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Does higher surgical volume predict better patient outcomes?
Insights
Hospital procedural volume in Kentucky is an imprecise predictor of quality for coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA) outcomes. Quality assessment should not solely rely on procedure volume, especially for older emergent patients.
Area of Science:
- Cardiovascular Surgery and Interventional Cardiology
- Health Services Research and Policy
Background:
- Hospital procedural volume is often used as a proxy for healthcare quality.
- The association between volume and outcomes for complex procedures like CABG and PTCA requires further investigation.
Purpose of the Study:
- To determine the relationship between hospital procedural volume and patient mortality for coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA).
- To examine if hospital volume predicts quality of care for these cardiac procedures in Kentucky.
Main Methods:
- Retrospective analysis of Kentucky hospital discharge data (2000-2005) for CABG and PTCA procedures.
- Hospitals categorized into low, medium, and high-volume facilities based on annual procedure counts.
- Multiple logistic regression used to compare mortality odds, controlling for patient and hospital factors.
Main Results:
- No significant difference in mortality for non-emergent CABG/PTCA patients (ages 18-65) across volume categories.
- Older emergent patients (≥65 years) had higher mortality in high- and low-volume hospitals compared to medium-volume facilities.
- Specific odds ratios indicated increased mortality risk in certain volume categories for older emergent patients undergoing CABG and PTCA.
Conclusions:
- Hospital procedural volume in Kentucky is an imprecise predictor of quality for CABG and PTCA outcomes.
- Volume alone should not be the sole index for hospital quality assessment by policymakers and purchasers.
- Further nuanced quality metrics are needed, particularly considering patient demographics and urgency for cardiac procedures.
Objective:
To measure the relationship between procedural volume and quality by examining the association between hospital procedural volume and mortality in coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA).
Methods:
A retrospective quantitative analysis was conducted of Kentucky hospital discharge database for patients who underwent CABG and PTCA from 2000 through 2005. Hospitals were classified into three categories based on annual number of procedures--low (12-249), medium (250-499), and high-volume (> or = 500) CABG and PTCA facilities. This study employed a multiple logistic regression model to compare the odds for fatal outcome for patients treated in high, medium, and low-volume facilities, while controlling for patient age, gender, admission urgency, hospital length-of-stay, case severity, and pre-existing clinical conditions.
Results:
From 2000 through 2005, 24 facilities performed 47,972 CABGs, while 30 facilities performed 75,869 PTCAs across the state of Kentucky. In non-emergent CABG and PTCA patients between the ages of 18 to 65 years, there was no statistically significant difference in the odds for fatal outcomes between low-, medium-, and high-volume hospitals. However, older (> or = 65 years old) emergent CABG and PTCA patients were more likely to die at high-volume and low-volume hospitals than medium-volume hospitals (odds ratio for CABG surgery--1.260 [1.004-1.580], 1.753 [1.266-2.4261, and odds ratio for PTCA--1.106 [1.207-2.163], 1.616 [1.207-2.163]).
Conclusions:
This study indicates that in hospital procedural volume Kentucky, is an imprecise predictor of quality as measured by CABG and PTCA outcomes, and should not be used by purchasers and policy makers as the only index of hospital quality.
