Volume-based referral for cardiovascular procedures in the United States: a cross-sectional regression analysis
Why the study?
Does treatment at high volume hospitals reduce in-hospital mortality in patients undergoing CABG or PCI compared to low volume hospitals?
Population
3,997,733 patients in the United States who underwent PCI or CABG between 1998 and 2001.
Comparison
Treatment at high volume hospitals vs Treatment at low volume hospitals
Design
Cross-sectional
Follow-up
In-hospital
Authors
Discussion
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Member takes
Implication
May support volume-based regionalization for CABG/PCI; leaves open feasibility and causality given observational design and large transfer requirements.
Key Points
- To evaluate the impact of hospital procedure volume minimums on mortality rates for CABG and PCI surgeries.
- Retrospective analysis of a national hospital discharge database (n = 4,997,733) from 1998 to 2001.
- Comparison of in-hospital mortality rates between low volume and high volume hospitals for CABG and PCI.
- Simulation of deaths averted by moving patients to hospitals that meet volume recommendations.
- Patients in low volume hospitals had higher mortality odds for CABG (OR 1.16, 95% CI 1.10-1.24) and PCI (OR 1.12, 95% CI 1.05-1.20).
- Estimated 728 deaths could be prevented annually in the U.S. by adhering to recommended volume minimums.
- Moving 232 CABG patients or 805 PCI patients would be necessary to prevent a single death.
Structured PICO
Does treatment at high volume hospitals reduce in-hospital mortality in patients undergoing CABG or PCI compared to low volume hospitals?
P
Population
3,997,733 patients in the United States who underwent PCI (n = 2,500,796) or CABG (n = 1,496,937) between 1998 and 2001.
I
Intervention
Treatment at high volume hospitals (annual procedure minimums of 450 for CABG and 400 for PCI)
C
Comparator
Treatment at low volume hospitals
O
Outcome
In-hospital mortalityhard clinical
Adopting recommended hospital volume minimums for CABG and PCI would prevent an estimated 728 deaths annually in the US, but requires moving large numbers of patients, questioning the feasibility of such a policy.
Cite This Study
Epstein et al. (2005) studied this question.