Quality of care may be more important than volume when it comes to heart bypass surgery
Research Activities, November 2009
When it comes to heart bypass surgery, the most experienced hospitals that perform a high volume of such surgeries typically have better outcomes than low-volume hospitals, including a lower risk of patient death. However, a new study finds that differences in the quality of care may be more important when patients are looking for the "best" hospital for their surgery. Researchers examined administrative data from 164 U.S. hospitals on 81,289 adults who received coronary artery bypass graft surgery (CABG) from 1,451 surgeons from 2003 to 2005. They analyzed various quality measures, such as the timely use of aspirin, antibiotics, cholesterol-lowering drugs (statins), beta-blockers, and compression devices to improve blood flow after surgery. They found that the lowest surgeon CABG case volume was associated with the highest mortality rates among the various hospitals and that the highest hospital volume of surgeries was associated with lower rates of readmission due to complications.
However, quality of care measures were also important. Patients were at increased risk for dying if they did not receive aspirin or beta-blocker drugs during the first 2 days of surgery. Interestingly, if all quality measures were met, volume did not matter. There were similar mortality rates for both the lowest- and highest-volume hospitals when hospitals adhered to recommended care quality measures. When shopping for the right hospital, looking at higher volume centers is a good start. However, consumers should look deeper at quality measures when considering coronary artery bypass surgery, conclude the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS11416). See “Shop for quality or volume? Volume, quality, and outcomes of coronary artery bypass surgery,” by Andrew D. Auerbach, M.D., M.P.H., Joan F. Hilton, Sc.D., Judith Maselli, M.S.P.H., and others, in the May 19, 2009 Annals of Internal Medicine 150(10), pp. 696-704.