F Javier Goicolea Ruigómez1, Francisco J Elola2, Alejandro Durante-López1, Cristina Fernández Pérez3, José L Bernal4, Carlos Macaya5. 1. Servicio de Cardiología, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain. 2. Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain. Electronic address: fjelola@movistar.es. 3. Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Medicina Preventiva, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain. 4. Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Servicio de Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, Spain. 5. Servicio de Cardiología, Hospital Clínico Universitario de San Carlos, Madrid, Spain.
Abstract
INTRODUCTION AND OBJECTIVES: To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. METHODS: We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMR) and 30-day readmissions (RARR) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. RESULTS: A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07% vs 4.96%±1.76%; P <.001) and a negative linear correlation between volume and RARR (r=-0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. CONCLUSIONS: The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention.
INTRODUCTION AND OBJECTIVES: To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. METHODS: We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMR) and 30-day readmissions (RARR) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. RESULTS: A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07% vs 4.96%±1.76%; P <.001) and a negative linear correlation between volume and RARR (r=-0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. CONCLUSIONS: The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention.
Authors: Manuel Carnero Alcazar; Daniel Hernandez-Vaquero; Hector Cubero-Gallego; Jose Lopez Menendez; Miguel Piñon; Jose Albors Martin; Gregorio Cuerpo Caballero; Javier Cobiella Carnicer; Cristina Villamor; Alberto Forteza; Isaac Pascual; Luis Carlos Maroto Castellanos Journal: BMJ Open Date: 2021-04-07 Impact factor: 2.692