Smaller hospitals OK for heart bypass surgery - if your risk is small

First study to combine patient health status with hospital bypass results challenges earlier findings

High-risk patients still better off at high-volume hospitals, but others can stick closer to home

ANN ARBOR, MI - Learning you have to have a heart bypass operation is scary enough. But now, a new study may take some of the fear out of choosing where to have the operation.

Researchers from the University of Michigan Health System report today a finding that challenges the perception that all bypass patients should go to the biggest medical center they can, no matter how far away from home, to get a surgical team that does hundreds of bypasses.

This "practice makes perfect" effect on patient survival was popularized in recent years by several studies that found better results for patients who had their bypass surgery at big hospitals that do many such operations a year, versus patients treated at smaller local hospitals.

But, the U-M researchers report in the December Journal of the American College of Cardiology, those generalizations about differences between hospitals overlooked the differences between patients themselves. When you factor in the patients' own health risks, the picture changes.

In fact, the U-M team finds, patients whose overall health is good - aside from their clogged arteries - do fine if they have a bypass at a hospital that does less than 200 of them a year. But moderate- and high-risk patients, such as those with high blood pressure, diabetes or other health problems that could make an operation tricky, should be sure to seek out a major medical center whose surgical teams do hundreds of bypasses a year, in order to lower their chance of dying.

"It may seem strange for physicians from a major hospital to do a study that finds you don't necessarily have to come to us or our peers for your surgery, but our results strongly suggest this," says senior author Kim E

Contact: Kara Gavin
University of Michigan Health System

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