Limits...
Early efficacy of CABG care delivery in a low procedure-volume community hospital: operative and midterm results.

Papadimos TJ, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A - BMC Surg (2005)

Bottom Line: All CABGs were performed by 5 high-volume surgeons (161-285 per year). "Best practice" care at LVH -- including effective practice guidelines, protocols, data acquisition capabilities, case review process, dedicated facilities and support personnel -- were closely modeled after a high-volume hospital served by the same surgeon-team.Operative mortality was similar for LVH and STS (OM: 2.38% vs. 2.53%), and the corresponding LVH observed-to-expected mortality (O/E = 0.81) indicated good quality relative to the STS risk model (O/E<1).Also, these results were consistent irrespective of risk category: O/E was 0, 0.9 and 1.03 for very-low risk (<1%), low risk (1-3%) and moderate-to-high risk category (>3%), respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Medical College of Ohio, 3000 Arlington Avenue, Toledo, OH 43614, USA. TPapadimos@mac.com

ABSTRACT

Background: The Leapfrog Group recommended that coronary artery bypass grafting (CABG) surgery should be done at high volume hospitals (>450 per year) without corresponding surgeon-volume criteria. The latter confounds procedure-volume effects substantially, and it is suggested that high surgeon-volume (>125 per year) rather than hospital-volume may be a more appropriate indicator of CABG quality.

Methods: We assessed 3-year isolated CABG morbidity and mortality outcomes at a low-volume hospital (LVH: 504 cases) and compared them to the corresponding Society of Thoracic Surgeons (STS) national data over the same period (2001-2003). All CABGs were performed by 5 high-volume surgeons (161-285 per year). "Best practice" care at LVH -- including effective practice guidelines, protocols, data acquisition capabilities, case review process, dedicated facilities and support personnel -- were closely modeled after a high-volume hospital served by the same surgeon-team.

Results: Operative mortality was similar for LVH and STS (OM: 2.38% vs. 2.53%), and the corresponding LVH observed-to-expected mortality (O/E = 0.81) indicated good quality relative to the STS risk model (O/E<1). Also, these results were consistent irrespective of risk category: O/E was 0, 0.9 and 1.03 for very-low risk (<1%), low risk (1-3%) and moderate-to-high risk category (>3%), respectively. Postoperative leg wound infections, ventilator hours, renal dysfunction (no dialysis), and atrial fibrillation were higher for LVH, but hospital stay was not. The unadjusted Kaplan-Meier survival for the LVH cohort was 96%, 94%, and 92% at one, two, and three years, respectively.

Conclusion: Our results demonstrated that high quality CABG care can be achieved at LVH programs if 1) served by high volume surgeons and 2) patient care procedures similar to those of large programs are implemented. This approach may prove a useful paradigm to ensure high quality CABG care and early efficacy at low volume institutions that wish to comply with the Leapfrog standards.

Show MeSH

Related in: MedlinePlus

Kaplin-Meyer survival curve for 504 LVH CABG patients. Bars = standard error.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC1131908&req=5

Figure 1: Kaplin-Meyer survival curve for 504 LVH CABG patients. Bars = standard error.

Mentions: Unadjusted Kaplan-Meier survival was 96%, 94 %, and 92% at 1, 2, and 3 years, respectively (Figure 1), which was comparable to the STS. Effects of six patient variables on survival are shown in Figure 2. Gender and diabetes did not affect midterm survival, while survival for older (> 65 years) patients, cerebral vascular disease, longer time on CPB, and higher STS predicted operative mortality risk all exhibited significantly worse midterm survival.


Early efficacy of CABG care delivery in a low procedure-volume community hospital: operative and midterm results.

Papadimos TJ, Habib RH, Zacharias A, Schwann TA, Riordan CJ, Durham SJ, Shah A - BMC Surg (2005)

Kaplin-Meyer survival curve for 504 LVH CABG patients. Bars = standard error.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1131908&req=5

Figure 1: Kaplin-Meyer survival curve for 504 LVH CABG patients. Bars = standard error.
Mentions: Unadjusted Kaplan-Meier survival was 96%, 94 %, and 92% at 1, 2, and 3 years, respectively (Figure 1), which was comparable to the STS. Effects of six patient variables on survival are shown in Figure 2. Gender and diabetes did not affect midterm survival, while survival for older (> 65 years) patients, cerebral vascular disease, longer time on CPB, and higher STS predicted operative mortality risk all exhibited significantly worse midterm survival.

Bottom Line: All CABGs were performed by 5 high-volume surgeons (161-285 per year). "Best practice" care at LVH -- including effective practice guidelines, protocols, data acquisition capabilities, case review process, dedicated facilities and support personnel -- were closely modeled after a high-volume hospital served by the same surgeon-team.Operative mortality was similar for LVH and STS (OM: 2.38% vs. 2.53%), and the corresponding LVH observed-to-expected mortality (O/E = 0.81) indicated good quality relative to the STS risk model (O/E<1).Also, these results were consistent irrespective of risk category: O/E was 0, 0.9 and 1.03 for very-low risk (<1%), low risk (1-3%) and moderate-to-high risk category (>3%), respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Anesthesiology, Medical College of Ohio, 3000 Arlington Avenue, Toledo, OH 43614, USA. TPapadimos@mac.com

ABSTRACT

Background: The Leapfrog Group recommended that coronary artery bypass grafting (CABG) surgery should be done at high volume hospitals (>450 per year) without corresponding surgeon-volume criteria. The latter confounds procedure-volume effects substantially, and it is suggested that high surgeon-volume (>125 per year) rather than hospital-volume may be a more appropriate indicator of CABG quality.

Methods: We assessed 3-year isolated CABG morbidity and mortality outcomes at a low-volume hospital (LVH: 504 cases) and compared them to the corresponding Society of Thoracic Surgeons (STS) national data over the same period (2001-2003). All CABGs were performed by 5 high-volume surgeons (161-285 per year). "Best practice" care at LVH -- including effective practice guidelines, protocols, data acquisition capabilities, case review process, dedicated facilities and support personnel -- were closely modeled after a high-volume hospital served by the same surgeon-team.

Results: Operative mortality was similar for LVH and STS (OM: 2.38% vs. 2.53%), and the corresponding LVH observed-to-expected mortality (O/E = 0.81) indicated good quality relative to the STS risk model (O/E<1). Also, these results were consistent irrespective of risk category: O/E was 0, 0.9 and 1.03 for very-low risk (<1%), low risk (1-3%) and moderate-to-high risk category (>3%), respectively. Postoperative leg wound infections, ventilator hours, renal dysfunction (no dialysis), and atrial fibrillation were higher for LVH, but hospital stay was not. The unadjusted Kaplan-Meier survival for the LVH cohort was 96%, 94%, and 92% at one, two, and three years, respectively.

Conclusion: Our results demonstrated that high quality CABG care can be achieved at LVH programs if 1) served by high volume surgeons and 2) patient care procedures similar to those of large programs are implemented. This approach may prove a useful paradigm to ensure high quality CABG care and early efficacy at low volume institutions that wish to comply with the Leapfrog standards.

Show MeSH
Related in: MedlinePlus