Coronary Artery Bypass Care Quality Not Tied to Quantity

High- and low-volume cardiac centers have similar mortality rates when adherence to quality is similar
By Jeff Muise
HealthDay Reporter

TUESDAY, May 19 (HealthDay News) -- Adherence to quality measures in coronary artery bypass follow-up care results in similar mortality rates whether the procedure is performed at a high-volume or low-volume cardiac care center, according to a study reported in the May 19 issue of the Annals of Internal Medicine.

Andrew D. Auerbach, M.D., of the University of California in San Francisco, and colleagues analyzed data on 81,289 patients who had coronary artery bypass surgery at 164 cardiac care centers in the United States from 2003 to 2005. To determine associations between procedure quantity and quality, researchers looked at the hospital and surgeon caseloads, the use of specific medications, and the number of quality measures missed. Study endpoints included death and hospital readmission up to 30 days.

The researchers found that the lowest surgeon volume was associated with higher mortality rates and highest hospital volume was associated with lower risk of readmission. Among quality measures missed, the patients who did not receive aspirin or beta-blockers had higher odds for death (odds ratios, 1.89 and 1.29, respectively) after adjustment for case volume and clinical factors. If no quality measures were missed, the mortality rates were similar at the lowest- and highest-volume cardiac care centers (adjusted mortality rates, 1.05 and 0.98 percent, respectively).

"Maximizing adherence to quality measures is associated with improved mortality rates, independent of hospital or surgeon volume," the authors conclude.

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