Seminars in vascular surgery · 2025
Institutional impact of multidisciplinary aortic team implementation on practice patterns and surgical productivity.
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Sorber Rebecca, Byers Peter H, Schwarze Ulrike, Buber Yonatan, Kirkpatrick James N, Otto Catherine M, DeRoo Scott C, Zettervall Sara L, Burke Christopher R, Sweet Matthew P
Аннотация
BACKGROUND: Multidisciplinary aortic teams (MAT) are integral to the management of aortic pathology. This study quantifies the effects of MAT implementation on aortic case volumes, practice patterns and surgical productivity at a single academic institution.
METHODS: Patients receiving aortic procedures were identified using CPT codes. Three time periods were defined: 2 years prior to MAT (2018), the first year with MAT (2020), and 2 years post implementation of MAT (2022). Full MAT was defined as having aortic-focused providers from cardiothoracic surgery, vascular surgery, cardiology and genetics.
RESULTS: Total aortic case volume increased over 300 over the study period. Increased volume was seen for both cardiothoracic and vascular cases with a significant increase in the proportion of ascending aortic replacements as well as thoracic endografting (P < .01). Patients receiving multiple procedures significantly increased from 2018 to 2020 (70.3% vs. 84.9%) as well as mean number of procedures per patient (1.98 vs. 2.42, both P < .05). While the number of patients receiving genetic testing and followed by the institutional cardiology team remained constant during the study period, the number of patients receiving joint cardiothoracic and vascular evaluation increased significantly (23.8% 2018 vs 41.1% 2020, P = .02). Overall procedural RVUs increased from 6.8k in 2018 to 21.1k in 2022 (310% increase).
CONCLUSIONS: Implementation of MAT correlated with increased aortic case volumes for cardiothoracic and vascular surgeons as well as increased overall productivity. These data suggest that robust multidisciplinary involvement is crucial to expand complex aortic volume and develop comprehensive treatment plans for patients with thoracoabdominal pathology.
METHODS: Patients receiving aortic procedures were identified using CPT codes. Three time periods were defined: 2 years prior to MAT (2018), the first year with MAT (2020), and 2 years post implementation of MAT (2022). Full MAT was defined as having aortic-focused providers from cardiothoracic surgery, vascular surgery, cardiology and genetics.
RESULTS: Total aortic case volume increased over 300 over the study period. Increased volume was seen for both cardiothoracic and vascular cases with a significant increase in the proportion of ascending aortic replacements as well as thoracic endografting (P < .01). Patients receiving multiple procedures significantly increased from 2018 to 2020 (70.3% vs. 84.9%) as well as mean number of procedures per patient (1.98 vs. 2.42, both P < .05). While the number of patients receiving genetic testing and followed by the institutional cardiology team remained constant during the study period, the number of patients receiving joint cardiothoracic and vascular evaluation increased significantly (23.8% 2018 vs 41.1% 2020, P = .02). Overall procedural RVUs increased from 6.8k in 2018 to 21.1k in 2022 (310% increase).
CONCLUSIONS: Implementation of MAT correlated with increased aortic case volumes for cardiothoracic and vascular surgeons as well as increased overall productivity. These data suggest that robust multidisciplinary involvement is crucial to expand complex aortic volume and develop comprehensive treatment plans for patients with thoracoabdominal pathology.