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General Thoracic and Cardiovascular Surgery

, Volume 55, Issue 12, pp 483–492 | Cite as

An attempt to analyze the relation between hospital surgical volume and clinical outcome

  • Committee for Scientific Affairs
  • Teruhisa Kazui
  • Hiroaki Osada
  • Hiromasa Fujita
ORIGINAL ARTICLE

Abstract

Objectives

The aim of this study was to investigate the relation between hospital volume and clinical surgical outcome for 10 cardiac, lung, and esophageal surgical procedures.

Methods

The Committee for Scientific Affairs of the Japanese Association for Thoracic Surgery collected the pooled data on cardiac, lung, and esophageal surgical procedures between 2000 and 2004 from the annual reports. The relation between operative mortality (30-day or in-hospital mortality) and hospital volume was analyzed using a logistic regression model. The surgical procedures studied were surgery for acquired cardiac diseases [coronary artery bypass grafting (CABG), valve procedures, acute type A dissection surgery], total CABG (elective + emergency), elective CABG, emergency CABG, single-valve surgery, acute type A dissection surgery, open heart surgery for the newborn, open heart surgery for the infants, lung cancer surgery, and esophageal cancer surgery. The data used in this study were not risk-adjusted.

Results

The data on the relation between hospital volume and operative mortality generally tended to show an inverse correlation for all 10 cardiac, lung, and esophageal surgical procedures; that is, the higher was the volume the lower was the mortality. However, wide variations in operative mortality were noted among the very-low-volume hospital groups.

Conclusion

An inverse correlation was noted between hospital volume and operative mortality in the present study, although wide variations in clinical outcome were noted among the very low-volume hospitals. Further analysis is warranted using risk-adjusted data.

Key words

Hospital volume Clinical outcome Cardiac surgery Lung cancer surgery Esophageal cancer surgery 

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References

  1. 1.
    Luft, HS, Bunker, JP, Enthoven, AC 1979Should operations be regionalized? The empirical relation between surgical volume and mortalityN Engl J Med30113649PubMedCrossRefGoogle Scholar
  2. 2.
    Luft, HS 1980The relation between surgical volume and mortality: an exploration of causal factors and alternative modelsMed Care1894059PubMedCrossRefGoogle Scholar
  3. 3.
    Begg, CB, Crammer, LD, Hoskins, WJ, Brennan, MF 1998Impact of hospital volume on operative mortality for major cancer surgeryJAMA280174751PubMedCrossRefGoogle Scholar
  4. 4.
    Birkmeyer, JD, Siewers, AE, Finlayson, EVA, Stukel, TA 2002Hospital volume and surgical mortality in the United StatesN Engl J Med346112838PubMedCrossRefGoogle Scholar
  5. 5.
    Cowan, JA,Jr, Dimick, JB, Henke, PK, Huber, TS, Stanley, JC, Upchurch, GR,Jr 2003Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomesJ Vasc Surg37116974PubMedCrossRefGoogle Scholar
  6. 6.
    Halm, EA, Lee, C, Chassin, MR 2002Is volume related to outcome in health care? A systematic review and methodologic critique of the literatureAnn Intern Med13751120Review: summary for patients in: Ann Intern Med 2002;137(6):I52PubMedGoogle Scholar
  7. 7.
    Birkmeyer, JD, Stukel, TA, Siewers, AE, Goodney, PP, Wennberg, DE, Lucas, FL 2003Surgeon volume and operative mortality in the United StatesN Engl J Med349211727PubMedCrossRefGoogle Scholar
  8. 8.
    El, Hannan, Radzyner, M, Rubin, D, Dougherty, J, Brennan, M 2002The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy and lung lobectomy in patients with cancerSurgery131615CrossRefGoogle Scholar
  9. 9.
    Metzger, R, Bollschweiler, E, Vallbohmer, D, Maish, M, DeMeester, TR, Holscher, AH 2004High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality?Dis. Esophagus173104PubMedCrossRefGoogle Scholar
  10. 10.
    Zacharias, A, Schwann, TA, Riordan, CJ, Durham, SJ, Shah, A, Papadimos, TJ,  et al. 2005Is hospital procedure volume a reliable marker of quality for coronary artery bypass surgery? A comparison of risk and propensity adjusted operative and midterm outcomesAnn Thorac Surg7919619PubMedCrossRefGoogle Scholar
  11. 11.
    Treasure, T, Utley, M, Baily, A 2003Assessment of whether in-hospital mortality for lobectomy is a useful standard for quality of lung cancer surgery: retrospective studyBMJ327735PubMedCrossRefGoogle Scholar
  12. 12.
    Dudley, RA, Johansen, KL, Brand, R, Rennie, DJ, Milstein, A 2000Selective referral to high-volume hospitals: estimating potentially avoidable deathsJAMA283115966PubMedCrossRefGoogle Scholar
  13. 13.
    Nishida, H, Yoshida, E 2005Suggestions from non-pandering governmental health care policy groups: across-the-board 30% cut of surgeon's fee according to number of operation-pandering fool and disguised health care cost-cutting policy under fiscal crisisCardiovasc Med Surg741729Google Scholar
  14. 14.
    Osada, H, Yamakoshi, E 2007Hospital volume and surgical outcome: lung cancer in JapanGen Thorac Cardiovasc Surg553605PubMedCrossRefGoogle Scholar
  15. 15.
    Hatori S, Yanagawa T. Martel-Haenszel projection method estimator for sparse data. Presented at the International Biometric Conference, Montreal, July 2006Google Scholar
  16. 16.
    Liang, KY, Zeger, SL 1986Longitudinal data analysis using generalized linear modelsBiometrika731322CrossRefGoogle Scholar
  17. 17.
    Wada, J, Nakajima, H 1987Current status of thoracic and cardiovascular surgery in Japan 1964, 1965 National Database AnalysisJpn J Thorac Cardiovasc Surg359189Google Scholar
  18. 18.
    Yasui, H, Osada, H, Ando, U, Koyanagi, H 1988Thoracic and cardiovascular surgery in Japan during 1996: annual report by the Japanese Association for Thoracic SurgeryJpn J Thorac Cardiovasc Surg4640620Google Scholar
  19. 19.
    Yasuda, K, Ayabe, H, Ide, H, Yasui, H 2002Thoracic and cardiovascular surgery in Japan during 2000: annual report by the Japanese Association for Thoracic SurgeryJpn J Thorac Cardiovasc Surg50398412Google Scholar
  20. 20.
    Yada, I, Wada, H, Shinoda, M, Yasuda, K 2003Thoracic and cardiovascular surgery in Japan during 2001: annual report of the Japanese Association for Thoracic SurgeryJpn J Thorac Cardiovasc Surg51699716PubMedCrossRefGoogle Scholar
  21. 21.
    Yada, I, Wada, H, Fujita, H 2004Thoracic and cardiovascular surgery in Japan during 2002: annual report of the Japanese Association for Thoracic SurgeryJpn J Thorac Cardiovasc Surg52491508Google Scholar
  22. 22.
    Kazui, T, Wada, H, Fujita, H 2005Thoracic and cardiovascular surgery in Japan during 2003: annual report of the Japanese Association for Thoracic SurgeryJpn J Thorac Cardiovasc Surg5351736PubMedCrossRefGoogle Scholar
  23. 23.
    Kazui, T, Osada, H, Fujita, H 2006Thoracic and cardiovascular surgery in Japan during 2004: annual report by the Japanese Association for Thoracic SurgeryJpn J Thorac Cardiovasc Surg5436386PubMedCrossRefGoogle Scholar
  24. 24.
    Shroyer, ALW, Coombs, LP, Eric, D, Peterson, ED, Eiken, MC, DeLong, ER,  et al. 2003The Society of Thoracic Surgeons: 30-day operative mortality and morbidity risk modelsAnn Thorac Surg75185665PubMedCrossRefGoogle Scholar
  25. 25.
    STS Adult CV Surgery National Database—Spring 2006 Executive Summer Contents, STS Spring 2006 ReportGoogle Scholar
  26. 26.
    Trimarchi, S, Nienaber, CA, Rampoldi, V, Myrmel, T, Suzuki, T, Mehta, RH,  et al. 2005Contemporary results of surgery in acute type A aortic dissection experienceJ Thorac Cardiovasc Surg12911222PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2007

Authors and Affiliations

  • Committee for Scientific Affairs
    • 1
  • Teruhisa Kazui
    • 1
  • Hiroaki Osada
    • 2
  • Hiromasa Fujita
    • 3
  1. 1.First Department of SurgeryHamamatsu University School of MedicineHamamatsuJapan
  2. 2.Department of Surgery, Division of Chest SurgerySt. Marianna University School of MedicineKawasakiJapan
  3. 3.Department of SurgeryKurume University School of MedicineFukuokaJapan

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