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Volume Heart Surgeries Translate into Better Patient Outcomes

Research suggests that patients undergoing bypass surgery for coronary artery disease are best served by having the surgery performed at a Hospital that has successfully completed the procedure hundreds of times before.

“This is a pretty well-established concept,” said Walter Halloran, M.D., Director of Cardiovascular Surgical Services at Elkhart General. “The architect of this concept is the Empire (New York) State Medical Association, which looked in detail at Medicare cardiovascular and cancer surgery performances back in the 1980s and 1990s. The association found a strong connection between mortality and the volume of surgeries performed at any given facility. The more procedures, the less likely the patient would die.”

Other studies also validate the original findings of the Empire State Medical Association. “Certain surgical operations performed in higher-volume centers are done more safely and more effectively,” said Dr. Halloran who, in addition to coronary bypass grafting, frequently schedules valve repair/replacement for valvular heart disease and treats aneurysms by repairing or replacing the artery affected by the aneurysm. “All three of these surgical areas have been included in studies that demonstrate a statistically significant benefit to institutions that do a lot of these procedures, as well as to individual surgeons performing higher volumes.”

Dr. Halloran completed his training in General and Cardiothoracic Surgery at Strong Memorial Hospital in Rochester, NY in 1991. He began performing cardiac procedures at Elkhart General in 1996. To date, Dr. Halloran estimates that he has personally performed close to 5,000 procedures at the Hospital. In 2010 alone, the cardiovascular surgical team at Elkhart General completed approximately 400 open-heart surgeries.

Last year, Dr. Halloran performed complex bypass surgery on a 75-year-old male. About three weeks later, the patient returned to the Hospital with a dissecting aneurysm. “This was an inordinately complex surgery that had to be done immediately,” Dr. Halloran said. “Because of my experience and the experience of the team, the patient did very well.”

Another female heart patient was found to have an unexpected anatomical abnormality of her heart in 2010. “Again, because of the team’s experience, we were able to shift gears and take care of the valve problem and correct the newly discovered problem,” said Dr. Halloran.

The recovery period from within the Hospital for these common cardiac procedures typically ranges from three days to two weeks. “Patients are looking for experience, personal attention, safety and good outcomes,” Dr. Halloran said. He also noted that consumers can easily research the data of individual hospitals and physicians through several websites, including the free “Society of Thoracic Surgeons” site, www.sts.org. Conversely, the for-profit HealthGrades® charges a nominal fee to secure the surgical results on an individual surgeon or specific hospital.

“Patients are encouraged to speak frankly with their primary physician, listen to the experiences of others and seek information from independent resources,” Dr. Halloran said. “I will often urge my patients to seek second opinions.”

Aside from his own experiences in treating cardiac patients, Dr. Halloran praises the collegial, collaborative working environment at Elkhart General. “Cases that may not be normally presented to either the surgeon or the cardiologist at other institutions are almost always discussed between the two groups here,” he said. “We have a very active collaboration. There are different treatment options for various diseases. For example, sometimes coronary blockages can be treated with stents or with surgery or with both. The best treatment should be decided by consensus rather than by an individual edict.”

According to Dr. Halloran, there is also a continuity of individual care at Elkhart General that is often lacking at large medical centers where patients are often treated by covering physicians, residents and nonsurgical doctors. “At Elkhart General, nearly all the patient’s post-operative care is handled by the patient’s surgeon,” he said. “We have specific nursing coordinators and support staff that communicate with the family while the patient is in the operating room, the recovery room and finally his or her own room.”

These lines of communication also encompass a host of other physicians, pharmacists, therapists and support personnel who are involved in the patient’s care. “That way we have minute-to-minute integration of all these teams to support our heart surgery staff,” said Dr. Halloran.

For More Information

For more information on the Center for Cardiac Care, call 574-523-3303.