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

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 2...

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Autores principales: Boudreaux, Joel C., Urban, Marian, Castleberry, Anthony W., Um, John Y., Moulton, Michael J., Siddique, Aleem
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542019/
https://www.ncbi.nlm.nih.gov/pubmed/35864745
http://dx.doi.org/10.1111/jocs.16783
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author Boudreaux, Joel C.
Urban, Marian
Castleberry, Anthony W.
Um, John Y.
Moulton, Michael J.
Siddique, Aleem
author_facet Boudreaux, Joel C.
Urban, Marian
Castleberry, Anthony W.
Um, John Y.
Moulton, Michael J.
Siddique, Aleem
author_sort Boudreaux, Joel C.
collection PubMed
description 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.
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spelling pubmed-95420192022-10-14 In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes Boudreaux, Joel C. Urban, Marian Castleberry, Anthony W. Um, John Y. Moulton, Michael J. Siddique, Aleem J Card Surg Original Articles 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. John Wiley and Sons Inc. 2022-07-21 2022-10 /pmc/articles/PMC9542019/ /pubmed/35864745 http://dx.doi.org/10.1111/jocs.16783 Text en © 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Boudreaux, Joel C.
Urban, Marian
Castleberry, Anthony W.
Um, John Y.
Moulton, Michael J.
Siddique, Aleem
In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes
title In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes
title_full In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes
title_fullStr In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes
title_full_unstemmed In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes
title_short In a large‐volume multidisciplinary setting individual surgeon volume does not impact LVAD outcomes
title_sort in a large‐volume multidisciplinary setting individual surgeon volume does not impact lvad outcomes
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542019/
https://www.ncbi.nlm.nih.gov/pubmed/35864745
http://dx.doi.org/10.1111/jocs.16783
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