Single Versus Multi-Center Surgeons' Risk-Adjusted Coronary Artery Bypass Graft Procedural Outcomes

Shroyer and colleagues evaluated observed-to-expected outcome ratios for 30-day operative mortality and major morbidity across over 540,000 nonemergent first-time coronary artery bypass graft (CABG) procedures in The Society for Thoracic Surgeons Adult Cardiac Surgery Database. Given the increasing number of US health care system mergers and the decreasing proportion of cardiothoracic surgeons in private practice, the authors sought to determine whether risk-adjusted CABG outcomes varied based on the number of centers at which a surgeon operates. They found that observed-to-expected mortality ratios were better for single-center than for multicenter surgeons (0.97, 95% CI 0.94-1.00, versus 1.06, 95% CI 1.01-1.12), and that ratios for multicenter surgeons were better at their primary hospital (1.01, 95% CI 0.96-1.07) than at their satellite facilities (1.17, 95% CI 1.09-1.27).