Related Experiment Video
Updated: Jul 24, 2026
Surgical Placement of Catheters for Long-term Cardiovascular Exercise Testing in Swine
Published on: February 9, 2016
Volume-outcome relationships in cardiovascular operations: New York State, 1990-1995
J A Sollano1, A C Gelijns, A J Moskowitz
1International Center for Health Outcomes, (InCHOIR), Columbia University, New York, USA.
Insights
Hospital procedure volume impacts patient outcomes. Higher volume hospitals showed better results for abdominal aortic aneurysm repair and congenital heart defect repair, but not for coronary artery bypass grafting.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Quality Improvement
Background:
- A persistent inverse relationship between clinical outcomes and procedure volume in cardiovascular operations has been recognized for two decades.
- This volume-outcome relationship highlights potential disparities in patient care quality based on hospital surgical capacity.
Purpose of the Study:
- To investigate the association between hospital procedure volume and in-hospital mortality for three distinct cardiovascular operations.
- Specifically examining coronary artery bypass grafting (CABG), elective repair of abdominal aortic aneurysms (AAA), and repair of congenital cardiac defects (CCD).
Main Methods:
- Analysis of a New York State inpatient database from 1990 to 1995.
- Utilized standard logistic regression to assess the correlation between hospital volume and in-hospital death rates for the selected procedures.
Main Results:
- No significant volume-outcome relationship was observed for coronary artery bypass grafting (CABG) (2.75% mortality).
- A significant inverse relationship between hospital volume and mortality was found for elective abdominal aortic aneurysm (AAA) repair (5.5% mortality).
- A significant inverse relationship between hospital volume and mortality was identified for congenital cardiac defect (CCD) repairs, particularly pronounced in neonates.
Conclusions:
- A notable difference exists in the volume-outcome relationship for AAA and CCD repairs compared to CABG.
- The absence of a volume-outcome relationship for CABG may be attributed to New York State's quality improvement initiatives implemented since 1989.
- Findings suggest the potential for expanding quality improvement programs to other high-risk cardiovascular procedures like AAA and CCD repairs.
Background:
It has been known for nearly 20 years that, in cardiovascular operations, a significant inverse relationship exists between clinical outcomes and the volume of procedures performed. Interestingly, this relationship persists 2 decades after it was recognized.
Objective:
The purpose of this study was to examine the relationship between hospital volume and in-hospital deaths in 3 cardiovascular procedures: coronary artery bypass grafting, elective repair of abdominal aortic aneurysms, and repair of congenital cardiac defects.
Methods:
The database includes all patients who were hospitalized in New York State during the years 1990 to 1995. Using standard logistic regression techniques, we analyzed the relationship between hospital volume and outcome.
Results:
No correlation exists between hospital volume and in-hospital deaths in coronary artery bypass grafting. Statewide, 31 hospitals performed 97,137 operations over the 6-year period (overall mortality rate, 2. 75%). By contrast, most of the hospitals statewide (195 of 230 hospitals) performed 9847 elective abdominal aortic aneurysm repairs with an overall mortality rate of 5.5%. In abdominal aortic aneurysm operations, a significant inverse relationship between hospital volume and in-hospital deaths was determined. Sixteen hospitals performed 7199 repairs for congenital cardiac defects. A significant inverse relationship (which was most pronounced for neonates) was found between volume and death.
Conclusions:
The importance of these findings lies in the rather striking difference between the volume-outcome relationship found for operations for abdominal aortic aneurysms and congenital cardiac defects and the lack of such a relationship for coronary artery bypass grafting. This observation may be largely explained by the quality improvement program in New York State for bypass operations since 1989. If so, these results have important implications for expanding the scope of quality improvement efforts in New York State.
Related Concept Videos
01:11Cardiac Output and Stroke Volume
In an average resting adult male, the typical cardiac output averages...
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
01:19Cardiac Output I:Effect of Heart Rate on Cardiac Output
Cardiac output (CO) refers to the total amount of blood ejected by one of the ventricles in liters per minute (L/min). In a resting adult, CO ranges from 5 to 6 L/min, adjusting according to the body's metabolic requirements.
Effect of Heart Rate on Cardiac Output
Cardiac output adapts to metabolic demands during stress, physical activity, or illness. The autonomic nervous system regulates heart rate via the sinoatrial node. The parasympathetic nervous system decreases heart rate...
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management