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Original Research

Open Access

Predictors of short- and long-term outcome after open cardiac surgery in a high-volume referral tertiary hospital: the role of surgical team caseload

  • Fabrizio Monaco1,*,
  • Gaia Barucco1
  • Gabriele Valsecchi1
  • Margherita Licheri1
  • Elisa Nicelli1
  • Elidodoro Cama1
  • Marina Pieri1
  • Giuseppe Dalessandro1
  • Cristina Nakhnoukh1
  • Carola Galbiati1
  • Gabriele Sanchini1
  • Camilla Biselli2
  • Rosalba Lembo1
  • Evgeny Fominskiy1
  • IRCCS San Raffaele Scientific Institute§

1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy

2Anesthésie et Réanimation Chirurgie Cardiaque Pédiatrique, Hospital Universitarie Necker Enfants Malades, rue de Sèvres 149, 75015 Paris, France

DOI: 10.22514/sv.2022.044

Submitted: 23 March 2021 Accepted: 13 April 2021

Online publish date: 16 June 2022

*Corresponding Author(s): Fabrizio Monaco E-mail: monaco.fabrizio@hsr.it

§ The author’s own special request.

About author: §IRCCS San Raffaele Scientific Institute: Di Prima AL, Di Tomasso N, Mucchetti M, Oriani A, Carcò F, Belletti A, Nardelli P.

Abstract

Very few studies have investigated the role of surgeon and anesthesiologist caseloads and high-sensitive troponin I (hs-TnI) on short- and long-term outcomes in cardiac surgery. In this study we assessed the relationship between perioperative hs-TnI measurements with 1-year mortality and major cardiovascular events (MACE) at 30 days as a function of surgeon and anesthesiologist volume experience. This is a single center, prospective observational study in a tertiary high-volume hospital enrolling 1000 consecutive adult patients undergoing open cardiac surgery. All patients were managed according to a standardized protocol, as per routine practice. Exclusion criteria were age <18, no written consent, ongoing myocardial infarction, preoperative hs-TnI ≥300 ng/L, salvage cardiac surgery, isolated thoracic aortic surgery or implantation of a ventricular assist device. At the multivariable analysis, lowest hematocrit during cardiopulmonary bypass [Odd ratio (OR): 0.81; 95% confidence intervals (CI): 0.74–0.92], preoperative activated thromboplastin time (OR: 1.04; 95% CI: 1.01–1.08), expert anesthesiologist (OR: 22.8; 95% CI: 1.73–301.87), post-operative intra-aortic balloon pump (OR: 5.20: 95% CI: 1.62–16.44), post-operative venous-arterial-extracorporeal membrane oxygenator (OR: 83.93; 95% CI: 4.95–1436.55), transfusion (OR: 10.17; 95% CI: 2.41–42.94) and MACE (OR: 3.93; 95% CI: 1.28–12.18) were independently associated with 1-year mortality [Hosmer and Lemeshow chi-test = 4.82; p = 0.77; AUC of the model corrected for optimism: 0.92 (95% CI: 0.89–0.94)]. We found that surgeons and anesthesiologists were not independent predictors of MACE at 30 days. The hs-TnI, measured at several time points, was not effective in predicting 1-year mortality or MACE at 30 days. Anesthesiologist- and surgeon-related annual case volume did not affect MACE at 30 days, while 1-year mortality was independently associated with anesthesiologist providers with the highest caseload.


Keywords

Perioperative; Outcome; Mortality; MACE; Cardiac surgery; Anesthesiologist; Perioperative; Quality; Surgical volume


Cite and Share

Fabrizio Monaco,Gaia Barucco,Gabriele Valsecchi,Margherita Licheri,Elisa Nicelli,Elidodoro Cama,Marina Pieri,Giuseppe Dalessandro,Cristina Nakhnoukh,Carola Galbiati,Gabriele Sanchini,Camilla Biselli,Rosalba Lembo,Evgeny Fominskiy,IRCCS San Raffaele Scientific Institute. Predictors of short- and long-term outcome after open cardiac surgery in a high-volume referral tertiary hospital: the role of surgical team caseload. Signa Vitae. 2022.doi:10.22514/sv.2022.044.

References

[1] Nguyen NT, Paya M, Stevens CM, Mavandadi S, Zainabadi K, Wilson SE. The Relationship between Hospital Volume and Outcome in Bariatric Surgery at Academic Medical Centers. Annals of Surgery. 2004; 240: 586–593.

[2] Lo H, Wu S. Reappraisal learning curve of laparoscopic Roux-en Y gastric bypass: retrospective results of one hundred and eight cases from a low-volume unit. BMC Surgery. 2021; 21: 86.

[3] Memtsoudis SG, Wilson LA, Bekeris J, Liu J, Poultsides L, Fiasconaro M, et al. Anaesthesia provider volume and perioperative outcomes in total joint arthroplasty surgery. British Journal of Anaesthesia. 2019; 123: 679–687.

[4] Papachristofi O, Mackay JH, Powell SJ, Nashef SAM, Sharples L. Impact of the Anesthesiologist and Surgeon on Cardiac Surgical Outcomes. Journal of Cardiothoracic and Vascular Anesthesia. 2014; 28: 103–109.

[5] Wassie M, Lee M, Sun BC, Wu Y, Baecker AS, Redberg RF, et al. Single vs Serial Measurements of Cardiac Troponin Level in the Evaluation of Patients in the Emergency Department with Suspected Acute Myocardial Infarction. JAMA Network Open. 2021; 4: e2037930.

[6] Li Y, Li Y, Hu Q, Zheng S, Tian B, Meng F, et al. Association of early elevated cardiac troponin i concentration and longitudinal change after off-pump coronary artery bypass grafting and adverse events: a prospective cohort study. Journal of Thoracic Disease. 2020; 12: 6542–6551.

[7] Monaco F, Landoni G, Biselli C, De Luca M, Frau G, Bignami E, et al. Predictors of Cardiac Troponin Release after Mitral Valve Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2010; 24: 931–938.

[8] Mohammed AA, Agnihotri AK, van Kimmenade RRJ, Martinez-Rumayor A, Green SM, Quiroz R, et al. Prospective, comprehensive assessment of cardiac troponin T testing after coronary artery bypass graft surgery. Circulation. 2009; 120: 843–850.

[9] Weidenmann V, Robinson NB, Rong LQ, Hameed I, Naik A, Morsi M, et al. Diagnostic dilemma of perioperative myocardial infarction after coronary artery bypass grafting: A review. International Journal of Surgery. 2020; 79: 76–83.

[10] World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Journal of the American Medical Association. 2013; 310: 2191–2194.

[11] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Van-denbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. International Journal of Surgery. 2014; 12: 1495–1499.

[12] Monaco F, Drummond GB, Ramsay P, Servillo G, Walsh TS. Do simple ventilation and gas exchange measurements predict early successful weaning from respiratory support in unselected general intensive care patients? British Journal of Anaesthesia. 2010; 105: 326–333.

[13] Friedman J, Hastie T, Tibshirani R. Regularization Paths for Generalized Linear Models via Coordinate Descent. Journal of Statistical Software. 2010; 33: 1–22.

[14] Zou H. The Adaptive Lasso and its Oracle Properties. Journal of the American Statistical Association. 2006; 101: 1418–1429.

[15] Minnier J, Tian L, Cai T. A Perturbation Method for Inference on Regularized Regression Estimates. Journal of the American Statistical Association. 2011; 106: 1371–1382.

[16] Agniel D, Liao KP, Cai T. Estimation and testing for multiple regulation of multivariate mixed outcomes. Biometrics. 2016; 72: 1194–1205.

[17] Afilalo J, Sharma A, Zhang S, Brennan JM, Edwards FH, Mack MJ, et al. Gait Speed and 1‐Year Mortality Following Cardiac Surgery: A Landmark Analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Journal of the American Heart Association. 2018; 7: e010139.

[18] Wilson LA, Fiasconaro M, Poeran J, Liu J, Girardi F, Memtsoudis SG. The impact of anesthesia and surgical provider characteristics on outcomes after spine surgery. European Spine Journal. 2019; 28: 2112–2121.

[19] Hannan EL, Kilburn H, Bernard H, O’Donnell JF, Lukacik G, Shields EP. Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors. Medical Care. 1991; 29: 1094–1107.

[20] Papachristofi O, Sharples LD, Mackay JH, Nashef SAM, Fletcher SN, Klein AA. The contribution of the anaesthetist to risk-adjusted mortality after cardiac surgery. Anaesthesia. 2016; 71: 138–146.

[21] Morone EJ, Barker SJ, Martinez Licha CR, Timsina LR, Namburi N, Milward JB, et al. Impact of troponin I level on coronary artery bypass grafting outcomes. Journal of Cardiac Surgery. 2020; 35: 2704–2709.

[22] Monaco F, Di Prima AL, Kim JH, Plamondon M-J, Yavorovskiy A, Likhvantsev V, et al. Management of Challenging Cardiopulmonary Bypass Separation. Journal of Cardiothoracic and Vascular Anesthesia. 2020; 34: 1622–1635.

[23] Kaddoura R, Omar AS, Ibrahim MIM, Alkhulaifi A, Lorusso R, Elsherbini H, et al. The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis. Journal of Cardiothoracic and Vascular Anesthesia. 2021; 35: 2483–2495.

[24] Acheampong B, Johnson JN, Stulak JM, Dearani JA, Kushwaha SS, Daly RC, et al. Postcardiotomy ECMO Support after High-risk Operations in Adult Congenital Heart Disease. Congenital Heart Disease. 2016; 11: 751–755.

[25] Khorsandi M, Dougherty S, Bouamra O, Pai V, Curry P, Tsui S, et al. Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis. Journal of Cardiothoracic Surgery. 2017; 12: 55.

[26] Arias-Morales CE, Stoicea N, Gonzalez-Zacarias AA, Slawski D, Bhandary SP, Saranteas T, et al. Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective. F1000Research. 2017; 6: F1000 Faculty Rev-168.

[27] Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A. Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed? Journal of Thoracic and Cardiovascular Surgery. 2003; 125: 1438–1450.

[28] Godino C, Sisinni A, Pivato CA, Adamo M, Taramasso M, Parlati A, et al. Prognostic Value of Pre-operative Atrial Fibrillation in Patients With Secondary Mitral Regurgitation Undergoing MitraClip Implantation. American Journal of Cardiology. 2021; 143: 51–59.

[29] Rupprecht L, Schopka S, Keyser A, Lunz D, Sossalla S, Hilker M, et al. 25 Years’ Experience with Redo Operations in Cardiac Surgery-Third-Time Sternotomy Procedures. Thoracic and Cardiovascular Surgeon. 2020. (in press)

[30] Sanfilippo F, Arcadipane A, Scolletta S. Transoesophageal echocardiog-raphy skills. Anaesthesia. 2016; 71: 598.


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