Trends in Hospital Volume and Operative Mortality for High-Risk Surgery
Why the study?
Does surgery at high-volume hospitals reduce operative mortality in Medicare patients undergoing high-risk cancer and cardiovascular operations?
Population
Medicare patients undergoing one of eight different cancer and cardiovascular operations from 1999 through…
Comparison
Surgery at high-volume hospitals vs Surgery at lower-volume hospitals
Design
Cohort
Follow-up
1999 through 2008
Authors
Discussion
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Member takes
Implication
Declines support selective regionalization for some cancer operations; leaves open volume's role and other drivers in cardiovascular procedures.
Key Points
- To determine how hospital procedure volume, market concentration, and operative mortality changed over a decade for high-risk cancer and cardiovascular operations.
- Analyzed national Medicare claims data from 1999 through 2008 for patients undergoing eight high-risk surgical procedures.
- Calculated procedural trends in median hospital volume and market concentration, defined as the proportion of surgeries performed in the top decile of hospitals by annual volume.
- Used regression-based models adjusted for patient case mix to assess the relative contribution of hospital volume and market concentration to mortality reductions.
- Operative mortality declined across all eight procedures, with relative reductions ranging from 8% for carotid endarterectomy (1.3% in 1999 to 1.2% in 2008) to 36% for abdominal aortic aneurysm repair (4.4% in 1999 to 2.8% in 2008).
- Increasing hospital volume accounted for a substantial share of the mortality decline in pancreatectomy (67%), cystectomy (37%), and esophagectomy (32%), but not for the other five operations.
Structured PICO
Does surgery at high-volume hospitals reduce operative mortality in Medicare patients undergoing high-risk cancer and cardiovascular operations?
P
Population
Medicare patients undergoing one of eight different cancer and cardiovascular operations (lung, esophagus, pancreas, bladder resections, abdominal aortic aneurysm repair, aortic-valve replacement, coronary-artery bypass grafting, and carotid endarterectomy) from 1999 through 2008
I
Intervention
Surgery at high-volume hospitals (top decile of hospitals by volume per year)
C
Comparator
Surgery at lower-volume hospitals
O
Outcome
Operative mortalityhard clinical
While operative mortality for high-risk surgeries fell substantially over a decade, increased hospital volume explained the decline for some cancer operations but not for cardiovascular procedures.
Cite This Study
Finks et al. (2011) studied this question.