Related Experiment Videos
Hospital vascular surgery volume and procedure mortality rates in California, 1982-1994
L M Manheim1, M W Sohn, J Feinglass
1Institute for Health Services Research and Policy Studies, the Division of General Internal Medicine, Northwestern University Medical School, Hines VA Hospital, Chicago, Ill 60611, USA.
Insights
Vascular surgery outcomes improved over time, with lower mortality for lower extremity arterial bypass (LEAB), carotid endarterectomy (CEA), and abdominal aortic aneurysm repair (AAA) in high-volume hospitals.
Area of Science:
- Vascular Surgery Outcomes
- Health Services Research
- Epidemiology
Background:
- Long-term trends and outcomes of major vascular surgery procedures are not well-documented.
- Understanding procedure utilization and hospital volume impact is crucial for quality improvement.
Purpose of the Study:
- To describe trends in lower extremity arterial bypass (LEAB), carotid endarterectomy (CEA), and abdominal aortic aneurysm repair (AAA) from 1982-1994.
- To examine the relationship between hospital procedure volume and in-hospital mortality for these vascular procedures.
Main Methods:
- Analysis of California hospital discharge records (1982-1994) for LEAB, CEA, and AAA.
- Age- and sex-adjusted analysis to assess procedure growth.
- Logistic regression to evaluate the impact of hospital volume on in-hospital mortality, controlling for risk factors.
Main Results:
- Modest growth in vascular procedures; lower extremity angioplasty increased significantly then plateaued.
- In-hospital mortality decreased for LEAB, CEA, and unruptured AAA.
- Higher hospital procedure volume was associated with significantly lower mortality for LEAB, CEA, and AAA.
Conclusions:
- In-hospital mortality for CEA, LEAB, and unruptured AAA has decreased.
- Mortality is inversely related to hospital volume and directly related to patient age and emergency status.
- Ruptured AAA mortality trends remain unchanged but are lower in high-volume centers.
Purpose:
Little is known about the long-term growth and outcomes of vascular surgery procedures over time. Trends in the use of three major vascular surgery procedures by a general population-lower extremity arterial bypass (LEAB), carotid endarterectomy (CEA), and abdominal aortic aneurysm repair (AAA)-are described. The extent to which these procedures are being performed in low-, moderate-, and high-volume hospitals is examined.
Methods:
California hospital discharge records for LEAB, CEA, AAA, lower extremity angioplasty, coronary angioplasty, and coronary bypass surgery (CABG) were studied in all non-federal hospitals between 1982 and 1994. The data were age- and sex-adjusted to describe procedure growth. In-hospital mortality rates for LEAB, CEA, and AAA are related to overall hospital procedure volume, using logistic regression to control for risk factors and time trends.
Results:
Growth in the number of vascular procedures performed in California was modest between 1982 and 1994, with no age-adjusted growth. Lower extremity angioplasty grew considerably in the 1980s and has since plateaued. Annual in-hospital death rates declined for all procedures except ruptured AAA. Comparing the two 5-year periods of 1982-1986 and 1990-1994, in-hospital death rates decreased from 4.2% to 3.3% for LEAB, from 9.2% to 6.2% for unruptured AAA, and from 1.6% to 1.0% for CEA (p < 0.0001). The odds of dying for patients treated in high-volume hospitals for LEAB and CEA procedures compared with patients treated in hospitals performing fewer than 20 procedures in a year were 66.7% (p = < 0.0001) and 66.1% (p < 0.0001), respectively. For patients with ruptured and unruptured AAA procedures, the odds of dying in hospitals with at least 50 AAA procedures in a year were 49.1% (p < 0.0001) and 83.8% (p = 0.016), respectively, compared with the odds of dying in low-volume hospitals.
Conclusions:
In-hospital mortality rates for CEA, LEAB, and unruptured AAA have been significantly decreasing over time. Mortality is inversely related to hospital volume and directly related to patient age and emergency status. Mortality trends over time for ruptured AAA remains unchanged; however, mortality is less in high-volume hospitals. Coronary angioplasty (PTCA) has not had an impact on rates for LEAB.