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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 percent.

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 Medical Association 274(16), pp. 1282-1288.

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