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Published on: March 27, 2018
Association between surgeon and hospital volume in coronary artery bypass graft surgery outcomes: a population-based
Hsyien-Chia Wen1, Chao-Hsiun Tang, Herng-Ching Lin
1Taipei Medical University, School of Health Care Administration, Tri-Service General Hospital, Taipei, Taiwan.
Insights
Surgeon experience significantly impacts coronary artery bypass graft surgery outcomes in Taiwan. Higher surgeon volume correlates with lower patient mortality, highlighting individual skill over hospital resources.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Medical Quality Improvement
Background:
- Limited research exists on surgeon volume and patient outcomes for coronary artery bypass graft (CABG) surgery outside the United States.
- Investigating this association in Taiwan provides crucial international data.
Purpose of the Study:
- To examine the relationship between surgeon and hospital CABG volume and patient outcomes in Taiwan.
- To determine if surgeon experience or hospital resources are more predictive of patient survival.
Main Methods:
- Utilized Taiwan's National Health Insurance Research Database (2000-2002).
- Analyzed 9,895 first-time CABG admissions performed by 316 surgeons across 46 hospitals.
Main Results:
- Patients treated by low-volume surgeons (<50 cases) had significantly higher mortality rates (7.0%) compared to higher volume surgeons.
- Increasing surgeon volume was associated with a decline in the odds of in-patient death.
- Hospital CABG volume alone was not a significant predictor of in-patient deaths (p=0.078).
Conclusions:
- Individual surgeon skill and experience are more critical determinants of patient outcomes in CABG surgery than hospital equipment or team size.
- Findings emphasize the importance of surgeon volume in ensuring patient safety and improving results for CABG procedures.
Background:
We have found no study conducted outside of the United States on the association between physician volume and patient outcomes after coronary artery bypass graft surgery. The aim of this study is to examine the association between surgeon-hospital coronary artery bypass graft volume and patient outcomes using three-year population-based data on Taiwan.
Methods:
This study uses the Taiwan National Health Insurance Research Database covering the period 2000 to 2002, with the study sample comprising 9,895 first-time coronary artery bypass graft admissions, treated by 316 surgeons in 46 hospitals.
Results:
Of the sampled patients, 356 (3.6%) were discharged after death. Those patients treated by low-volume (1-50 cases) surgeons had significantly higher mortality rates than those treated by medium-volume (51-100 cases) surgeons (7.0% vs 3.8%), high-volume (101-150 cases) surgeons (7.0% vs 2.7%), or very-high-volume (> or = 151 cases) surgeons (7.0% vs 3.2%). However, hospital coronary artery bypass graft volume alone is an insufficient predictor of hospital in-patient deaths (p = 0.078). The adjusted odds ratio of hospital in-patient deaths declined with increasing surgeon volume, with the odds of in-patient death for those patients treated by low-volume surgeons being 1.52 times those of medium-volume surgeons, 1.89 times those of high-volume surgeons, and 2.04 times those of very-high-volume surgeons.
Conclusions:
We conclude that for all coronary artery bypass graft surgeries taking place in Taiwan, the skill and experience of individual surgeons is a more critical factor for patient outcome than either hospital equipment or surgical teams.
