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Health Serv Res. 2017 Apr;52(2):863-878. doi: 10.1111/1475-6773.12508. Epub 2016 May 16.

Hospital Surgical Volumes and Mortality after Coronary Artery Bypass Grafting: Using International Comparisons to Determine a Safe Threshold.

Author information

1
Centre for Health Economics, University of York, York, UK.
2
Department of Health Sciences, University of York, York, UK.
3
Division of Epidemiology and Biostatistics, University of Leeds, UK.
4
Department of Cardiothoracic Surgery, University Hospital Birmingham Queen Elizabeth, Edgbaston, UK.
5
Department of Cardiovascular Surgery, Hospital Clinic de Barcelona, Barcelona, Spain.
6
Institute for Health Sciences, IIS Aragón, Zaragoza, Spain.

Abstract

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.

KEYWORDS:

Coronary artery bypass surgery; center-volume; international comparisons; mortality

PMID:
27198068
PMCID:
PMC5346497
DOI:
10.1111/1475-6773.12508
[Indexed for MEDLINE]
Free PMC Article

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