Hospital volume may not be best criteria for selecting hospital for coronary bypass surgery

For coronary artery bypass graft surgery (CABG), hospital procedural volume is only modestly associated with outcomes and therefore may not be an adequate quality indicator, according to a study in the January 14 issue of The Journal of the American Medical Association (JAMA).

There have been recent calls for using hospital procedural volume as a quality indictor for CABG surgery, but further research into analysis and policy implication is needed before hospital procedural volume is accepted as a standard quality measure, according to background information in the article.

Eric D. Peterson, M.D., M.P.H., of the Duke Clinical Research Institute, Durham, N.C., and colleagues examined the association between hospital CABG procedural volume and outcome using clinical data available from the Society of Thoracic Surgeons (STS) National Cardiac Database. The analysis included 267,089 CABG procedures performed at 439 U.S. hospitals between January 1, 2000, and December 31, 2001.

The researchers found that the median (interquartile range) annual hospital volume for isolated CABG procedures was 253 (165-417), with 82 percent of centers performing fewer than 500 procedures per year. The overall operative mortality was 2.66 percent. After adjusting for patient risk and clustering effects, rates of operative mortality decreased with increasing hospital CABG volume (0.07 percent for every 100 additional CABG procedures). "While the association between volume and outcome was statistically significant overall, this association was not observed in patients younger than 65 years or in those at low operative risk and was confounded by surgeon volume. The ability of hospital volume to discriminate those centers with significantly better or worse mortality was limited due to the wide variability in risk-adjusted mortality among hospitals with similar volume. Closure of up to 100 of the lowest-volume centers (i.e., those performing 150 or less CABG proc

Contact: Richard Merritt
JAMA and Archives Journals

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