Key result
High hospital volume linked to ~3-point lower 30-day mortality, suggesting a 415-case annual threshold.
Why the study?
Does higher hospital surgical volume reduce 30-day in-hospital mortality in patients undergoing CABG surgery?
Observational (n=106,149)
Yes
Does higher hospital surgical volume reduce 30-day in-hospital mortality in patients undergoing CABG surgery?
Absolute Event Rate: 2.1% vs 5.2%
Performing CABG in high-volume centers (over 415 cases/year) is associated with significantly lower 30-day in-hospital mortality compared to low-volume centers.
Lower mortality associated with high-volume CABG centers; hypothesis-generating, requires prospective validation before practice change.
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.
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Gutacker et al. (2016) conducted an observational in Coronary artery bypass graft (CABG) surgery (n=106,149). High hospital surgical volume (>415 cases/year) vs. Low hospital surgical volume was evaluated on 30-day in-hospital mortality rate. High-volume hospitals had a 2.1% 30-day in-hospital mortality rate compared to 5.2% in low-volume hospitals, suggesting a safe threshold of 415 cases per year.
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