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The Journal of Cardiovascular Surgery 2003 October;44(5):591-6


lingua: Inglese

“Learning curves” of cardiac surgery in relation to risk stratification and hospital location

Anagnostopoulos C. E. 1, 2, 3, Siminelakis S. 1, Ananiadou O. 1, Katsaraki A. 1, Drossos G. 1, Katritsis D. 2, Panagiotopoulos J. 2, Papadopoulos G. 1

1 Department of Cardiac Surgery, University of Ioannina, Greece 2 Department of Cardiac Surgery, Athens Euroclinic, Greece 3 Section of Cardiac Surgery, St. Luke’s Roosevelt Hospital, Columbia University, New York, NY, USA


Aim. The pur­pose of ­this ­study was to deter­mine any sig­nif­i­cant dif­fer­ences in “­learning ­curves” ­between pri­vate and ­public hos­pi­tals ­when the ­same ­senior sur­geon was respon­sible ­during the ­initial ­phases of ­open-­heart sur­gery pro­grams devel­op­ment, in rela­tion to ­risk strat­ifi­ca­tion and hos­pital loca­tion.
­Methods. A pros­pec­tive ­review of 610 ­patients ­records was per­formed at a ­newly-­opened car­di­oth­o­racic pro­gram in a ­public Uni­ver­sity Hos­pital (PUH) in the ­periphery of ­Greece, and a pri­vate insti­tu­tion (PI) ­with an expe­ri­enced inten­sive ­care ­unit (ICU) in the cap­ital ­city of ­Athens. Pre­op­er­a­tive ­risk strat­ifi­ca­tion, mor­tality and post­op­er­a­tive ­length of ­stay (LOS) ­were ana­lysed ­between 1999 to 2001.
­Results. At PUH 298 ­patients ­were oper­ated and 312 ­patients at PI. ­There ­were 136 low ­risk (EuroS­CORE 0-2) and 474 ­medium and ­high-­risk ­patients (EuroS­CORE ≥3). ­There was no sig­nif­i­cantly ele­vated mor­tality or ­learning ­curve in low ­risk sur­gery ­either at PUH (57 ­patients ­with 1 ­death) or PI (79 ­patients 1 ­death). In ­medium and ­high-­risk sur­gery at PI ­there was no mor­tality in 68 ­patients oper­ated by the ­senior sur­geon and no ­learning ­curve in all 233 ­such ­patients. In 240 ­medium and ­high-­risk ­patients at PUH ­there was a ­learning ­curve ­despite the involve­ment of the ­same ­senior sur­geon. In 1999 and 2000 the ­observed mor­tality (OM) in 150 ­patients was 15.33%, EuroS­CORE 5.98, and in 2001 in 91 ­patients OM 3.29%, EuroS­CORE 5.95 ­with p=0.0038 ­when “expe­ri­enced” ICU ­staff was ­employed. LOS was sig­nif­i­cantly ­reduced in 97 ­patients in 2001 at PUH (8.7 d ± 2.81 vs 11.07­days ± 7.9 in 1999 and 2000, p=0.046) con­firming the exis­tence of a ­learning ­curve at the PUH. No ­such ­change was ­observed at PI (8.2 ­days vs 7.8, p=0.45).
Con­clu­sion. No mor­tality dif­fer­ences or ­learning ­curve char­ac­ter­is­tics ­were ­detected for low ­risk oper­a­tions ­either at PUH or PI. For ­medium and ­high ­risk sur­gery ­there ­appears to be a ­learning ­curve in PUH but not in PI ­despite ­senior sur­geon involve­ment in ­both. The pres­ence of an expe­ri­enced ICU ­appears to ­play a crit­ical ­role in the out­come of oper­a­tions in ­newly ­opened car­di­oth­o­racic pro­grams.

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