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Relationship between provider volume and mortality for carotid endarterectomies in New York state
E L Hannan1, A J Popp, B Tranmer
1Department of Health Policy, Management, and Behavior, State University of New York, University at Albany School of Public Health, Albany Medical College, NY, USA. elh03@albnydh2.health.state.ny.us
Insights
Higher volume surgeons and hospitals performing carotid endarterectomies (CEs) are associated with lower in-hospital mortality rates. Low-volume providers significantly increase patient risk for this procedure.
Area of Science:
- Vascular Surgery
- Health Services Research
- Outcome Analysis
Background:
- Carotid endarterectomy (CE) is a common surgical procedure.
- Provider volume is a potential indicator of surgical quality.
- Assessing the impact of hospital and surgeon volume on CE outcomes is crucial.
Purpose of the Study:
- To evaluate the association between provider volume (hospital and surgeon) and in-hospital mortality for carotid endarterectomies (CEs).
- To determine if higher procedural volumes correlate with improved patient outcomes in CE.
Main Methods:
- Utilized New York's SPARCS administrative database for 28,207 CE patients (1990-1995).
- Developed a statistical model to adjust for patient severity, age, and admission status.
- Calculated risk-adjusted mortality rates across various hospital and surgeon volume strata.
Main Results:
- Risk-adjusted mortality was 1.96% for low-volume surgeons (<5/year) in low-volume hospitals (
- Risk-adjusted mortality decreased to 0.94% for high-volume surgeons (>5/year) in high-volume hospitals (>100/year).
- The difference in mortality rates between low- and high-volume providers was statistically significant.
Conclusions:
- In-hospital mortality for carotid endarterectomies is significantly higher with extremely low surgeon and hospital volumes.
- Higher provider volume, even after risk adjustment, is associated with better outcomes in CE.
- This highlights the importance of procedural volume in optimizing patient safety for carotid endarterectomies.
Background And Purpose:
The objective of this study was to assess the relationship between each of 2 provider volume measures for carotid endarterectomies (CEs) (annual hospital volume and annual surgeon volume) and in-hospital mortality. New York's Statewide Planning and Research (SPARCS) administrative database was used to identify all 28 207 patients for whom carotid endarterectomy was the principal procedure performed in New York State hospitals between January 1, 1990, and December 31, 1995.
Methods:
A statistical model was developed to predict in-hospital mortality using age, admission status, and several conditions found to be associated with higher-than-average mortality. This model was then used to calculate risk-adjusted mortality rates for various intersections of hospital and surgeon volume ranges.
Results:
Risk-adjusted in-hospital mortality ranged from 1.96% (95% confidence interval, 1.47 to 2.57) for patients having surgeons with annual CE volumes of <5 in hospitals with annual CE volumes of /=5 in hospitals with annual CE volumes of >100. These 2 rates were statistically different.
Conclusions:
We conclude that the in-hospital mortality rates for carotid endarterectomies performed by surgeons with extremely low annual volumes (<5) and for hospitals with low volumes (
