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Coronary Angioplasty Volume-Outcome Relationships for Hospitals and Cardiologists
Abstract
Objective. —To assess the relationship between each of 2 provider volume measures (annual hospital volume and annual cardiologist volume) for percutaneous transluminal coronary angioplasty (PTCA) and 2 outcomes of PTCA (in-hospital mortality and same-stay coronary artery bypass graft [CABG] surgery). Design. —Cohort study, using data from January 1,1991, through December 31, 1994, from the Coronary Angioplasty Reporting System of the New York State Department of Health. Setting. —Thirty-one hospitals in New York State in which PTCA was performed during 1991-1994. Patients. —All 62 670 patients discharged after undergoing PTCA in these hospitals during 1991-1994. Main Outcome Measures. —Rates of in-hospital mortality and CABG surgery during the same stay as the PTCA. Results. —The overall in-hospital mortality rate for patients undergoing PTCA in New York during 1991-1994 was 0.90%, and the same-stay CABG surgery rate was 3.43%. Patients undergoing PTCA in hospitals with annual PTCA volumes less than 600 experienced a significantly higher risk-adjusted in-hospital mortality rate of 0.96% (95% confidence interval [CI], 0.91%-1.01%) and risk-adjusted same-stay CABG surgery rate of 3.92% (95% CI, 3.76%-4.08%). Patients undergoing PTCA by cardiologists with annual PTCA volumes less than 75 had mortality rates of 1.03% (95% CI, 0.91%-1.17%) and same-stay CABG surgery rates of 3.93% (95% CI, 3.65%-4.24%); both of these rates were also significantly higher than the rates for all patients. Also, same-stay CABG surgery rates for patients undergoing PTCA in hospitals with annual volumes of 600 to 999 performed by cardiologists with annual volumes of 75 to 174 (2.99%; 95% CI, 2.69%-3.31%) and 175 or more (2.84%; 95% CI, 2.57%-3.14%) were significantly lower than the overall statewide rate (3.43%). Conclusions. —In New York State, both hospital PTCA volume and cardiologist PTCA volume are significantly inversely related to in-hospital mortality rate and same-stay CABG surgery rate for patients undergoing PTCA.
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Cited by
Halm, E. A., Lee, C., & Chassin, M. R. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-137-6-200209170-00012 · Cited by 1,704
2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery
Hillis, L. D., Smith, P. K., Anderson, J. L., Bittl, J. A., Bridges, C. R., Byrne, J. G., Cigarroa, J. E., DiSesa, V. J., Hiratzka, L. F., Hutter, A. M., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.08.009 · Cited by 820
Smith, S. C., Dove, J. T., Jacobs, A. K., Kennedy, J. W., Kereiakes, D., Kern, M. J., Kuntz, R. E., Popma, J. J., Schaff, H. V., Williams, D. O., et al. (2001) · Circulation · doi:10.1161/01.cir.103.24.3019 · Cited by 608
A systematic review of the impact of volume of surgery and specialization on patient outcome
Chowdhury, M. M., Dagash, H., & Pierro, A. (2007) · British Journal of Surgery · doi:10.1002/bjs.5714 · Cited by 608
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention
Smith, S. C., Feldman, T. E., Hirshfeld, J. W., Jacobs, A. K., Kern, M. J., King, S. B., Morrison, D. A., O’Neill, W. W., Schaff, H. V., Whitlow, P. L., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.12.001 · Cited by 532
Metadata
- Authors
- Hannan, E. L.
- Venue
- JAMA: The Journal of the American Medical Association
- Publisher
- American Medical Association (AMA)
- Published
- 1997-03-19
- Volume
- 277
- Issue
- 11
- Pages
- 892
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W4299323459
- Cited by
- 339
- References
- 0
- FWCI
- 22.74
- Type
- journal article
- Language
- en
- Open access
- closed
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