Inter-Institutional Collaboration Between Quaternary and Tertiary Hospitals: Cardiac Surgery Impact

Authors

  • Mehmet H. Akay, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Ismael A. Salas De Armas, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Maria Patarroyo-Aponte, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Manish K. Patel, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Jayeshkumar Patel, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Bindu Akkanti, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Arpita Patel, PA-C Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Barbi M. Witz, PA-C Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Mateja Jezovnik, PhD, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Rajko Radovancevic, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Biswajit Kar, MD Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX
  • Igor D. Gregoric Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX

DOI:

https://doi.org/10.1532/hsf.4723

Keywords:

Cardiac Surgery, Mortality, Quality Improvement, STS-PROM

Abstract

Background: An inter-institutional collaboration between a quaternary hospital (QH) with a high volume of cardiac surgery and a community-based, tertiary hospital (TH) with a newly established cardiac surgery program was established.

Methods: We retrospectively reviewed data of patients admitted to the TH between September 2015 and June 2017 for cardiac surgery. The decision to transfer a patient to the QH was based on a Society of Thoracic Surgeon-Predicted Risk of Mortality (STS-PROM) score of ≥ 3%, the potential need for hemodialysis, and other risk factors. The same team of surgeons performed operations at both hospitals. We analyzed the perioperative outcomes of the patients and the referral pattern.

Results: A total of 116 patients met eligibility criteria; 105 underwent surgery at the TH, while 11 were transferred to the QH. Among the 11 patients transferred to the QH, eight had a score of  3% (median = 8.2 [IQR 5.7-25.0]). The patients transferred to the QH prior to surgery had a significantly higher STS-PROM score (P = ≤ .001). Overall, the mortality of patients who underwent surgery at the TH was 0.9% (1/105); while surgeries at the QH had a mortality rate of 0% (0/11).

Conclusion: The collaborative effort between high-volume cardiac surgery programs and emerging community-based hospitals showed acceptable outcomes in perioperative cardiac surgical mortality. Elevated STS-PROM scores (>3%), previous sternotomy and anticipation of coagulopathy, and low left ventricular ejection fraction or dilated ventricles are factors that influenced the need to transfer from a TH to QH.

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Published

2022-07-13

How to Cite

Akay, M., Salas de Armas, I., Patarroyo-Aponte, M., Patel, M., Patel, J., Akkanti, B., Patel, A., Witz, B., Jezovnik, M., Radovancevic, R., Kar, B., & Gregoric, I. D. (2022). Inter-Institutional Collaboration Between Quaternary and Tertiary Hospitals: Cardiac Surgery Impact. The Heart Surgery Forum, 25(4), E525-E529. https://doi.org/10.1532/hsf.4723

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Section

Articles