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

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JournalHealth services research
DateIn preparation - 2016
DateAccepted/In press - 18 Jan 2016
DateE-pub ahead of print - 16 May 2016
DatePublished (current) - 3 Apr 2017
Issue number2
Volume52
Number of pages16
Pages (from-to)863-878
Early online date16/05/16
Original languageEnglish

Abstract

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% overall, 5.2% (95% CI 4.0-6.4) in low volume hospitals and 2.1% (95% 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.

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