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Regionalizing cardiac surgery facilities contributes to
improved outcomes and lower costs
Restricting coronary artery bypass graft (CABG) surgery to a few
regional hospitals may improve patient outcomes and reduce
duplication of services without unduly restricting access to
care, according to a study supported in part by the Agency for
Health Care Policy and Research (HS06503 and HS07373).
The study shows that most regional cardiac surgery facilities in
New York State and three Canadian provinces perform 500 or more
CABG surgeries each year. In contrast, many California
hospitals—where cardiac surgery facilities have not been
regionalized—perform fewer than 100 CABG operations each
year. This surgery rate has been shown to be too low for
consistently good patient outcomes, and these hospitals have
twice the hospital mortality rate of hospitals that perform 500
or more CABGs per year (4.7 percent compared with 2.4 percent).
Yet only 26 percent of Californians who underwent CABG had the
procedure in hospitals performing 500 or more CABGs each year,
compared with 60 percent in New York and Canada.
Despite restriction of CABGs in New York State to certain
regional facilities, 82 percent of residents lived within 25
miles of a CABG hospital, compared with 91 percent of California
residents. Less than 60 percent of Canadian residents lived that
close to a CABG hospital. More importantly, if the 34 California
hospitals with volumes of fewer than 100 CABGs were not
available, the proportion of Californians within 25 miles of a
CABG hospital falls by only 0.2 percent, and even the proportion
within 5 miles of a facility only drops from 59.1 percent to 54.3
The Californian and Canadian researchers conclude that
regionalizing CABG facilities in New York and Canada avoided
redundant facilities and the high mortality rates associated with
low-volume hospitals, while still providing residents with a
geographically convenient selection of hospitals.
Their findings are based on analysis of hospital discharge
records and small-area analysis of the association between CABG
rates and distances to the nearest CABG hospital. Included in the
study were all non-Federal hospitals in New York, California,
Ontario, Manitoba, and British Columbia.
Details are in "Regionalization of cardiac surgery in the United
States and Canada," by Kevin Grumbach, M.D., Geoffrey M.
Anderson, M.D., Ph.D., Harold S. Luft, Ph.D., and others, in the
October 25, 1995 issue of the Journal of the American
Association 274(16), pp. 1282-1288.
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