In a large-volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes

Joel C. Boudreaux, Marian Urban, Anthony W. Castleberry, John Y. Um, Michael J. Moulton, Aleem Siddique

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In complex operations surgeon volume may impact outcomes. We sought to understand if individual surgeon volume affects left ventricular assist device (LVAD) outcomes. Methods: We reviewed primary LVAD implants at an experienced ventricular assist devices (VAD)/transplant center between 2013 and 2019. Cases were dichotomized into a high-volume group (surgeons averaging 11 or more LVAD cases per year), and a low-volume group (10 or less per year). Propensity score matching was performed. Survival to discharge, 1-year survival, and incidence of major adverse events were compared between the low- and high-volume groups. Predictors of survival were identified with multivariate analysis. Results: There were 315 patients who met inclusion criteria-45 in the low-volume group, 270 in the high-volume group. There was no difference in survival to hospital discharge between the low (91.9%) and high (83.3%) volume matched groups (p =.22). Survival at 1-year was also similar (85.4% vs. 80.6%, p =.55). There was no difference in the incidence of major adverse events between the groups. Predictors of mortality in the first year included: age (hazards ratio [HR]: 1.061, p <.001), prior sternotomy (HR: 1.991, p =.01), increasing international normalized ratio (HR: 4.748, p <.001), increasing AST (HR: 1.001, p <.001), increasing bilirubin (HR: 1.081, p =.01), and preoperative mechanical ventilation (HR: 2.662, p =.005). Individual surgeon volume was not an independent predictor of discharge or 1-year survival. Conclusion: There was no difference in survival or adverse events between high and low volume surgeons suggesting that, in an experienced multidisciplinary setting, low-volume VAD surgeons can achieve similar outcomes to their high-volume colleagues.

Original languageEnglish (US)
Pages (from-to)3290-3299
Number of pages10
JournalJournal of cardiac surgery
Volume37
Issue number10
DOIs
StatePublished - Oct 2022

Keywords

  • circulatory support
  • heart failure
  • ventricular assist device

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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