Zeitschrift für Kardiologie

, Volume 94, Issue 4, pp 231–238 | Cite as

The relationship between hospital or operator volume and outcomes of coronary patients undergoing percutaneous coronary interventions

  • A. Dibra
  • A. Kastrati
  • H. Schühlen
  • A. Schömig
REVIEW

Summary

The relationship between volume and outcome in medicine has been intensively investigated in the last few decades. The large amount of accumulated data demonstrates that for many surgical or non-surgical procedures and medical conditions, patients being treated in high-volume hospitals or by high-volume physicians have lower mortality rates and better quality of life compared to those treated by low-volume hospitals or by low-volume physicians. Although the degree of the relationship between high volume and better outcome varies, it is persistent across a wide range of procedures and conditions.

Percutaneous coronary interventions (PCIs) have an important impact on public health, given the frequency of coronary heart disease for which these procedures are performed. Studies carried out before and after the advent of stents on the relationship between volume and outcome for PCIs have almost consistently reported that performance of PCIs in high-volume institutions or by high-volume operators is associated with improved outcomes for patients, regardless of the specific indication for PCI.

For those procedures for which a relationship between high volume and better outcome has been clearly demonstrated, patients as well as their referring physicians should be informed that patients can benefit both in terms of reduced mortality and improved quality of life if they are treated by high-volume health care providers. Consequently, for these procedures, a health care policy aiming at their concentration in high-volume institutions should be strongly considered.

Key words

Experience outcome percutaneous coronary intervention 

Zusammenhang zwischen Leistungsvolumen eines Krankenhauses oder eines Untersuchers mit den Ergebnissen nach koronaren Katheterinterventionen

Zusammenfassung

Der Zusammenhang zwischen der Menge einer bestimmten medizinischen Leistung und der entsprechenden Komplikationsrate bezogen auf einen Arzt oder eine Klinik wurde in den letzten Jahrzehnten bereits intensiv untersucht. Vorliegende Daten zu vielen diagnostischen und therapeutischen Eingriffen zeigen, dass Patienten, die von Ärzten oder in Kliniken mit hohen Untersuchungs- oder Behandlungszahlen betreut werden, niedrigere Mortalitätsraten oder eine bessere Lebensqualität haben als jene Patienten, die von Ärzten oder in Kliniken mit niedrigeren Zahlen betreut werden. Obwohl die Ausprägung dieses Zusammenhangs zwischen Mengen und Komplikationsraten für verschiedene Prozeduren sehr unterschiedlich sein kann, ist er für eine Vielzahl von medizinischen Leistungen nachgewiesen worden.

Perkutane Koronarinterventionen (PCI) haben eine zentrale Bedeutung für das Gesundheitswesen, gemessen an der Häufigkeit der zugrunde liegenden koronaren Herzerkrankung und der entsprechenden Anzahl an PCIs pro Jahr. Mehrere Studien zu Behandlungszahlen und Komplikationsraten bei PCI haben vor und nach der Einführung der Koronarstents konsistent gezeigt, dass eine Therapie in Kliniken oder von Ärzten mit hohen Behandlungszahlen mit einer besseren Prognose assoziiert ist, unabhängig von der Indikation zur PCI.

Für jene Prozeduren, für die ein klarer Zusammenhang zwischen Untersuchungs- bzw. Behandlungszahlen und Prognose nachgewiesen wurde, sollten Patienten und zuweisende Ärzte entsprechend informiert werden, dass die Patienten von einer niedrigeren Mortalität oder besseren Lebensqualität profitieren könnten, wenn die Behandlung in einem Zentrum mit hohen Zahlen erfolgt. Entsprechend empfehlen sich Strategien für die Strukturierung des Gesundheitswesens, mit dem Ziel, diese Prozeduren auf Zentren mit hohen Behandlungszahlen zu konzentrieren.

Schlüsselwörter

Erfahrung Komplikationen Perkutane Koronarinterventionen 

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Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • A. Dibra
    • 1
  • A. Kastrati
    • 2
  • H. Schühlen
    • 3
  • A. Schömig
    • 4
  1. 1.Deutsches HerzzentrumMünchenGermany
  2. 2.Deutsches HerzzentrumMünchenGermany
  3. 3.1. Medizinische Klinik rechts der IsarMünchenGermany
  4. 4.Deutsches HerzzentrumMünchenGermany

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