Key result
Longer postoperative stay is linked to ~1% higher hospital mortality per day.
Why the study?
The association between hospital procedural volume, postoperative efficiency, and in-hospital mortality and costs after coronary artery bypass grafting in São Paulo's public health system was unclear.
Does higher hospital procedural volume and postoperative efficiency reduce in-hospital mortality and costs in patients undergoing CABG?
Observational (n=82,398)
Yes
Does higher hospital procedural volume and postoperative efficiency reduce in-hospital mortality and costs in patients undergoing CABG?
Higher institutional volume and shorter postoperative length of stay are significantly associated with reduced in-hospital mortality and lower costs after CABG, emphasizing the importance of centralization and critical care efficiency.
Answers are grounded in this paper and cite their sources.
Longer postoperative stays were associated with higher hospital-level CABG mortality; hypothesis-generating for volume centralization, requires prospective confirmation before practice change.
Objective: To evaluate the association between hospital procedural volume, postoperative efficiency, and in-hospital mortality and costs among patients undergoing coronary artery bypass grafting in the public health system of the State of São Paulo, Brazil.Methods: This retrospective ecological study analyzed isolated coronary artery bypass grafting procedures recorded in the Brazilian Hospital Information System in São Paulo between 2008 and 2024.Outcomes included in-hospital mortality, postoperative length of stay, and inflation-adjusted hospitalization costs.We assessed mortality using Poisson regression models, while we analyzed costs and length of stay using linear mixed-effects models with hospital-level random intercepts.We performed sensitivity analyses using alternative inclusion criteria.Results: We included 82,398 procedures from 45 hospitals.Median annual hospital volume was 71 procedures.Overall in-hospital mortality was 6.75%, and mean length of stay was 12.2 days.High-performing centers showed substantially lower mortality (4.82% versus 9.94%), shorter length of stay (12.3 versus 16.5 days), and lower adjusted costs (R$24,246 versus R$28,633) compared with low-performing institutions.At the institutional level, longer mean postoperative stay was positively associated with higher hospital-level mortality rates (incidence rate ratios: 1.015 per day; 95%CI 1.006 -1.024), though reverse causation cannot be excluded given the ecological study design.Higher annual procedural volume was independently associated with lower costs, whereas prolonged hospitalization significantly increased expenditures.Between 2008 and 2024, total surgical volume declined, while mortality decreased, suggesting progressive improvements in care quality.Conclusion: Higher institutional volume and greater postoperative efficiency are associated with lower mortality and reduced costs after coronary artery bypass grafting in the public health system of the State of São Paulo, Brazil.Postoperative length of stay emerged as a key marker of institutional performance and clinical course.
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Martins et al. (2026) conducted an observational in Isolated coronary artery bypass grafting (CABG) (n=82,398). Higher hospital procedural volume and longer postoperative length of stay vs. Lower hospital procedural volume and shorter postoperative length of stay was evaluated on In-hospital mortality (IRR 1.015 per day, 95% CI 1.006-1.024, p=<0.001). Longer mean postoperative length of stay was positively associated with higher hospital-level in-hospital mortality rates and higher institutional volume was independently associated with lower costs.
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