Hospital surgical volumes and mortality after coronary artery bypass grafting: using international comparisons to determine a safe threshold

TY - JOUR

T1 - Hospital surgical volumes and mortality after coronary artery bypass grafting: using international comparisons to determine a safe threshold

AU - Gutacker, Nils

AU - Bloor, Karen Elizabeth

AU - Cookson, Richard Andrew

AU - Gale, Christopher

AU - Maynard, Alan Keith

AU - Pagano, Domenico

AU - Pomar, Jose

AU - Bernal-Delgado, Enrique

AU - ECHO collaboration, as part of the

N1 - © Health Research and Educational Trust. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details

PY - 2017/3/12

Y1 - 2017/3/12

N2 - Objective: To estimate a safe minimum hospital volume for hospitals performing coronary artery bypass graft (CABG) surgery. Data Source: Hospital data on all publicly funded CABG in five European countries, 2007–2009 (106,149 patients). Design: Hierarchical logistic regression models to estimate the relationship between hospital volume and mortality, allowing for case mix. Segmented regression analysis to estimate a threshold. Findings: The 30-day in-hospital mortality rate was 3.0 percent overall, 5.2 percent (95 percent CI: 4.0–6.4) in low-volume hospitals, and 2.1 percent (95 percent CI: 1.8–2.3) in high-volume hospitals. There is a significant curvilinear relationship between volume and mortality, flatter above 415 cases per hospital per year. Conclusions: There is a clear relationship between hospital CABG volume and mortality in Europe, implying a “safe” threshold volume of 415 cases per year.

AB - Objective: To estimate a safe minimum hospital volume for hospitals performing coronary artery bypass graft (CABG) surgery. Data Source: Hospital data on all publicly funded CABG in five European countries, 2007–2009 (106,149 patients). Design: Hierarchical logistic regression models to estimate the relationship between hospital volume and mortality, allowing for case mix. Segmented regression analysis to estimate a threshold. Findings: The 30-day in-hospital mortality rate was 3.0 percent overall, 5.2 percent (95 percent CI: 4.0–6.4) in low-volume hospitals, and 2.1 percent (95 percent CI: 1.8–2.3) in high-volume hospitals. There is a significant curvilinear relationship between volume and mortality, flatter above 415 cases per hospital per year. Conclusions: There is a clear relationship between hospital CABG volume and mortality in Europe, implying a “safe” threshold volume of 415 cases per year.

KW - Coronary artery bypass surgery

KW - center-volume

KW - international comparisons

KW - mortality

KW - Coronary Artery Bypass/mortality

KW - Hospital Mortality

KW - Humans

KW - Middle Aged

KW - England/epidemiology

KW - Diagnosis-Related Groups

KW - Male

KW - Slovenia/epidemiology

KW - Surgical Procedures, Operative/statistics & numerical data

KW - Denmark/epidemiology

KW - Surgery Department, Hospital/standards

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Aged

KW - Portugal/epidemiology

KW - Spain/epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85014923695&partnerID=8YFLogxK

U2 - 10.1111/1475-6773.12508

DO - 10.1111/1475-6773.12508

M3 - Article

C2 - 27198068

SN - 0017-9124

VL - 52

SP - 863

EP - 878

JO - Health services research

JF - Health services research

IS - 2

ER -