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CABG hospital volume not necessarily linked to better patient outcome.

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The number of total CABG surgeries performed is only modestly important in determining patient outcome after coronary artery bypass grafting (CABG), according to a US study published in the Journal of the American Medical Association.

Coronary artery bypass grafting is a type of surgery used to bypass a blockage in a coronary artery using a graft. Using a variety of conduits (leg veins, other arteries) a connection is made between the aorta and the blocked coronary artery (beyond the blockage). It is one of the most common operations performed in the US and Australia.The study in question investigated the relationship between the number of CABG operations performed in the various centres, and whether this had an effect on patient outcome.Based on this study – while being operated on in a hospital where a greater number of CABG operations are performed (greater CABG hospital volume) is statistically related to a slightly better outcome overall, this association was not seen in patients younger than 65 years, or those at low operative risk (<1.5%), and was also confounded by specific surgeon experience. Hospital procedural volumes have been proposed as indicators of the quality of surgery for use in selective referral strategies. To examine how CABG volume related to outcome, and therefore its value as a quality indicator, Eric Peterson (Duke Clinical Research Institute, North Carolina) and colleagues examined clinical data from the Society of Thoracic Surgeons National Cardiac Database. The investigators looked at the outcomes of isolated CABG surgery performed between 2000 and 2001, comprising a total of 267,089 procedures at 439 hospitals. The team found that the median annual hospital volume for isolated CABG operations was 253, with 82% of centers performing less than 500 procedures per year. 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, p=0.004). Peterson and co-workers note, however, that the ability of hospital volume to determine better or worse outcome was limited due to the wide variability in risk-adjusted mortality among hospitals with similar volumes. "Our study further demonstrates the limitations of using hospital volume as an indicator of the quality of CABG surgery," the authors conclude. In an accompanying editorial, David Shahian (Lahey Clinic, Boston, Massachusetts) comments: "Higher volume is, on average, associated with better outcomes but does not guarantee them... the processes that permit some hospitals and surgeons to consistently obtain better results must be identified."The resuls of this study may be applicable to hospitals within Australia.JAMA 2004; 291: 195-201


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Posted On: 15 January, 2004
Modified On: 3 December, 2013

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