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Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Impact of hospital volume on resource use after elective cardiac surgery: A contemporary analysis
Joseph Hadaya1, Yas Sanaiha1, Roland Hernandez2
1Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA.
Insights
High-volume hospitals reduce costs and mortality for cardiac surgery. Greater surgical volume leads to better outcomes, including fewer readmissions and non-home discharges, guiding value-based care.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Healthcare Economics
Background:
- Institutional experience is linked to better outcomes in major cardiac surgeries.
- Previous studies suggest hospital volume impacts patient results.
Purpose of the Study:
- To evaluate the effect of hospital volume on hospitalization costs and post-discharge resource use in elective cardiac operations.
- To compare outcomes between low-volume and high-volume cardiac surgery centers.
Main Methods:
- Analysis of a national cohort (2016-2017 Nationwide Readmissions Database) of adult patients undergoing elective coronary artery bypass grafting or valve operations.
- Institutions categorized into volume quartiles; comparisons focused on the lowest and highest quartiles using generalized linear models.
Main Results:
- High-volume hospitals (25.2% of cases) had patients who were younger and had more comorbidities than low-volume hospitals (24.8% of cases).
- Operations at high-volume hospitals were associated with $7,600 lower costs and reduced odds of mortality, non-home discharge, and 30-day readmission.
Conclusions:
- Increased operative volume at hospitals is independently associated with lower hospitalization costs and mortality for elective cardiac surgery.
- The benefits extend beyond acute care, with reduced non-home discharge and readmissions, supporting value-based care models.
Background:
Institutional experience has been associated with reduced mortality after coronary artery bypass grafting and valve operations. Using a contemporary, national cohort, we examined the impact of hospital volume on hospitalization costs and postdischarge resource utilization after these operations.
Methods:
Adults undergoing elective coronary artery bypass grafting or valve operations were identified in the 2016 to 2017 Nationwide Readmissions Database. Institutions were grouped into volume quartiles based on annual elective cardiac surgery caseload, and comparisons were made between the lowest and highest quartiles, using generalized linear models.
Results:
Of an estimated 296,510 patients, 24.8% were treated at low-volume hospitals and 25.2% at high-volume hospitals. Compared with patients treated at low-volume hospitals, patients managed at high-volume hospitals were younger, had more comorbidities, and more frequently underwent combined coronary artery bypass grafting valve (13.0% vs 12.3%, P < .001) and multivalve operations (6.2% vs 3.1%, P < .001). After adjustment, operations at high-volume hospitals were associated with a $7,600 reduction (95% confidence interval $4,700-$10,500) in costs. High-volume hospitals were also associated with reduced odds of mortality, non-home discharge, and 30-day non-elective readmission compared to low-volume hospitals.
Conclusion:
Despite increased complexity at high-volume centers, greater operative volume was independently associated with reduced hospitalization costs and mortality after elective cardiac operations. Reduction in non-home discharge and readmissions suggests this effect to extend beyond acute hospitalization, which may guide value-based care paradigms.
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