ABSTRACT
INTRODUCCIÓN Y OBJETIVOS: Analizar la asociación entre volumen y resultados en cirugía de revascularización aortocoronaria (CABG) en el Sistema Nacional de Salud de España. MÉTODOS: Se analizaron los eventos de CABG entre 2013-2015. Las variables de resultado seleccionadas fueron la mortalidad hospitalaria en el evento índice, así como los reingresos por causa cardiaca a los 30 días y la mortalidad en el reingreso. Mediante regresión logística multinivel, se obtuvieron las tasas ajustadas a riesgo de mortalidad hospitalaria (RAMER) y de reingresos (RARER). Se discriminó entre centros de alto y bajo volumen mediante un análisis no condicionado (k-medias), utilizando también para CABG la recomendación de volumen de las guías de práctica clínica. RESULTADOS: Se incluyeron 17.335 eventos de CABG con una mortalidad bruta del 5,0%. Los eventos atendidos en centros de bajo volumen para CABG (< 155 CABG al año) mostraron una RAMER un 17% superior (5,81%±2,07 frente a 4,96%±1,76; p <0,001) y una correlación lineal negativa entre volumen y RARER (r=-0,318; p = 0,029), así como una mayor proporción de complicaciones durante el evento. La misma asociación entre volumen y mejores resultados se encontró en la CABG aislada. CONCLUSIONES: Los hospitales del Sistema Nacional de Salud tienen un bajo volumen promedio de CABG. Se ha hallado una asociación entre mayor volumen y mejores resultados en la CABG total y aislada. Los hallazgos de este estudio aconsejan una mayor concentración de CABG y la publicación de los resultados ajustados a riesgo de la intervención coronaria
INTRODUCTION AND OBJECTIVES: To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. METHODS: We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMER) and 30-day readmissions (RARER) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. RESULTS: A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07 vs 4.96±1.76; P <.001) and a negative linear correlation between volume and RARR (r=−0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. CONCLUSIONS: The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention
Subject(s)
Humans , Middle Aged , Aged , Percutaneous Coronary Intervention/methods , Myocardial Revascularization/methods , Heart Diseases/surgery , Spain/epidemiology , Treatment Outcome , Hospital Mortality , Patient Readmission/statistics & numerical data , Retrospective Studies , Indicators of Morbidity and Mortality , Quality of Health Care/statistics & numerical data , Heart Diseases/complicationsABSTRACT
INTRODUCTION AND OBJECTIVES: To analyze the association between volume and outcomes in coronary artery bypass grafting (CABG) in the Spanish National Health System. METHODS: We analyzed CABG episodes from 2013 to 2015. The selected outcome variables were in-hospital mortality in the index episode, 30-day cardiac-related readmissions, and mortality during readmission. Risk-adjusted rates of in-hospital mortality (RAMR) and 30-day readmissions (RARR) were calculated using multilevel logistic regression. High- and low-volume hospitals for CABG were identified by a nonconditioned analysis (k-means) and by compliance with the volume recommendation of clinical practice guidelines. RESULTS: A total of 17 335 CABG index episodes were included, with a crude in-hospital mortality rate of 5.0%. Episodes attended in low-volume centers for CABG (< 155 CABG per year) showed 17% higher RAMR (5.81%±2.07% vs 4.96%±1.76%; P <.001) and a negative linear correlation between volume and RARR (r=-0.318; P=.029), as well as a higher percentage of complications during the episode. The same association between volume and more favorable outcomes was found in isolated CABG. CONCLUSIONS: The mean CABG volume is low in Spanish National Health System hospitals. Higher volume was associated with better outcomes in CABG, both total and isolated. The findings of this study indicate the need for a higher concentration of CABG programs, as well as the publication of risk-adjusted outcomes of coronary intervention.
