904845 ◽

2020 ◽

Vol 65 (7) ◽

pp. 454-462 ◽

Cited By ~ 2

Author(s):

Tanya S. Hauck ◽

Ning Liu ◽

Harindra C. Wijeysundera ◽

Paul Kurdyak

Keyword(s):

Myocardial Infarction ◽

Coronary Revascularization ◽

Artery Bypass ◽

Bypass Graft ◽

Coronary Intervention ◽

Population Based ◽

Geographic Region ◽

Time Varying ◽

The Impact ◽

The Relationship

Background: Cardiovascular disease is a major source of mortality in schizophrenia, and access to care after acute myocardial infarction (AMI) is poor for these patients. Aims: To understand the relationship between schizophrenia and access to coronary revascularization and the impact of revascularization on mortality among individuals with schizophrenia and AMI. Method: This study used a retrospective cohort of AMI in Ontario between 2008 and 2015. The exposure was a diagnosis of schizophrenia, and patients were followed 1 year after AMI discharge. The primary outcome was all-cause mortality within 1 year. Secondary outcomes were cardiac catheterization and revascularization (percutaneous coronary intervention or coronary artery bypass graft). Cox proportional hazard regression models were used to study the relationship between schizophrenia and mortality, and the time-varying effect of revascularization. Results: A total of 108,610 cases of incident AMI were identified, among whom 1,145 (1.1%) had schizophrenia. Schizophrenia patients had increased mortality, with a hazard ratio (HR) of 1.55 (95% CI, 1.37 to 1.77) when adjusted for age, sex, income, rurality, geographic region, and comorbidity. After adjusting for time-varying revascularization, the HR reduced to 1.38 (95% CI, 1.20 to 1.58). The impact of revascularization on mortality was similar among those with and without schizophrenia (HR: 0.42; 95% CI, 0.41 to 0.44 vs. HR: 0.40; 95% CI, 0.26 to 0.61). Conclusions: In this sample of AMI, mortality in schizophrenia is increased, and treatment with revascularization reduces the HR of schizophrenia. The higher mortality rate yet similar survival benefit of revascularization among individuals with schizophrenia relative to those without suggests that increasing access to revascularization may reduce the elevated mortality observed in individuals with schizophrenia.

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