June 3, 1997Circulation216 citations
Relationship Between Physician and Hospital Coronary Angioplasty Volume and Outcome in Elderly Patients
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Key Result
Low-volume physicians and hospitals were associated with higher rates of in-hospital bypass surgery and death after coronary angioplasty among Medicare patients (P < .001).
Key Points
- The aim is to investigate how the volume of coronary angioplasties performed by physicians and hospitals affects outcomes in elderly patients.
- Analysis of in-hospital outcomes, including bypass surgery and mortality post-angioplasty, using 1992 Medicare data.
- 6115 physicians performing angioplasty on 97,478 Medicare patients across 984 hospitals were evaluated.
- Median procedure volumes were calculated, and adjustments were made for patient demographics and comorbidities.
- Low-volume physicians had higher rates of bypass surgery (P < .001).
- Low-volume hospitals showed increased rates of both bypass surgery and death (P < .001).
- Outcomes improved significantly for physicians performing at least 75 cases and hospitals with 200 cases.
Study Design
Type
Observational (n=97,478)
Multicenter
Yes
Structured PICO
Does high physician and hospital coronary angioplasty volume reduce in-hospital bypass surgery and death in elderly Medicare patients undergoing angioplasty?
P
Population
97,478 Medicare patients undergoing coronary angioplasty in 1992 across 984 hospitals, treated by 6,115 physicians.
I
Intervention
High physician and hospital coronary angioplasty volume (thresholds of 75 Medicare cases per physician and 200 Medicare cases per hospital)
C
Comparator
Low physician and hospital coronary angioplasty volume
O
Outcome
In-hospital bypass surgery and death after angioplastyhard clinical
Higher physician and hospital coronary angioplasty volumes are associated with lower rates of in-hospital bypass surgery and death in elderly patients, supporting minimum volume guidelines.
Main Result
p-value: p=<.001
Limitations
- More recent data are required to determine whether the same relationships persist after the introduction of newer technologies
Abstract
BACKGROUND: With the expectation that physicians who perform larger numbers of coronary angioplasty procedures will have better outcomes, the American College of Cardiology/ American Heart Association guidelines recommend minimum physician volumes of 75 procedures per year. However, there is little empirical data to support this recommendation. METHODS AND RESULTS: We examined in-hospital bypass surgery and death after angioplasty according to 1992 physician and hospital Medicare procedure volume. In 1992, 6115 physicians performed angioplasty on 97,478 Medicare patients at 984 hospitals. The median numbers of procedures performed per physician and per hospital were 13 (interquartile range, 5 to 25) and 98 (interquartile range, 40 to 181), respectively. With the assumption that Medicare patients composed one half to one third of all patients undergoing angioplasty, these median values are consistent with an overall physician volume of 26 to 39 cases per year and an overall hospital volume of 196 to 294 cases per year. After adjusting for age, sex, race, acute myocardial infarction, and comorbidity, low-volume physicians were associated with higher rates of bypass surgery (P < .001) and low-volume hospitals were associated with higher rates of bypass surgery and death (P < .001). Improving outcomes were seen up to threshold values of 75 Medicare cases per physician and 200 Medicare cases per hospital. CONCLUSIONS: More than 50% of physicians and 25% of hospitals performing coronary angioplasty in 1992 were unlikely to have met the minimum volume guidelines first published in 1988, and these patients had worse outcomes. While more recent data are required to determine whether the same relationships persist after the introduction of newer technologies, this study suggests that adherence to minimum volume standards by physicians and hospitals will lead to better outcomes for elderly patients undergoing coronary angioplasty.
Cite This Study
Jollis et al. (1997) conducted an observational in Coronary angioplasty (n=97,478). High physician and hospital coronary angioplasty volume vs. Low physician and hospital volume was evaluated on In-hospital bypass surgery and death after angioplasty (p=<.001). Low-volume physicians and hospitals were associated with higher rates of in-hospital bypass surgery and death after coronary angioplasty among Medicare patients (P < .001).