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No continuous relationship between Veterans Affairs hospital coronary artery bypass grafting surgical volume and
A L Shroyer1, G Marshall, B A Warner
1Denver Veterans Affairs Medical Center, Division of Cardiothoracic Surgery, CO 80220, USA.
Background:
The purpose of this study was to determine whether risk-adjusted coronary artery bypass grafting mortality rates are significantly related to coronary artery bypass grafting surgical procedure volume within the Department of Veterans Affairs hospital system.
Methods:
From April 1987 to September 1992, expected mortality rates were calculated for 23,986 coronary artery bypass grafting procedures performed at 44 different Veterans Affairs hospitals.
Results:
This study found a statistically significant relationship between annual hospital coronary artery bypass grafting volume and observed mortality rates (p < 0.02). However, no statistically significant relationship between coronary artery bypass grafting volume and risk-adjusted operative mortality was found (p = 0.10). Using analysis of variance on hospital-level data, hospitals with 100 or less cases per year have higher observed to expected mortality ratios than hospitals performing more than 100 cases per year (p = 0.03). Using Poisson regression models, however, a volume threshold could not be found.
Conclusions:
These findings are consistent with the current Veterans Affairs policy requirements to periodically review quality at low-volume hospitals.