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Beyond volume: hospital-based healthcare technology as a predictor of mortality for cardiovascular patients in Korea

View Article: PubMed Central - PubMed

ABSTRACT

To examine whether hospital-based healthcare technology is related to 30-day postoperative mortality rates after adjusting for hospital volume of cardiovascular surgical procedures.

This study used the National Health Insurance Service–Cohort Sample Database from 2002 to 2013, which was released by the Korean National Health Insurance Service. A total of 11,109 cardiovascular surgical procedure patients were analyzed. The primary analysis was based on logistic regression models to examine our hypothesis.

After adjusting for hospital volume of cardiovascular surgical procedures as well as for all other confounders, the odds ratio (OR) of 30-day mortality in low healthcare technology hospitals was 1.567-times higher (95% confidence interval [CI] = 1.069–2.297) than in those with high healthcare technology. We also found that, overall, cardiovascular surgical patients treated in low healthcare technology hospitals, regardless of the extent of cardiovascular surgical procedures, had the highest 30-day mortality rate.

Although the results of our study provide scientific evidence for a hospital volume–mortality relationship in cardiovascular surgical patients, the independent effect of hospital-based healthcare technology is strong, resulting in a lower mortality rate. As hospital characteristics such as clinical pathways and protocols are likely to also play an important role in mortality, further research is required to explore their respective contributions.

No MeSH data available.


Adjusted effect between hospital-based healthcare technology and 30-day all-cause mortality for percutaneous coronary intervention (PCI) patients.
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Figure 2: Adjusted effect between hospital-based healthcare technology and 30-day all-cause mortality for percutaneous coronary intervention (PCI) patients.

Mentions: After adjusting for age, sex, residential region, PCCL, inpatient type, diagnostic code, type of surgery, hospital type, organization type, hospital region, bed, doctor, and magnetic resonance imaging, the odds ratio (OR) of 30-day mortality in low-volume hospitals (model 1) was 1.412-times higher (95% confidence interval [CI]: 1.012–2.013) than in high-volume hospitals (Table 2 , Figure 1). After adjusting for hospital volume of cardiovascular surgical procedures and all other confounders, the OR of 30-day mortality in low healthcare technology hospitals (model 2) was 1.567-times higher (95% CI: 1.069–2.297) than in high healthcare technology hospitals. Model 3 examined the combined effects of hospital-based healthcare technology and hospital volume of cardiovascular surgical procedures as well as all other confounders. The OR of 30-day mortality in low healthcare technology hospitals and low-volume hospitals (low-low) was 1.985 times higher (95% CI: 1.258–3.132) than in high healthcare technology hospitals and high-volume hospitals (high–high). Overall, we found that low healthcare technology hospitals, regardless of volume of cardiovascular surgical procedures, had a higher 30-day mortality rate than high healthcare technology hospitals. Table 3 and Figure 2 show a subgroup analysis of percutaneous coronary intervention patients after adjusting for all confounders, which suggests a trend similar to that seen from an analysis of cardiovascular patients.


Beyond volume: hospital-based healthcare technology as a predictor of mortality for cardiovascular patients in Korea
Adjusted effect between hospital-based healthcare technology and 30-day all-cause mortality for percutaneous coronary intervention (PCI) patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998484&req=5

Figure 2: Adjusted effect between hospital-based healthcare technology and 30-day all-cause mortality for percutaneous coronary intervention (PCI) patients.
Mentions: After adjusting for age, sex, residential region, PCCL, inpatient type, diagnostic code, type of surgery, hospital type, organization type, hospital region, bed, doctor, and magnetic resonance imaging, the odds ratio (OR) of 30-day mortality in low-volume hospitals (model 1) was 1.412-times higher (95% confidence interval [CI]: 1.012–2.013) than in high-volume hospitals (Table 2 , Figure 1). After adjusting for hospital volume of cardiovascular surgical procedures and all other confounders, the OR of 30-day mortality in low healthcare technology hospitals (model 2) was 1.567-times higher (95% CI: 1.069–2.297) than in high healthcare technology hospitals. Model 3 examined the combined effects of hospital-based healthcare technology and hospital volume of cardiovascular surgical procedures as well as all other confounders. The OR of 30-day mortality in low healthcare technology hospitals and low-volume hospitals (low-low) was 1.985 times higher (95% CI: 1.258–3.132) than in high healthcare technology hospitals and high-volume hospitals (high–high). Overall, we found that low healthcare technology hospitals, regardless of volume of cardiovascular surgical procedures, had a higher 30-day mortality rate than high healthcare technology hospitals. Table 3 and Figure 2 show a subgroup analysis of percutaneous coronary intervention patients after adjusting for all confounders, which suggests a trend similar to that seen from an analysis of cardiovascular patients.

View Article: PubMed Central - PubMed

ABSTRACT

To examine whether hospital-based healthcare technology is related to 30-day postoperative mortality rates after adjusting for hospital volume of cardiovascular surgical procedures.

This study used the National Health Insurance Service–Cohort Sample Database from 2002 to 2013, which was released by the Korean National Health Insurance Service. A total of 11,109 cardiovascular surgical procedure patients were analyzed. The primary analysis was based on logistic regression models to examine our hypothesis.

After adjusting for hospital volume of cardiovascular surgical procedures as well as for all other confounders, the odds ratio (OR) of 30-day mortality in low healthcare technology hospitals was 1.567-times higher (95% confidence interval [CI] = 1.069–2.297) than in those with high healthcare technology. We also found that, overall, cardiovascular surgical patients treated in low healthcare technology hospitals, regardless of the extent of cardiovascular surgical procedures, had the highest 30-day mortality rate.

Although the results of our study provide scientific evidence for a hospital volume–mortality relationship in cardiovascular surgical patients, the independent effect of hospital-based healthcare technology is strong, resulting in a lower mortality rate. As hospital characteristics such as clinical pathways and protocols are likely to also play an important role in mortality, further research is required to explore their respective contributions.

No MeSH data available.