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The 30-Year Influence of a Regional Consortium on Quality Improvement in Cardiac Surgery. Ann Thorac Surg 2020; 110:63-69. [DOI: 10.1016/j.athoracsur.2019.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/10/2019] [Accepted: 10/01/2019] [Indexed: 11/22/2022]
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Shahian DM. Professional Society Leadership in Health Care Quality: The Society of Thoracic Surgeons Experience. Jt Comm J Qual Patient Saf 2019; 45:466-479. [DOI: 10.1016/j.jcjq.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shahian DM, Fernandez FG, Badhwar V. The Society of Thoracic Surgeons National Database at 30: Honoring Our Heritage, Celebrating the Present, Evolving for the Future. Ann Thorac Surg 2019; 107:1259-1266. [DOI: 10.1016/j.athoracsur.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/01/2022]
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Rich JB, Fonner CE, Quader MA, Ailawadi G, Speir AM. Impact of Regional Collaboration on Quality Improvement and Associated Cost Savings in Coronary Artery Bypass Grafting. Ann Thorac Surg 2018; 106:454-459. [DOI: 10.1016/j.athoracsur.2018.02.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 01/29/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
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Mehaffey JH, Hawkins RB, Byler M, Smith J, Kern JA, Kron I, Ailawadi G, Wanchek T, Yarboro LT. Amiodarone Protocol Provides Cost-Effective Reduction in Postoperative Atrial Fibrillation. Ann Thorac Surg 2018; 105:1697-1702. [PMID: 29374511 DOI: 10.1016/j.athoracsur.2017.12.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/09/2017] [Accepted: 12/20/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) after cardiac operations results in a significant increase in morbidity, mortality, and health care costs. Prophylactic amiodarone has been shown to reduce the incidence of POAF; however, the cost-effectiveness of a protocol-driven approach remains unknown. METHODS All patients with a Society of Thoracic Surgeons risk score enrolled in a prophylactic amiodarone protocol (n = 153) were propensity score matched 1:3 with patients before protocol implementation (n = 3,574). Multivariate logistic and linear regressions assessed the relative risks (POAF reduction and adverse medication effects) in the matched cohort of amiodarone therapy and costs, respectively. TreeAge cost-effectiveness software (TreeAge Software, Inc, Williamstown, MA) modeled the effects of prophylactic amiodarone costs, complication rates, and quality of life. RESULTS Of patients eligible for the prophylactic amiodarone protocol, 94.3% (281 of 298) were enrolled. Prophylactic amiodarone significantly reduced the rate of POAF (25.7% vs 16.8%, p < 0.0001). A total of 600 matched patients demonstrate no baseline differences in demographics, comorbidities, disease state, or operative factors, with a significant reduction in POAF without an increase in other associated complications. With the use these adjusted estimates, the prophylactic amiodarone protocol demonstrated a cost savings of $458 per patient. Sensitivity analysis confirmed the protocol is cost-effective for all protocol-related POAF risk reductions below an odds ratio of 0.726. CONCLUSIONS Implementation of a prophylactic amiodarone protocol significantly reduced risk-adjusted rates of POAF, with a cost savings of $458 per patient. This analysis demonstrates how rigorous quantitative analysis can evaluate the benefits of quality improvement projects.
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Affiliation(s)
- J Hunter Mehaffey
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert B Hawkins
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Matthew Byler
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Judy Smith
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - John A Kern
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Irving Kron
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Tanya Wanchek
- Department of Public Health, University of Virginia, Charlottesville, Virginia
| | - Leora T Yarboro
- Division of Thoracic & Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Hawkins RB, Mehaffey JH, Yount KW, Yarboro LT, Fonner C, Kron IL, Quader M, Speir A, Rich J, Ailawadi G. Coronary artery bypass grafting bundled payment proposal will have significant financial impact on hospitals. J Thorac Cardiovasc Surg 2018; 155:182-188. [DOI: 10.1016/j.jtcvs.2017.07.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/28/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
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Bhatt DL, Drozda JP, Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED, Welke KF. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise. J Am Coll Cardiol 2015; 66:2230-2245. [DOI: 10.1016/j.jacc.2015.07.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Bhatt DL, Drozda JP, Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED, Welke KF, Heidenreich PA, Albert NM, Chan PS, Curtis LH, Bruce Ferguson T, Fonarow GC, Michael Ho P, Jurgens C, O’Brien S, Russo AM, Thomas RJ, Ting HH, Varosy PD. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise. Circ Cardiovasc Qual Outcomes 2015; 8:634-48. [DOI: 10.1161/hcq.0000000000000013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bhatt DL, Drozda JP, Shahian DM, Chan PS, Fonarow GC, Heidenreich PA, Jacobs JP, Masoudi FA, Peterson ED, Welke KF. ACC/AHA/STS Statement on the Future of Registries and the Performance Measurement Enterprise: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and The Society of Thoracic Surgeons. Ann Thorac Surg 2015; 100:1926-41. [PMID: 26438978 DOI: 10.1016/j.athoracsur.2015.07.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 07/28/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022]
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Osnabrugge RL, Speir AM, Head SJ, Jones PG, Ailawadi G, Fonner CE, Fonner E, Kappetein AP, Rich JB. Cost, quality, and value in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2014; 148:2729-35.e1. [DOI: 10.1016/j.jtcvs.2014.07.089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/02/2014] [Accepted: 07/13/2014] [Indexed: 01/21/2023]
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Osnabrugge RL, Speir AM, Head SJ, Jones PG, Ailawadi G, Fonner CE, Fonner E, Kappetein AP, Rich JB. Prediction of Costs and Length of Stay in Coronary Artery Bypass Grafting. Ann Thorac Surg 2014; 98:1286-93. [DOI: 10.1016/j.athoracsur.2014.05.073] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/17/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
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Grover FL, Shahian DM, Clark RE, Edwards FH. The STS National Database. Ann Thorac Surg 2014; 97:S48-54. [DOI: 10.1016/j.athoracsur.2013.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 10/04/2013] [Accepted: 10/04/2013] [Indexed: 12/29/2022]
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Osnabrugge RLJ, Speir AM, Head SJ, Fonner CE, Fonner E, Ailawadi G, Kappetein AP, Rich JB. Costs for surgical aortic valve replacement according to preoperative risk categories. Ann Thorac Surg 2013; 96:500-6. [PMID: 23782647 DOI: 10.1016/j.athoracsur.2013.04.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The introduction of transcatheter aortic valve replacement (TAVR) led to more rigorous evaluation of surgical aortic valve replacement (SAVR) as a benchmark for TAVR. However, limited real-life cost data of SAVR are available. Therefore, the purpose of our study was to assess actual costs and resource utilization of SAVR in patients at different operating risk. METHODS Study data were drawn from a multi-institutional statewide database comprised of all cardiac surgical procedures in the Commonwealth of Virginia. The study included 2,530 elective, primary, isolated SAVRs performed from 2003 to 2012. Clinical data were matched with universal billing data. Patients were stratified into low-, intermediate- and high-risk categories according to the Society of Thoracic Surgeons- Predicted Risk of Mortality (STS-PROM) score: 0% to 4%, 4% to 8% , and greater than 8%, respectively. Clinical outcomes, resource use, and costs were compared between categories. RESULTS With increasing risk, there were higher rates of postoperative mortality (low 1.2% versus intermediate 2.7% versus high 6.2%, p < 0.001) and renal failure (2.7% vs 7.2% vs 10.6%; p < 0.001). The proportion of patients with any postoperative complication was higher with increasing risk (34% vs 48% vs 53%; p < 0.001). Length-of-stay increased from 6.8 days in the low-risk category to 10.2 and 11.3 days in the intermediate- and high-risk category, respectively (p < 0.001). There was an increase in mean total costs from the low- (n = 2,002) to intermediate- (n = 415) to high-risk (n = 113) category ($35,021 ± $22,642 vs $46,101 ± $42,460 vs $51,145 ± $31,655; p < 0.001). CONCLUSIONS Higher STS-PROM was significantly associated with higher postoperative mortality, complications, length-of-stay, and costs. The SAVR cost data provide a basis for the analysis of TAVR cost-effectiveness and its impact on payment systems.
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Affiliation(s)
- Ruben L J Osnabrugge
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Shahian DM, Jacobs JP, Edwards FH, Brennan JM, Dokholyan RS, Prager RL, Wright CD, Peterson ED, McDonald DE, Grover FL. The society of thoracic surgeons national database. Heart 2013; 99:1494-501. [PMID: 23335498 DOI: 10.1136/heartjnl-2012-303456] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS The Society of Thoracic Surgeons (STS) National Database collects detailed clinical information on patients undergoing adult cardiac, paediatric and congenital cardiac, and general thoracic surgical operations. These data are used to support risk-adjusted, nationally benchmarked performance assessment and feedback; voluntary public reporting; quality improvement initiatives; guideline development; appropriateness determination; shared decision making; research using cross-sectional and longitudinal registry linkages; comparative effectiveness studies; government collaborations including postmarket surveillance; regulatory compliance and reimbursement strategies. INTERVENTIONS All database participants receive feedback reports which they may voluntarily share with their hospitals or payers, or publicly report. STS analyses are regularly used as the basis for local, regional and national quality improvement efforts. POPULATION More than 90% of adult cardiac programmes in the USA participate, as do the majority of paediatric cardiac programmes, and general thoracic participation continues to increase. Since the inception of the Database in 1989, more than 5 million patient records have been submitted. BASELINE DATA Each of the three subspecialty databases includes several hundred variables that characterise patient demographics, diagnosis, medical history, clinical risk factors and urgency of presentation, operative details and postoperative course including adverse outcomes. DATA CAPTURE Data are entered by trained data abstractors and by the care team, using detailed data specifications for each element. DATA QUALITY Quality and consistency checks assure accurate and complete data, missing data are rare, and audits are performed annually of selected participant sites. ENDPOINTS All major outcomes are reported including complications, status at discharge and mortality. DATA ACCESS Applications for STS Database participants to use aggregate national data for research are available at http://www.sts.org/quality-research-patient-safety/research/publications-and-research/access-data-sts-national-database.
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Affiliation(s)
- David M Shahian
- Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, , Boston, Massachusetts, USA
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Shahian DM, Edwards FH, Jacobs JP, Prager RL, Normand SLT, Shewan CM, O'Brien SM, Peterson ED, Grover FL. Public Reporting of Cardiac Surgery Performance: Part 1—History, Rationale, Consequences. Ann Thorac Surg 2011; 92:S2-11. [DOI: 10.1016/j.athoracsur.2011.06.100] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 06/07/2011] [Accepted: 06/09/2011] [Indexed: 11/24/2022]
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Speir AM, Kasirajan V, Barnett SD, Fonner E. Additive Costs of Postoperative Complications for Isolated Coronary Artery Bypass Grafting Patients in Virginia. Ann Thorac Surg 2009; 88:40-5; discussion 45-6. [DOI: 10.1016/j.athoracsur.2009.03.076] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
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