December 11, 2013JAMA Surgery
Understanding the Volume-Outcome Effect in Cardiovascular Surgery
Key result
Patients at very low-volume hospitals were 12% more likely to have a major complication but 57% more likely to die after a complication compared to those at very high-volume hospitals.
Why the study?
Does treatment at high-volume hospitals reduce mortality and failure-to-rescue rates compared to low-volume hospitals in older adults undergoing cardiovascular surgery?
Population
119,434 Medicare fee-for-service beneficiaries aged 65 to 99 years undergoing coronary artery bypass…
Comparison
Treatment at high-volume hospitals vs Treatment at low-volume hospitals
Design
Cohort
Authors
Discussion
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Member takes
Implication
Higher failure-to-rescue rates explain volume-outcome gaps in cardiovascular surgery; leaves open whether targeted rescue protocols narrow disparities.
Study Design
Type
Cohort (n=119,434)
Multicenter
Yes
Structured PICO
Does treatment at high-volume hospitals reduce mortality and failure-to-rescue rates compared to low-volume hospitals in older adults undergoing cardiovascular surgery?
P
Population
119,434 Medicare beneficiaries aged 65 to 99 years undergoing coronary artery bypass grafting, aortic valve repair, or abdominal aortic aneurysm repair between 2005 and 2006.
E
Exposure
Treatment at high-volume hospitals (highest quintile of procedural volume)
C
Comparator
Treatment at low-volume hospitals (lowest quintile of procedural volume)
O
Outcome
Hospital rates of risk-adjusted mortality, major complications, and failure to rescue (case fatality among patients with complications)hard clinical
Higher mortality in low-volume cardiovascular surgery hospitals is primarily driven by failure to rescue patients from complications rather than a significantly higher incidence of complications.
Cite This Study
Gonzalez et al. (2013) conducted a cohort in Cardiovascular surgery (coronary artery bypass grafting, aortic valve repair, or abdominal aortic aneurysm repair) (n=119,434). Very low-volume hospitals vs. Very high-volume hospitals was evaluated on Hospital rates of risk-adjusted mortality, major complications, and failure to rescue. Patients at very low-volume hospitals were 12% more likely to have a major complication but 57% more likely to die after a complication compared to those at very high-volume hospitals.