Procedural volume as a marker of quality for CABG surgery

被引:246
作者
Peterson, ED
Coombs, LP
DeLong, ER
Haan, CK
Ferguson, TB
机构
[1] Duke Clin Res Inst, Outcomes Res & Assessment Grp, Durham, NC 27715 USA
[2] Univ Florida, Hlth Sci Ctr, Jacksonville, FL 32209 USA
[3] LSu Hlth Sci Ctr, New Orleans, LA USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2004年 / 291卷 / 02期
关键词
D O I
10.1001/jama.291.2.195
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context There have been recent calls for using hospital procedural volume as a quality indicator for coronary artery bypass graft (CABG) surgery, but further research into analysis and policy implication is needed before hospital procedural volume is accepted as a standard quality metric. Objective To examine the contemporary association between hospital CABG procedure volume and outcome in a large national clinical database. Design, Setting, and Participants Observational analysis of 267089 isolated CABG procedures performed at 439 US hospitals participating in the Society of Thoracic Surgeons National Cardiac Database between January 1, 2000, and December 31, 2001. Main Outcome Measure Association between hospital CABG procedural volume and all-cause operative mortality (in-hospital or 30-day, whichever was longer). Results The median (interquartile range) annual hospital-isolated CABG volume was 253 (165-417) procedures, with 82% of centers performing fewer than 500 procedures per year. The overall operative mortality was 2.66%. After adjusting for patient risk and clustering effects, rates of operative mortality decreased with increasing hospital CABG volume (0.07% for every 100 additional CABG procedures; adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; P=.004). While the association between volume and outcome was statistically significant overall, this association was not observed in patients younger than 65 years or in those at low operative risk and was confounded by surgeon volume. The ability of hospital volume to discriminate those centers with significantly better or worse mortality was limited due to the wide variability in risk-adjusted mortality among hospitals with similar volume. Closure of up to 100 of the lowest-volume centers (ie, those performing less than or equal to150 CABG procedures/year) was estimated to avert fewer than 50 of 7110 (<1% of total) CABG-related deaths. Conclusion in contemporary practice, hospital procedural volume is only modestly associated with CABG outcomes and therefore may not be an adequate quality metric for CABG surgery.
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页码:195 / 201
页数:7
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