COLLEGE OF CARDIAC SURGERY

COLLEGE OF CARDIAC
SURGERY
ACTIVITY REPORT 2004
Members of the College
Dr Inez Rodrigus
Dr Guido Vannooten
Dr Philippe Kohl
Dr Christiaan Van Kerrebrouck
Dr Frank Van Praet
Dr Jean-Marie Desmet
Cardiac Surgery in Belgium
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Number of centers
Number of participating Centers
Number of Cardiac Surgeons BACTS
Cardiac Surgeons/center
Nr of interventions
Interventions/center
Interventions/surgeon
Interventions adult/pediatric
Isolated CABG (on ECC)
Isolated valve
CABG without ECC
Transplant Surgery /Heart
Redo Surgery
1998
2000
32
31
32
28
131
120
4,12
4,28
14.931 15.856
466,9
511,48
113,97 132,13
14.135/689 15.017/839
8.678
6.887
1.759
2.378
214
1.502
110/88
96/84
794
Dynamic Analysis
• Referred exclusively by cardiologists
• Pre-op visit
– Bedside visit at the moment of angiography
– Ambulatory consultation
– Referral by telephone/letter
• Surgical Intervention
– Pre-op investigation(ambulatory)
– Surgery
– Post op care (intensive care, medium care, ward)
– Mean length of stay?
• Post op follow-up
– One or more ambulatory visits
– Long term follow-up by cardiologists
SWOT analysis - 1
• Strength
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Unique cost and risk per patient
Cardiac operations are reproducible and durable
Overall good 5 and 10 y survival without added morbidity
Lifesaving in acute conditions
• Weaknesses
- Dependence on cardiologist’s referral without multidicsiplinary
consultations
- Many centers, no definition of minimal required workload
- Delayed reimbursement for New Technologies
SWOT -analysis 2
• Opportunities
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Homogeneous study populations
Opportunities for biomedical science
Core mission is accomplishment of excellent surgical care
Fundamental and applied research tradition must be supported
• Threats
– Further sparing and limitations of health care expenditures by the
Government
– Increasing competition from other specialists
– Loss of social esteem and respect for the medical profession
– Declining residency programs
– Underpayment for high risk surgery
– Referral patterns
Priorities
• Updating nomenclature codes (redo surgery, assist device
placement,etc…)
• Better participation in governmental and RIZI/INAMI
consultative bodies (technical committees)
• Training programs
- redefining residency programs
- need for Physician Assistants
Activities of the College of Cardiac Surgery
• The intent of a database is to trend outcomes over time and
to establish benchmarks against which to measure and
refine their work
• Ability to monitor our clinical effectiveness and promote
quality environment
• Initial work of the QCC was crossed by the installation of
the College for Cardiac Pathology
• New database committee is at work again
SWOT-analysis of the College (1)
• Strength
– Homogenous subgroups in cardiac surgery
– Data gathering should be easy
• Weaknesses
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Data gathering is in fact not easy
Confidentiality
Costs of data management (software,hardware,data manager)
Surgical database should include comorbidities, technical details
SWOT- analysis of the College (2)
• Opportunities
– Databases potentially benefit future patients and the public
– Databases can determine the value of new techniques
• Threats
– What is the individual or institutional drive towards cooperation?
Conclusions
• The activity of the former College of Cardiac Pathology
has not contributed to a better patient care
• There is a profound degree of skepticism amongst cardiac
surgeons about the value of the College
• The individual and institutional drive towards cooperation
should be encouraged