title: Outcomes of concomitant aortic valve replacement and coronary artery bypass grafting at teaching hospitals versus nonteaching hospitals.
abstract: OBJECTIVE
  Hospitals with a high volume and academic status produce better patient outcomes than other hospitals after complex surgical procedures. Risk models show that concomitant aortic valve replacement and coronary artery bypass grafting pose a greater risk than isolated coronary artery bypass grafting or aortic valve replacement. We examined the relationship of hospital teaching status and the presence of a thoracic surgery residency program with aortic valve replacement/coronary artery bypass grafting outcomes.
  
  
  METHODS
  By using the Nationwide Inpatient Sample database, we identified patients who underwent concomitant aortic valve replacement/coronary artery bypass grafting from 1998 to 2007 at nonteaching hospitals, teaching hospitals without a thoracic surgery residency program, and teaching hospitals with a thoracic surgery residency program. Multivariate analysis was performed to identify intergroup differences. Risk-adjusted multivariable logistic regression analysis was used to assess independent predictors of in-hospital mortality and complication rates.
  
  
  RESULTS
  The 3 groups of patients did not differ significantly in their baseline characteristics. Patients who underwent aortic valve replacement/coronary artery bypass grafting had higher overall risk-adjusted complication rates in nonteaching hospitals (odds ratio 1.58; 95% confidence interval, 1.39-1.80; P < .0001) and teaching hospitals without a thoracic surgery residency program (odds ratio 1.42; 95% confidence interval, 1.26-1.60; P < .0001) than in thoracic surgery residency program hospitals. However, no difference was observed in the adjusted mortality rate for nonteaching hospitals (odds ratio 0.95; 95% confidence interval, 0.87-1.04; P = .25) or teaching hospitals without a thoracic surgery residency program (odds ratio 1.00; 95% confidence interval, 0.92-1.08; P = .98) when compared with thoracic surgery residency program hospitals. Robust statistical models were used for analysis, with c-statistics of 0.98 (complications) and 0.82 (mortality).
  
  
  CONCLUSIONS
  Patients who require complex cardiac operations may have better outcomes when treated at teaching hospitals with a thoracic surgery residency program.
authors: Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. gopaldasr@health.missouri.edu
authors: Raja R
authors: RR
authors: Gopaldas
authors: Faisal G
authors: FG
authors: Bakaeen
authors: Tam K
authors: TK
authors: Dao
authors: Joseph S
authors: JS
authors: Coselli
authors: Scott A
authors: SA
authors: LeMaire
authors: Joseph
authors: J
authors: Huh
authors: Danny
authors: D
authors: Chu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D004503:Education, Medical, Graduate / Q000706:statistics & numerical data; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013903:Thoracic Surgery / Q000193:education* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology