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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:

§ 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.


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.


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

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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.


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