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?

Chuntao Wu, Edward L. Hannan, Thomas J. Ryan, Edward Bennett, Alfred T. Culliford, Jeffrey P. Gold, O. Wayne Isom, Robert H. Jones, Barbara McNeil, Eric A. Rose, Valavanur A. Subramanian

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)784-789
Number of pages6
JournalCirculation
Volume110
Issue number7
DOIs
StatePublished - Aug 17 2004

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Hospital Mortality
Coronary Artery Bypass
Transplants
Mortality
High-Volume Hospitals
Surgeons
Referral and Consultation
Low-Volume Hospitals
Numbers Needed To Treat

Keywords

  • Bypass
  • Mortality
  • Risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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? / Wu, Chuntao; Hannan, Edward L.; Ryan, Thomas J.; Bennett, Edward; Culliford, Alfred T.; Gold, Jeffrey P.; Isom, O. Wayne; Jones, Robert H.; McNeil, Barbara; Rose, Eric A.; Subramanian, Valavanur A.

In: Circulation, Vol. 110, No. 7, 17.08.2004, p. 784-789.

Research output: Contribution to journalArticle

Wu, C, Hannan, EL, Ryan, TJ, Bennett, E, Culliford, AT, Gold, JP, Isom, OW, Jones, RH, McNeil, B, Rose, EA & Subramanian, VA 2004, '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, vol. 110, no. 7, pp. 784-789. https://doi.org/10.1161/01.CIR.0000138744.13516.B5
Wu, Chuntao ; Hannan, Edward L. ; Ryan, Thomas J. ; Bennett, Edward ; Culliford, Alfred T. ; Gold, Jeffrey P. ; Isom, O. Wayne ; Jones, Robert H. ; McNeil, Barbara ; Rose, Eric A. ; Subramanian, Valavanur A. / 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?. In: Circulation. 2004 ; Vol. 110, No. 7. pp. 784-789.
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abstract = "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.",
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T1 - 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?

AU - Wu, Chuntao

AU - Hannan, Edward L.

AU - Ryan, Thomas J.

AU - Bennett, Edward

AU - Culliford, Alfred T.

AU - Gold, Jeffrey P.

AU - Isom, O. Wayne

AU - Jones, Robert H.

AU - McNeil, Barbara

AU - Rose, Eric A.

AU - Subramanian, Valavanur A.

PY - 2004/8/17

Y1 - 2004/8/17

N2 - 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.

AB - 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.

KW - Bypass

KW - Mortality

KW - Risk factors

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