COLLEGE OF CARDIAC
SURGERY
ACTIVITY REPORT
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