Optimal surgeon and hospital volume thresholds to reduce mortality and length of stay for CABG

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Health Policy

Background:

• Coronary artery bypass grafting (CABG) is a complex procedure where patient outcomes can be influenced by hospital and surgeon experience.
• Establishing optimal volume thresholds is crucial for improving surgical quality and patient safety in CABG procedures.

Purpose of the Study:

• To determine the optimal hospital and surgeon volume thresholds for coronary artery bypass grafting (CABG).
• To investigate the impact of these volume thresholds on operative mortality and length of stay (LOS) for CABG patients.

Main Methods:

• Retrospective cohort study utilizing nationwide population-based data from Taiwan (2011-2015).
• Analysis of 12,892 CABG cases using restricted cubic splines, generalized estimating equation regression, Cox proportional-hazards modeling, and instrumental variables analysis.
• Identification of hospital and surgeon volume thresholds associated with reduced operative mortality and LOS.

Main Results:

• Optimal volume thresholds were identified as 55 cases/year for hospitals and 5 cases/year for surgeons.
• Patients undergoing CABG at hospitals below the volume threshold experienced higher operative mortality.
• Patients treated by surgeons below the volume threshold had increased operative mortality and longer LOS.

Conclusions:

• This study provides the first evidence identifying optimal hospital and surgeon volume thresholds for improving CABG outcomes.
• Findings support policies that centralize CABG procedures in high-volume hospitals to enhance patient care.
• Understanding these volume thresholds can guide patients, providers, and policymakers in optimizing CABG care delivery.