1. COLLEGE OF CARDIAC SURGERY ACTIVITY REPORT 2004

2. 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

3. Cardiac Surgery in Belgium 1998 2000 Number of centers 32 31 Number of participating Centers 32 28 Number of Cardiac Surgeons BACTS 131 120 Cardiac Surgeons/center 4,12 4,28 Nr of interventions 14.931 15.856 Interventions/center 466,9 511,48 Interventions/surgeon 113,97 132,13 Interventions adult/pediatric 14.135/689 15.017/839 Isolated CABG (on ECC) 8.678 6.887 Isolated valve 1.759 2.378 CABG without ECC 214 1.502 Transplant Surgery /Heart 110/88 96/84 Redo Surgery 794

4. 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

5. SWOT analysis - 1 Strength -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

6. SWOT -analysis 2 Opportunities –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

7. 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

8. 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

9. SWOT-analysis of the College (1) Strength –Homogenous subgroups in cardiac surgery –Data gathering should be easy Weaknesses –Data gathering is in fact not easy –Confidentiality –Costs of data management (software,hardware,data manager) –Surgical database should include comorbidities, technical details

10. 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?

11. 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