You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 165 No. 3, February 14, 2005 TABLE OF CONTENTS
  Archives
  •  Online Features
  Original Investigation
 This Article
 •Full text
 •PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on ISI (11)
 •Contact me when this article is cited
 Related Content
 •Related letters
 •Similar articles in this journal
 Topic Collections
 •Quality of Care, Other
 •Surgery
 •Cardiovascular/ Cardiothoracic Surgery
 •Prognosis/ Outcomes
 •Revascularization
 •Alert me on articles by topic

Impact of Patient Risk on the Hospital Volume–Outcome Relationship in Coronary Artery Bypass Grafting

Brahmajee K. Nallamothu, MD, MPH; Sanjay Saint, MD, MPH; Timothy P. Hofer, MD, MSc; Sandeep Vijan, MD, MSc; Kim A. Eagle, MD; Steven J. Bernstein, MD, MPH

Arch Intern Med. 2005;165:333-337.

Background  The impact of surgical risk on the relationship between hospital volume and outcomes in coronary artery bypass grafting (CABG) is uncertain. We assessed (1) whether in-hospital mortality rates differ across lower- and higher-volume hospitals by expected surgical risk and (2) whether high-risk patients are more likely to undergo CABG at low-volume centers.

Methods  We used clinical data on 27 355 adults who underwent CABG at 68 hospitals in California between 1997 and 1998. Hospitals were divided into low-volume (n = 44), medium-volume (n = 19), and high-volume (n = 5) categories on the basis of tertiles of annual CABG volume. Using hierarchical logistic regression and log-binomial regression models, we assessed for differences in in-hospital mortality rates across hospital volume categories and the likelihood of CABG being performed in each hospital volume category after adjusting for expected surgical risk.

Results  Differences in adjusted in-hospital mortality rates between low- and high-volume centers rose as the expected risk of in-hospital death increased: 0.8% vs 0.4% at the 20th risk percentile and 3.8% vs 2.5% at the 80th risk percentile (P<.001 for all comparisons). While a similar trend was seen between medium- and high-volume centers, absolute differences were substantially smaller. The likelihood of patients having surgery at a low-volume center also rose significantly with expected surgical risk (relative risk of undergoing CABG at a low-volume center for patients at 80th vs 20th risk percentile, 1.29 [95% confidence interval, 1.14-1.51; P<.001]).

Conclusion  High-risk patients are more likely to undergo CABG at low-volume facilities where their risk of dying is higher.


Author Affiliations: Department of Internal Medicine, University of Michigan Medical School, Ann Arbor (Drs Nallamothu, Saint, Hofer, Vijan, Eagle, and Bernstein); Patient Safety Enhancement Program, University of Michigan Health System, Ann Arbor (Drs Nallamothu, Saint, and Hofer); and Health Services Research and Development Field Program, Veterans Affairs Medical Center, Ann Arbor (Drs Saint, Hofer, Vijan, and Bernstein).


RELATED LETTERS

Controlling for Patient Risk in Volume-Outcome Studies
Vivian Ho
Arch Intern Med. 2005;165(14):1664.
EXTRACT | FULL TEXT  

Controlling for Patient Risk in Volume-Outcome Studies—Reply
Brahmajee K. Nallamothu, Timothy P. Hofer, and Steven J. Bernstein
Arch Intern Med. 2005;165(14):1664.
EXTRACT | FULL TEXT  


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association Between Physician Volume and Hospitalization Costs for Patients With Stroke in Taiwan: A Nationwide Population-Based Study
Lin et al.
Stroke 2007;38:1565-1569.
ABSTRACT | FULL TEXT  

The Year in Cardiovascular Surgery
Jones
J Am Coll Cardiol 2006;47:2094-2107.
FULL TEXT  

Should Coronary Artery Bypass Grafting Be Regionalized?
Nallamothu et al.
Ann. Thorac. Surg. 2005;80:1572-1581.
FULL TEXT  

Controlling for Patient Risk in Volume-Outcome Studies
Ho
Arch Intern Med 2005;165:1664-1664.
FULL TEXT  

Controlling for Patient Risk in Volume-Outcome Studies--Reply
Nallamothu et al.
Arch Intern Med 2005;165:1664-1664.
FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2005 American Medical Association. All Rights Reserved.