Optimal surgeon and hospital volume thresholds to reduce mortality and length of stay for CABG

Abstract

Objective We used nationwide population-based data to identify optimal hospital and surgeon volume thresholds and to discover the effects of these volume thresholds on operative mortality and length of stay (LOS) for coronary artery bypass surgery (CABG). Design Retrospective cohort study. Setting General acute care hospitals throughout Taiwan. Participants A total of 12,892 CABG patients admitted between 2011 and 2015 were extracted from Taiwan National Health Insurance claims data. Main Outcome Measures Operative mortality and LOS. Restricted cubic splines were applied to discover the optimal hospital and surgeon volume thresholds needed to reduce operative mortality. Generalized estimating equation regression modeling, Cox proportional-hazards modeling and instrumental variables analysis were employed to examine the effects of hospital and surgeon volume thresholds on the operative mortality and LOS. Results The volume thresholds for hospitals and surgeons were 55 cases and 5 cases per year, respectively. Patients who underwent CABG from hospitals that did not reach the volume threshold had higher operative mortality than those who received CABG from hospitals that did reach the volume threshold. Patients who underwent CABG with surgeons who did not reach the volume threshold had higher operative mortality and LOS than those who underwent CABG with surgeons who did reach the volume threshold. Conclusions This is the first study to identify the optimal hospital and surgeon volume thresholds for reducing operative mortality and LOS. This supports policies regionalizing CABG at high-volume hospitals. Identifying volume thresholds could help patients, providers, and policymakers provide optimal care.

Use of computer simulation to identify effects on hospital census with reduction of transfers for non-procedural patients in community hospitals

“…Often, complex procedures are not viable to provide in a small hospital as volumes at smaller sites may be insufficient to maintain high-level multidisciplinary skills yielding the best possible patient care and outcomes. [17][18][19][20] In reducing the work of patient movement, we may find that other systems have increased capacity for innovative work. Considering the transportation requirements for all transferred patients, a reduction in the number of patients being moved between sites will enable ambulance and patient transportation services to maintain focus on emergency response.…”

Associations of acute medical care with the transfer and acceptance functions of hospitals in a region in Japan with limited medical resources

“…Our results showed that the number of first hospitalized patients per physician had a significant association with shortened LOS and a significant and positive association with increased medical service fees per day only indirectly. Previous studies have also shown that high-volume surgeons have a shorter LOS compared with low-volume surgeons [ 20 – 24 ]. High-volume surgeons, teaching hospitals, and high-volume hospitals are associated with improved outcomes when providing acute care for a variety of patient conditions and treatments [ 20 , 21 , 24 – 32 ].…”

“…Our results showed that the number of first hospitalized patients per physician had a significant association with shortened LOS and a significant and positive association with increased medical service fees per day only indirectly. Previous studies have also shown that high-volume surgeons have a shorter LOS compared with low-volume surgeons [20][21][22][23][24]. High-volume…”

“…surgeons, teaching hospitals, and high-volume hospitals are associated with improved outcomes when providing acute care for a variety of patient conditions and treatments [20,21,[24][25][26][27][28][29][30][31][32]. These reasons are suggested to be related to the skill and experience of individual physicians, composition and experience of the clinical team, appropriate training, effective teamwork, availability of complementary medical and support services, and range of diagnostic and surgical procedures in use.…”