Patient Data

The Virginia Cardiac Services Quality Initiative (VCSQI) currently includes 18 hospitals and cardiac surgical practices in the Commonwealth of Virginia that captures approximately 99% of adult cardiac surgery cases in the Commonwealth. VCSQI clinical and cost data acquisition and matching has been described previously [13, 14]. Clinical data is collected from each participating institution using Society of Thoracic Surgeons (STS) data entry forms. The VCSQI database pairs STS clinical data with hospital patient discharge information. Clinical variables utilize standard STS definitions including for operative mortality (in-hospital and 30-day) as well as major morbidity (permanent stroke, renal failure, prolonged ventilation, deep sternal wound infection, and reoperation).

Patient records for isolated SAVR and SAVR with coronary artery bypass grafting (CABG; n=11,565) were identified from January 1, 2002 through June 30, 2016, excluding patients with endocarditis. Patients were stratified for analysis by surgical era: pre-TAVR era (2002–2008, n=5,113), early-TAVR era (2009–2011, n=2,709), and commercial-TAVR era (2012–2015, n=3,743). Hospitals were classified as TAVR performing if they performed the procedure in the early-TAVR era. Six hospitals met this criterion, and only since 2015 have other hospitals begun performing TAVR. For cost analyses patients were excluded for missing or zero total cost. Cases in the first six months of 2016 (n=478) were included only in the case volume analysis after extrapolating for the rest of the year. The Institutional Review Board for the University of Virginia granted exemption due to lack of Health Insurance Portability and Accountability Act patient identifiers (IRB#19457).