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Relative impact of surgeon and center volume on early mortality after the Norwood operation.

Publication ,  Journal Article
Hornik, CP; He, X; Jacobs, JP; Li, JS; Jaquiss, RDB; Jacobs, ML; O'Brien, SM; Welke, K; Peterson, ED; Pasquali, SK
Published in: Ann Thorac Surg
June 2012

BACKGROUND: Previous studies suggest center volume is associated with outcome after the Norwood operation; however, the impact of surgeon volume is less clear. We evaluated the relative impact of surgeon and center volume on mortality in a large Norwood cohort. METHODS: Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Norwood operation (2000 to 2009) were included. Using multivariable logistic regression, we evaluated the relationship between in-hospital mortality and annual center and surgeon volume, adjusting for patient factors. RESULTS: A total of 2,555 patients were operated on at 53 centers by 111 surgeons. Overall unadjusted mortality was 22.1%. When analyzed individually, both lower center and surgeon volume were associated with higher mortality (odds ratio for centers with 0 to 10 vs >20 cases per year 1.56 [95% confidence interval 1.05 to 2.31]; odds ratio for surgeons with 0 to 5 vs >10 cases per year 1.60 [95% confidence interval 1.12 to 2.27]). When analyzed together, the addition of surgeon volume to the center volume models attenuated but did not completely mitigate the association of center volume with outcome (relative attenuation of odds ratio=34%). Adjusted mortality rates in low, medium, and high volume centers were 25.6%, 22.3%, and 17.7%, respectively. Across all center volume strata, lower volume surgeons had higher adjusted mortality rates. CONCLUSIONS: Both center and surgeon volumes appear to influence Norwood outcomes. These data suggest outcomes may potentially be improved through strategies that take advantage of the positive influence of both of these variables. This could include further investigation into the feasibility of regional collaborations, and the development of quality improvement initiatives within and across centers.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2012

Volume

93

Issue

6

Start / End Page

1992 / 1997

Location

Netherlands

Related Subject Headings

  • Utilization Review
  • United States
  • Survival Rate
  • Risk Factors
  • Respiratory System
  • Odds Ratio
  • Norwood Procedures
  • Male
  • Infant, Newborn
  • Humans
 

Citation

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Hornik, C. P., He, X., Jacobs, J. P., Li, J. S., Jaquiss, R. D. B., Jacobs, M. L., … Pasquali, S. K. (2012). Relative impact of surgeon and center volume on early mortality after the Norwood operation. Ann Thorac Surg, 93(6), 1992–1997. https://doi.org/10.1016/j.athoracsur.2012.01.107
Hornik, Christoph P., Xia He, Jeffrey P. Jacobs, Jennifer S. Li, Robert D. B. Jaquiss, Marshall L. Jacobs, Sean M. O’Brien, Karl Welke, Eric D. Peterson, and Sara K. Pasquali. “Relative impact of surgeon and center volume on early mortality after the Norwood operation.Ann Thorac Surg 93, no. 6 (June 2012): 1992–97. https://doi.org/10.1016/j.athoracsur.2012.01.107.
Hornik CP, He X, Jacobs JP, Li JS, Jaquiss RDB, Jacobs ML, et al. Relative impact of surgeon and center volume on early mortality after the Norwood operation. Ann Thorac Surg. 2012 Jun;93(6):1992–7.
Hornik, Christoph P., et al. “Relative impact of surgeon and center volume on early mortality after the Norwood operation.Ann Thorac Surg, vol. 93, no. 6, June 2012, pp. 1992–97. Pubmed, doi:10.1016/j.athoracsur.2012.01.107.
Hornik CP, He X, Jacobs JP, Li JS, Jaquiss RDB, Jacobs ML, O’Brien SM, Welke K, Peterson ED, Pasquali SK. Relative impact of surgeon and center volume on early mortality after the Norwood operation. Ann Thorac Surg. 2012 Jun;93(6):1992–1997.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2012

Volume

93

Issue

6

Start / End Page

1992 / 1997

Location

Netherlands

Related Subject Headings

  • Utilization Review
  • United States
  • Survival Rate
  • Risk Factors
  • Respiratory System
  • Odds Ratio
  • Norwood Procedures
  • Male
  • Infant, Newborn
  • Humans