CABG outcomes better in high-volume hospitals
MedWire News: The overall cost and length of stay (LOS) associated with coronary artery bypass graft (CABG) surgery is reduced when performed in a hospital with a high patient-volume and maximum level quality of care, a US study suggests.
The results suggest that "maximizing overall rather than individual measure performance is critical," say Andrew Auerbach (University of California, San Francisco) and colleagues.
The team analyzed the quality of care received by 81,289 patients (mean age 65 years) undergoing CABG in 164 US hospitals (1451 surgeons) between October 2003 and September 2005.
The team used guidelines, such as those of the American Heart Association, to assess the quality of care provided by each hospital and surgeon. They evaluated the number of recommended medications and services received by eligible patients, the overall number of measures missed, and the volume of patients treated by each surgeon and hospital.
As reported in the Archives of Internal Medicine, the median LOS was 7 days, at an average cost of US $25,140 (€19,446).
Hospital patient-volumes ranged from 112 (for lowest quartile) to 644 per year (for highest quartile), and surgeon patient-volumes ranged from 12 (for lowest quartile) to 155 per year (for highest quartile).
In all, only 12% of patients received all six quality-of-care measures, such as administration of beta blockers, and prophylactic antibiotics.
After adjustment for covariates, such as comorbidities, patients with just one missed quality measure had an 11.9% increase in LOS and a 7.8% increase in cost, compared with those who received all quality measures (p<0.001 for both).
However, the receipt of any individual quality of care measure had no consistent association with patients' overall cost or LOS.
After adjustment for covariates and quality of care, the team found that hospitals and surgeons in the lowest patient-volume quartile were associated with an 18.3% (p=0.02) and 3.1% (p= 0.01) increase in patient costs, respectively, compared with hospitals and surgeons in the highest patient-volume quartile.
However, little difference (nonsignificant 1.6% increase) was found between the LOS of patients in hospitals in the lowest versus the highest patient-volume quartile, and no association was found between surgeon patient-volume and LOS.
In an accompanying editorial, David Brown from SUNY-Stony Brook School of Medicine in New York, USA, said that "referrals are often made for the wrong reasons such as institutional loyalty" or in response to cardiac surgical marketing.
He concluded that publicizing the findings of studies such as that of Auerbach et al will allow patients to have more choice over which surgeon or institution they choose "to perform a complex, potentially high-risk operation."
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By Lauretta Ihonor