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Coronary artery bypass grafting in Spain. Influence of procedural volume on outcomes
F Javier Goicolea Ruigómez1, Francisco J Elola2, Alejandro Durante-López1
1Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
Insights
Higher volume hospitals performing coronary artery bypass grafting (CABG) are associated with better patient outcomes, including lower mortality and readmission rates. Consolidating CABG procedures in high-volume centers may improve care quality within the Spanish National Health System.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Quality Improvement
Background:
- The volume-outcome relationship is critical for optimizing complex surgical procedures like coronary artery bypass grafting (CABG).
- Understanding this association within national healthcare systems is essential for improving patient safety and resource allocation.
Purpose of the Study:
- To investigate the correlation between hospital volume and patient outcomes for CABG procedures in Spain.
- To assess whether higher CABG volumes are linked to reduced in-hospital mortality and 30-day readmissions.
Main Methods:
- Analysis of 17,335 CABG episodes from the Spanish National Health System (2013-2015).
- Calculation of risk-adjusted mortality (RAMR) and readmission (RARR) rates using multilevel logistic regression.
- Classification of hospitals into high- and low-volume categories based on annual CABG procedures.
Main Results:
- Low-volume CABG centers (<155 procedures/year) exhibited a 17% higher risk-adjusted in-hospital mortality rate.
- A negative linear correlation was observed between hospital volume and 30-day cardiac-related readmission rates (r=-0.318, P=.029).
- Higher volume was consistently associated with better outcomes for both total and isolated CABG procedures.
Conclusions:
- Mean CABG volume in Spanish National Health System hospitals is relatively low.
- Increased hospital volume for CABG is significantly associated with improved patient outcomes.
- Centralizing CABG programs in higher-volume centers is recommended to enhance care quality and patient results.
Introduction And Objectives:
To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System.
Methods:
We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMR) and 30-day readmissions (RARR) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines.
Results:
A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07% vs 4.96%±1.76%; P <.001) and a negative linear correlation between volume and RARR (r=-0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG.
Conclusions:
The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention.
