Relationship between hospital volume and risk-adjusted mortality rate following percutaneous coronary intervention in
1Division of Cardiology, Department of Internal medicine, Kangwon National University School of Medicine, Chuncheon City, South Korea.
Insights
Hospital volume did not impact risk-adjusted mortality for percutaneous coronary intervention (PCI) in Korea. While crude mortality rates varied by PCI volume, adjusted rates showed no significant difference across low, medium, and high-volume hospitals.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Quality Improvement
Background:
- Provider volume is a known factor influencing patient outcomes across various medical and surgical procedures.
- Understanding the relationship between hospital volume and mortality is crucial for quality assessment and patient safety in interventional cardiology.
Purpose of the Study:
- To investigate the association between hospital percutaneous coronary intervention (PCI) volume and risk-adjusted 30-day mortality in Korea.
- To determine if higher hospital PCI volumes correlate with improved patient survival after the procedure.
Main Methods:
- Retrospective analysis of Korean National Health Insurance Review & Assessment Service and National Statistical Office databases (2003-2004).
- Logistic regression modeling for risk adjustment, validated with cross-validation.
- Categorization of hospitals into low (<200 cases/year), medium (200-399 cases/year), and high (≥400 cases/year) PCI volume groups.
Main Results:
- A risk-adjustment model identified ten significant factors affecting 30-day mortality (c-statistic=0.823).
- Crude 30-day mortality rates were 1.4% (low), 1.1% (medium), and 1.0% (high volume), showing a significant difference (p=0.0106).
- Risk-adjusted 30-day mortality rates did not differ significantly among the volume groups (1.3%, 1.0%, 1.1% respectively).
Conclusions:
- While crude mortality rates varied by hospital PCI volume, this association was not observed for risk-adjusted mortality.
- The study found no significant relationship between hospital PCI volume and 30-day risk-adjusted mortality in the Korean population.
- Findings suggest that factors other than hospital volume may be more critical in determining patient outcomes after PCI in this setting.
Objective:
There have been a large number of studies that have investigated the relationship between outcomes and provider volume for a wide variety of medical conditions and surgical conditions. The objective of this study was to explore the relation between hospital volume and risk-adjusted mortality following percutaneous coronary intervention between 2003 and 2004 in Korea.
Methods:
This is a retrospective analysis of database in National Health Insurance Review & Assessment Service and Korean National Statistical Office. The study data set confined to the ICD-10 diagnosis and procedure codes that were recorded in the National Health Insurance Review Agency. Risk modeling was performed through logistic regression and validated with cross-validation. The statistical performance of the developed model was evaluated using c-statistics, R², and Hosmer-Lemeshow statistic. Crude and risk-adjusted 30-day mortality was evaluated among patients who underwent Percutaneous Coronary Intervention (PCI) between 2003 and 2004 at low (less 200 cases/year), medium (200~399 cases/year), and high (400 cases or more/year) PCI volume hospitals.
Results:
The final risk-adjustment model consisted of ten risk factors for 30-day mortality. These factors were found to have statistically significant effects on patient mortality. The c-statistic and Hosmer-Lemeshow χ² goodness-of-fit test and the model's performance were good [R²=0.147, c-statistic 0.823, 4.1037 (p=0.8476)]. A total number of 60 low-volume hospitals (9.071 patients) and 27 medium-volume hospitals (15.623 patients) and 15 high-volume hospitals (19.669 patients) were included. Crude 30-day mortality rate was 1.4%, 1.1%, and 1.0% (p=0.0106) in each volume hospitals. But risk-adjusted mortality rate was not significantly different among three groups (1.3%, 1.0%, and 1.1% in each volume hospitals).
Conclusion:
Although we found a significant different crude 30-day mortality rates according to hospital PCI volume, but did not find a relationship between hospital volume and 30-day risk-adjusted mortality rates following PCI in Korea.
