JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
 QUICK SEARCH:   [advanced]


     


J Am Coll Cardiol, 2001; 38:1923-1930
© 2001 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nallamothu, B. K.
Right arrow Articles by Eagle, K. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nallamothu, B. K.
Right arrow Articles by Eagle, K. A.

CLINICAL STUDY: CORONARY BYPASS SURGERY

The role of hospital volume in coronary artery bypass grafting: is more always better?1

Brahmajee K. Nallamothu, MD, MPHa,2, Sanjay Saint, MD, MPHa,b, Scott D. Ramsey, MD, PhDc, Timothy P. Hofer, MD, MSca,b, Sandeep Vijan, MD, MSca,b and Kim A. Eagle, MD, FACCa,*

a Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
b Health Services Research and Development Field Program, Veterans Administration Medical Center, Ann Arbor, Michigan, USA
c Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA

Manuscript received January 23, 2001; revised manuscript received August 8, 2001, accepted August 22, 2001.

* Reprint requests and correspondence: Dr. Kim A. Eagle, Division of Cardiovascular Disease, Department of Internal Medicine, University of Michigan Medical Center, 3910 Taubman Center, Ann Arbor, Michigan 48109-0366, USA.
keagle{at}umich.edu

OBJECTIVES: The goal of this study was to determine whether outcomes of nonemergent coronary artery bypass grafting (CABG) differed between low- and high-volume hospitals in patients at different levels of surgical risk.

BACKGROUND: Regionalizing all CABG surgeries from low- to high-volume hospitals could improve surgical outcomes but reduce patient access and choice. "Targeted" regionalization could be a reasonable alternative, however, if subgroups of patients that would clearly benefit from care at high-volume hospitals could be identified.

METHODS: We assessed outcomes of CABG at 56 U.S. hospitals using 1997 administrative and clinical data from Solucient EXPLORE, a national outcomes benchmarking database. Predicted in-hospital mortality rates for subjects were calculated using a logistic regression model, and subjects were classified into five groups based on surgical risk: minimal (<0.5%), low (0.5% to 2%), moderate (2% to 5%), high (5% to 20%), and severe (≥20%). We assessed differences in in-hospital mortality, hospital costs and length of stay between low- and high-volume facilities (defined as ≥200 annual cases) in each of the five risk groups.

RESULTS: A total of 2,029 subjects who underwent CABG at 25 low-volume hospitals and 11,615 subjects who underwent CABG at 31 high-volume hospitals were identified. Significant differences in in-hospital mortality were seen between low- and high-volume facilities in subjects at moderate (5.3% vs. 2.2%; p = 0.007) and high risk (22.6% vs. 11.9%; p = 0.0026) but not in those at minimal, low or severe risk. Hospital costs and lengths of stay were similar across each of the five risk groups. Based on these results, targeted regionalization of subjects at moderate risk or higher to high-volume hospitals would have resulted in an estimated 370 transfers and avoided 16 deaths; in contrast, full regionalization would have led to 2,029 transfers and avoided 20 deaths.

CONCLUSIONS: Targeted regionalization might be a feasible strategy for balancing the clinical benefits of regionalization with patients’ desires for choice and access.

Abbreviations and Acronyms
  APR-DRG
  All Patient Refined-Diagnosis Related Groups
  CABG
  coronary artery bypass grafting
  DRG
  diagnosis related group
  ICD-9-CM
  International Classification of Diseases, Ninth Edition




This article has been cited by other articles:


Home page
J. Thorac. Cardiovasc. Surg.Home page
D. M. Shahian and S.-L. T. Normand
Low-volume coronary artery bypass surgery: Measuring and optimizing performance.
J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1202 - 1209.
[Full Text] [PDF]


Home page
Arch SurgHome page
R. Ricciardi, B. A. Virnig, J. W. Ogilvie Jr, P. S. Dahlberg, H. P. Selker, and N. N. Baxter
Volume-Outcome Relationship for Coronary Artery Bypass Grafting in an Era of Decreasing Volume
Arch Surg, April 1, 2008; 143(4): 338 - 344.
[Abstract] [Full Text] [PDF]


Home page
Card Surg AdultHome page
V. A. Ferraris, F. H. Edwards, D. M. Shahian, and S. P. Ferraris
Risk Stratification and Comorbidity
Card. Surg. Adult, January 1, 2008; 3(2008): 199 - 246.
[Full Text]


Home page
Int J Qual Health CareHome page
L. G. Glance, T. M. Osler, D. B. Mukamel, and A. W. Dick
Estimating the potential impact of regionalizing health care delivery based on volume standards versus risk-adjusted mortality rate
Int. J. Qual. Health Care, August 1, 2007; 19(4): 195 - 202.
[Abstract] [Full Text] [PDF]


Home page
J Public Health (Oxf)Home page
A. Judge, J. Chard, I. Learmonth, and P. Dieppe
The effects of surgical volumes and training centre status on outcomes following total joint replacement: analysis of the Hospital Episode Statistics for England
J. Public Health Med., June 1, 2006; 28(2): 116 - 124.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
B. K. Nallamothu, K. A. Eagle, V. A. Ferraris, and R. M. Sade
Should Coronary Artery Bypass Grafting Be Regionalized?
Ann. Thorac. Surg., November 1, 2005; 80(5): 1572 - 1581.
[Full Text] [PDF]


Home page
J. Thorac. Cardiovasc. Surg.Home page
V. Guru, G. M. Anderson, S. E. Fremes, G. T. O'Connor, F. L. Grover, J. V. Tu, and Canadian CABG Surgery Quality Indicator Consensus
The identification and development of Canadian coronary artery bypass graft surgery quality indicators
J. Thorac. Cardiovasc. Surg., November 1, 2005; 130(5): 1257 - 1257.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. M. Al-Khatib, F. L. Lucas, J. G. Jollis, D. J. Malenka, and D. E. Wennberg
The Relation Between Patients' Outcomes and the Volume of Cardioverter-Defibrillator Implantation Procedures Performed by Physicians Treating Medicare Beneficiaries
J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1536 - 1540.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
M. Moscucci, D. Share, D. Smith, M. J. O'Donnell, A. Riba, R. McNamara, T. Lalonde, A. C. Defranco, K. Patel, E. Kline Rogers, et al.
Relationship Between Operator Volume and Adverse Outcome in Contemporary Percutaneous Coronary Intervention Practice: An Analysis of a Quality-Controlled Multicenter Percutaneous Coronary Intervention Clinical Database
J. Am. Coll. Cardiol., August 16, 2005; 46(4): 625 - 632.
[Abstract] [Full Text] [PDF]


Home page
ChestHome page
L. G. Glance, A. W. Dick, T. M. Osler, and D. B. Mukamel
The Relation Between Surgeon Volume and Outcome Following Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery
Chest, August 1, 2005; 128(2): 829 - 837.
[Abstract] [Full Text] [PDF]


Home page
Am J Crit CareHome page
L. V. Doering, D. K. Moser, W. Lemankiewicz, C. Luper, and S. Khan
Depression, Healing, and Recovery From Coronary Artery Bypass Surgery
Am. J. Crit. Care., July 1, 2005; 14(4): 316 - 324.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, A. Shah, T. J. Papadimos, M. Engoren, and R. H. Habib
Is Hospital Procedure Volume a Reliable Marker of Quality for Coronary Artery Bypass Surgery? A Comparison of Risk and Propensity Adjusted Operative and Midterm Outcomes
Ann. Thorac. Surg., June 1, 2005; 79(6): 1961 - 1969.
[Abstract] [Full Text] [PDF]


Home page
Arch Intern MedHome page
B. K. Nallamothu, S. Saint, T. P. Hofer, S. Vijan, K. A. Eagle, and S. J. Bernstein
Impact of Patient Risk on the Hospital Volume-Outcome Relationship in Coronary Artery Bypass Grafting
Arch Intern Med, February 14, 2005; 165(3): 333 - 337.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
C. Wu, E. L. Hannan, T. J. Ryan, E. Bennett, A. T. Culliford, J. P. Gold, O. W. Isom, R. H. Jones, B. McNeil, E. A. Rose, et al.
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?
Circulation, August 17, 2004; 110(7): 784 - 789.
[Abstract] [Full Text] [PDF]


Home page
JAMAHome page
E. D. Peterson, L. P. Coombs, E. R. DeLong, C. K. Haan, and T. B. Ferguson
Procedural Volume as a Marker of Quality for CABG Surgery
JAMA, January 14, 2004; 291(2): 195 - 201.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
L. G. Glance, A. W. Dick, D. B. Mukamel, and T. M. Osler
Is the hospital volume-mortality relationship in coronary artery bypass surgery the same for low-risk versus high-risk patients?
Ann. Thorac. Surg., October 1, 2003; 76(4): 1155 - 1162.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
E. L. Hannan, C. Wu, T. J. Ryan, E. Bennett, A. T. Culliford, J. P. Gold, A. Hartman, O. W. Isom, R. H. Jones, B. McNeil, et al.
Do Hospitals and Surgeons With Higher Coronary Artery Bypass Graft Surgery Volumes Still Have Lower Risk-Adjusted Mortality Rates?
Circulation, August 19, 2003; 108(7): 795 - 801.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
B. K. Nallamothu, K. A. Eagle, S. Saint, A. J. Epstein, S. S. Rathore, P. Goodney, J. D. Birkmeyer, and F. L. Lucas
Coronary Artery Bypass Surgery, Hospital Volume, and Risk * Coronary Artery Bypass Surgery, Hospital Volume, and Risk * Response
Circulation, July 8, 2003; 108 (1): e6 - e7.
[Full Text] [PDF]


Home page
Arch SurgHome page
E. V. A. Finlayson, P. P. Goodney, and J. D. Birkmeyer
Hospital Volume and Operative Mortality in Cancer Surgery: A National Study
Arch Surg, July 1, 2003; 138(7): 721 - 725.
[Abstract] [Full Text] [PDF]


Home page
Ann. Thorac. Surg.Home page
D. M. Shahian and S.-L. T. Normand
The volume-outcome relationship: from Luft to Leapfrog
Ann. Thorac. Surg., March 1, 2003; 75(3): 1048 - 1058.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
P. P. Goodney, F.L. Lucas, and J. D. Birkmeyer
Should Volume Standards for Cardiovascular Surgery Focus Only on High-Risk Patients?
Circulation, January 28, 2003; 107(3): 384 - 387.
[Abstract] [Full Text] [PDF]


Home page
Card Surg AdultHome page
V. A. Ferraris and S. P. Ferraris
Risk Stratification and Comorbidity
Card. Surg. Adult, January 1, 2003; 2(2003): 187 - 224.
[Full Text]


Home page
Eval Health ProfHome page
S. Saint, J. Rose, A. S. Lichter, S. Forrest, and L. F. McMahon Jr.
Shifting Costs from High-Cost to Low-Cost Diagnosis-Related Groups?
Eval Health Prof, September 1, 2002; 25(3): 259 - 269.
[Abstract] [PDF]


Home page
NEJMHome page
J. E. Barone, D. A. Risucci, J. A. Savino, B. K. Nallamothu, S. Saint, K. A. Eagle, C. K. Senkowski, D. M. Kocs, A. K. Rowe, M. S. Deming, et al.
Volume and Outcome
N. Engl. J. Med., August 29, 2002; 347(9): 693 - 696.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
H. S. Luft
Better for whom? Policy implications of acting on the relation between volume and outcome in coronary artery bypass grafting
J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1931 - 1933.
[Full Text] [PDF]




HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2001 by the American College of Cardiology Foundation.