Hospital surgical volumes and mortality after coronary artery bypass grafting: using international comparisons to determine a safe threshold

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.

Metadata

Authors/Creators:	Gutacker, Nils https://orcid.org/0000-0002-2833-0621 Bloor, Karen Elizabeth https://orcid.org/0000-0003-4852-9854 Cookson, Richard Andrew https://orcid.org/0000-0003-0052-996X Gale, Christopher Maynard, Alan Keith Pagano, Domenico Pomar, Jose Bernal-Delgado, Enrique ECHO collaboration, as part of the
Copyright, Publisher and Additional Information:	© Health Research and Educational Trust. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details
Keywords:	Coronary artery bypass surgery, center-volume, international comparisons, mortality, Coronary Artery Bypass/mortality, Hospital Mortality, Humans, Middle Aged, England/epidemiology, Diagnosis-Related Groups, Male, Slovenia/epidemiology, Surgical Procedures, Operative/statistics & numerical data, Denmark/epidemiology, Surgery Department, Hospital/standards, Aged, 80 and over, Adult, Female, Aged, Portugal/epidemiology, Spain/epidemiology
Dates:	Accepted: 18 January 2016 Published (online): 16 May 2016 Published: 12 March 2017
Institution:	The University of York
Academic Units:	The University of York > Faculty of Social Sciences (York) > Centre for Health Economics (York) The University of York > Faculty of Sciences (York) > Health Sciences (York)
Depositing User:	Pure (York)
Date Deposited:	04 Apr 2017 14:00
Last Modified:	06 Dec 2023 11:14
Published Version:	https://doi.org/10.1111/1475-6773.12508
Status:	Published
Refereed:	Yes
Identification Number:	https://doi.org/10.1111/1475-6773.12508
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