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Multicenter Study
. 2024 Jul;168(1):165-174.e2.
doi: 10.1016/j.jtcvs.2023.05.009. Epub 2023 May 20.

Center case volume is associated with Society of Thoracic Surgeons-defined failure to rescue in cardiac surgery

Raymond J Strobel  1 , Andrew M Young  1 , Evan P Rotar  1 , Emily F Kaplan  2 , Robert B Hawkins  3 , Anthony V Norman  1 , Raza M Ahmad  1 , Mark Joseph  4 , Mohammed Quader  5 , Jeffrey B Rich  6 , Alan M Speir  7 , Leora T Yarboro  1 , J Hunter Mehaffey  1 , Nicholas R Teman  8 ; Virginia Cardiac Services Quality Initiative
Affiliations
Multicenter Study

Center case volume is associated with Society of Thoracic Surgeons-defined failure to rescue in cardiac surgery

Raymond J Strobel et al. J Thorac Cardiovasc Surg. 2024 Jul.

Abstract

Objective: Our understanding of the impact of a center's case volume on failure to rescue (FTR) after cardiac surgery is incomplete. We hypothesized that increasing center case volume would be associated with lower FTR.

Methods: Patients undergoing a Society of Thoracic Surgeons index operation in a regional collaborative (2011-2021) were included. After we excluded patients with missing Society of Thoracic Surgeons Predicted Risk of Mortality scores, patients were stratified by mean annual center case volume. The lowest quartile of case volume was compared with all other patients. Logistic regression analyzed the association between center case volume and FTR, adjusting for patient demographics, race, insurance, comorbidities, procedure type, and year.

Results: A total of 43,641 patients were included across 17 centers during the study period. Of these, 5315 (12.2%) developed an FTR complication, and 735 (13.8% of those who developed an FTR complication) experienced FTR. Median annual case volume was 226, with 25th and 75th percentile cutoffs of 136 and 284 cases, respectively. Increasing center-level case volume was associated with significantly greater center-level major complication rates but lower mortality and FTR rates (all P values < .01). Observed-to-expected FTR was significantly associated with case volume (P = .040). Increasing case volume was independently associated with decreasing FTR rate in the final multivariable model (odds ratio, 0.87 per quartile; confidence interval, 0.799-0.946, P = .001).

Conclusions: Increasing center case volume is significantly associated with improved FTR rates. Assessment of low-volume centers' FTR performance represents an opportunity for quality improvement.

Keywords: critical care; failure to rescue; quality.

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Conflict of interest statement

The authors had full control of the design of the study, methods used, results, data analysis and production of the written manuscript. Research reported in this publication/presentation/work was supported in part by the National Heart, Lung, and Blood Institute (grant T32 HL007849), as well as by a grant under Award Number 2UM HL088925.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Figures

Figure 1.
Figure 1.
CONSORT Diagram
Figure 2.
Figure 2.
Rate of Mortality, Major Complications, and Failure to Rescue, by Center-Level Case Volume Quartile
Figure 3.
Figure 3.
Rate of Failure to Rescue by Center-level Case Volume. Dotted Line corresponds to single linear regression. Each square corresponds to a single center.
Figure 4.
Figure 4.
Graphical Abstract
See this image and copyright information in PMC

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