Original articleAdult cardiacAortic Valve Replacement: Using a Statewide Cardiac Surgical Database Identifies a Procedural Volume Hinge Point
Section snippets
Material and Methods
The Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative is a multidisciplinary group consisting of all 33 hospitals performing adult cardiac operations in the state of Michigan. The structure, data collection systems, and auditing processes have been previously described [13]. Briefly, all data submitted to the Society of Thoracic Surgeons (STS) database is simultaneously submitted to the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative.
Results
The median age of the entire cohort was 72 years (63.1% male patients). The median PRoM was 2.57%. Frequent comorbidities included history of stroke (7.1%), hypertension (83.2%), diabetes (33.7%), moderate or severe chronic obstructive lung disease (10.2%), and previous CABG (9.4%), valve (4.5%), or percutaneous coronary (57.7%) procedures. The predominant aortic valve disease was aortic stenosis (87.9%), although 14.4% of participants had severe aortic insufficiency.
Early mortality was
Comment
Previous studies have suggested that important determinants of early mortality after AVR included age, urgency of presentation, diagnosis, and prolonged cardiopulmonary bypass times 1, 2, 3. In 2000, Astor and colleagues [4] from the US Food and Drug Administration used the Nationwide Inpatient Sample to suggest that hospital volume served as an important variable in predicting mortality after AVR.4 This supported a growing body of literature examining the association of improved outcomes with
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