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Relationship of hospital volume to outcome in cardiac surgery programs in California

Joseph S Carey1, John M Robertson, Gregory A Misbach

  • 1California Society of Thoracic Surgeons, Torrance, California, USA.

The American Surgeon
|February 11, 2003
PubMed

Insights

Hospital volume impacts cardiac surgery outcomes, with higher-volume centers showing lower mortality for procedures like coronary artery bypass grafting (CABG). However, patient factors and process improvements are also crucial for enhancing results.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Quality Improvement

Background:

  • California has over 120 cardiac surgery programs, with more than half performing fewer than 200 coronary artery bypass graft (CABG) procedures annually.
  • A significant portion of cardiac surgery programs operate at lower procedural volumes, raising questions about potential impacts on patient outcomes.

Purpose of the Study:

  • To analyze the relationship between annual procedural volume and patient outcomes for cardiac surgery in California.
  • To determine if hospital volume is a significant predictor of in-hospital mortality for procedures such as CABG, valve surgery, and aneurysm repair.

Main Methods:

  • Utilized the state of California discharge abstract database for data from 1997-1999.
  • Included all 119 nonfederal hospitals performing cardiac surgery, analyzing unadjusted and risk-adjusted outcomes based on annual procedural volume.

Main Results:

  • Unadjusted in-hospital mortality for CABG was significantly higher in hospitals with <200 procedures/year (3.91%) compared to those with >=500 procedures/year (2.09%).
  • Similar trends were observed for CABG combined with valve/aneurysm procedures and for valve procedures alone.
  • Risk-adjusted analysis confirmed a significant difference in outcomes between hospitals with <200 and >=200 procedures/year, though outcome variation existed among lower-volume providers.

Conclusions:

  • While hospital procedural volume is related to cardiac surgery outcomes, patient-related factors and process variables may play a more significant role.
  • Performance improvement initiatives should focus on enhancing communication among providers with varying outcomes to improve overall quality of care.

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