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Surgical procedure specialization is shown to improve patient outcomes however, evidence for or against subspecialization with regards to coronary surgery is nonexistent. As the most commonly performed cardiac operation, coronary artery bypass grafting (CABG) has not seen concentrated practice as mitral valve, aortic, or congenital cardiac surgery.

In a recent study led by Bradley S. Taylor, MD, MPH, surgeons at the University of Maryland Heart and Vascular Center determined the development of a specialized coronary surgery program does in fact improve patient outcomes after isolated CABG. Retrospective analysis of all isolated CABG operations, between 2002 to 2013 and 2013 to 2016, compared patient outcomes prior to and after the implementation of a specialized program. With the addition of established program leadership, surgical technique and postoperative procedural standardization as well as monthly multidisciplinary quality review, benefits showed a decrease in morbidity and mortality and complication rates.

"Our research presents a focused, multidisciplinary effort at improving CABG outcomes through specialization," Dr. Taylor said. "We found many operative factors and clinical outcomes to be significantly improved, demonstrating the effects of team and program specialization."

View the Programmatic and Surgeon Specialization Improves Mortality in Isolated Coronary Bypass Grafting paper.

Results

Between 2002 and 2013, 3,256 CABG operations were done by 16 surgeons, the most frequent surgeon doing 33%. Between 2013 and 2016, 1,283 operations were done by 10 surgeons, 70% by the coronary program director. CABGs done in the specialized era had shorter bypass and clamps times and increased use of bilateral internal mammary arteries. Blood transfusion and complication rates, including permanent stroke and prolonged ventilation, were significantly decreased after implementation of the coronary program. Likewise, overall operative mortality (2.67% vs 1.48%, p = 0.02) was significantly reduced.

Learn more about CABG at the University of Maryland Heart and Vascular Center.

Please call 410-328-5842 or visit UMMC's Consultation and Referring Services to make a referral.

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