Is the impact of hospital and surgeon volumes on the in-hospital mortality rate for coronary artery bypass graft surgery limited to patients at high risk?

Published

Journal Article

BACKGROUND: Restriction of volume-based referral for CABG surgery to high-risk patients has been suggested, and earlier studies have reached different conclusions regarding volume-based referral for low-risk patients. METHODS AND RESULTS: Patients who underwent isolated CABG surgery in New York from 1997 through 1999 (n=57 150) were separated into low-risk and moderate-to-high-risk groups with a predicted probability of in-hospital death of 2% as the cutoff point. The provider volume-mortality relationship was examined for both groups. For annual hospital volume thresholds between 200 and 600 cases, the adjusted ORs of in-hospital mortality for high-volume to low-volume hospitals ranged from 0.45 to 0.77 and were all significant for the low-risk group; for the moderate-to-high-risk group, ORs ranged from 0.62 to 0.91, and most were significant. The number needed to treat at higher-volume hospitals to avoid 1 death was greater for the low-risk group (a range of 114 to 446 versus 37 to 184). As the annual surgeon volume threshold increased from 50 to 150 cases, the ORs for high- to low-volume surgeons increased from 0.43 to 0.74 for the low-risk group; for the moderate-to-high-risk group, ORs ranged from 0.79 to 0.86. Compared with patients treated by surgeons with volumes of <125 in hospitals with volumes of <600, patients treated by higher-volume surgeons in higher-volume hospitals had a significantly lower risk of death; in particular, the OR was 0.52 for the low-risk group. CONCLUSIONS: For both low-risk and moderate-to-high-risk patients, higher provider volume is associated with lower risk of death.

Full Text

Duke Authors

Cited Authors

  • Wu, C; Hannan, EL; Ryan, TJ; Bennett, E; Culliford, AT; Gold, JP; Isom, OW; Jones, RH; McNeil, B; Rose, EA; Subramanian, VA

Published Date

  • August 17, 2004

Published In

Volume / Issue

  • 110 / 7

Start / End Page

  • 784 - 789

PubMed ID

  • 15302792

Pubmed Central ID

  • 15302792

Electronic International Standard Serial Number (EISSN)

  • 1524-4539

Digital Object Identifier (DOI)

  • 10.1161/01.CIR.0000138744.13516.B5

Language

  • eng

Conference Location

  • United States