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Center-Level CABG and Valve Operative Outcomes and Volume-outcome Relationships in New York State
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  • Cornell Brooks,
  • Makoto Mori,
  • Michael Shang,
  • Gabe Weininger,
  • Sameer Raul,
  • Pranammya Dey,
  • Prashanth Vallabhajosyula,
  • Arnar Geirsson
Cornell Brooks
Yale School of Medicine
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Makoto Mori
Yale University School of Medicine
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Michael Shang
Yale School of Medicine
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Gabe Weininger
Yale School of Medicine
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Sameer Raul
Yale School of Medicine
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Pranammya Dey
Yale School of Medicine
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Prashanth Vallabhajosyula
Yale School of Medicine
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Arnar Geirsson
Yale University School of Medicine
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Abstract

Background: We analyzed center-level outcome correlations between valve surgery and coronary artery bypass graft (CABG) in New York (NY) State and how volume-outcome effect differ between case types. Methods: We used the 2014-2016 NY cardiac surgery outcomes report. Center-level observedto-expected (O/E) ratio for operative mortality provided risk-adjusted operative outcomes for isolated CABG and valve operations. Correlation coefficient characterized the concordance in center-level outcomes in CABG and valve. Discordant outcomes were defined as having O/E ratio >2 in one operation type with O/E ratio ≤1 in another. Linearized slope of volume-outcome effect in case types offered insights into centers with discordant performances between procedures. Results: Among 37 NY centers, annual center volumes were 220±120 cases for CABG and 190±178 cases for valve operations. Modest center-level correlation between CABG and valve O/E ratio was shown (R2 = 0.31). Two centers had discordant performance between valve and CABG (O/E ≤1 for CABG while O/E > 2 for valve procedures). No centers had CABG O/E ratio > 2 while valve O/E ratio ≤1. Linearized slope describing volume-outcome effects showed stronger effect in valve operations compared to CABG: O/E ratio declined 0.1 units per 100 CABG volume increase, while O/E ratio declined 0.33 units per 100 valve volume increase. Conclusions: In NY hospitals, favorable valve outcomes may indicate good CABG outcomes but good CABG outcomes may not ensure valve outcomes. Outcome variation in valve operation could be related to stronger volume-outcome effect in valve operations relative to CABG. Valve operations may benefit from regionalization.

Peer review status:Published

12 Aug 2020Submitted to Journal of Cardiac Surgery
13 Aug 2020Submission Checks Completed
13 Aug 2020Assigned to Editor
04 Sep 2020Reviewer(s) Assigned
10 Sep 2020Review(s) Completed, Editorial Evaluation Pending
26 Sep 2020Editorial Decision: Revise Major
02 Oct 20201st Revision Received
09 Nov 2020Submission Checks Completed
09 Nov 2020Assigned to Editor
14 Nov 2020Reviewer(s) Assigned
15 Nov 2020Review(s) Completed, Editorial Evaluation Pending
20 Nov 2020Editorial Decision: Accept
18 Dec 2020Published in Journal of Cardiac Surgery. 10.1111/jocs.15240