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Related Experiment Videos

Does higher surgical volume predict better patient outcomes?

Owoicho Adogwa, Julia F Costich, Raymond Hill

    The Journal of the Kentucky Medical Association
    |February 6, 2009
    PubMed
    Summary

    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.

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    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.

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  • 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.