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Quality Care, Not Number of Procedures, Determines Bypass Results
As the number of heart surgeries has declined, so has death rate, study finds
By Steven Reinberg
HealthDay Reporter
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TUESDAY, April 22 (HealthDay News) -- Hospitals that perform fewer cardiac bypass operations don't have more deaths following the procedure than hospitals that handle a greater number of bypasses, a new study says.
This finding contradicts conventional wisdom, which has assumed that hospitals that do more cardiac bypass operations have better results, with fewer patient deaths.
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"Volume isn't the key ingredient or the driving force behind outcomes," said lead researcher Dr. Rocco Ricciardi, of the Lahey Clinic and Tufts University School of Medicine, in Massachusetts.
"We found over a long period of time that outcomes improved across the country no matter where you seek care," Ricciardi added. "It's been a gradual reduction in the number of coronary artery bypass graft cases performed because of the growth of less invasive techniques," such as angioplasty.
The study findings are published in the April issue of the Archives of Surgery.
In patients with coronary disease, the arteries that supply blood and oxygen to the heart become hardened and narrowed. If lifestyle modifications and medicines don't help, a doctor may recommend coronary artery bypass surgery (CABG). Surgeons take a piece of a vein from the leg or artery from the chest or wrist, and attach it to the coronary artery above and below the narrowed area or blockage. This allows blood to bypass the blockage, according to the U.S. National Library of Medicine.
For the study, Ricciardi and his colleagues collected data on 108,087,386 people admitted to U.S. hospitals from 1988 to 2003. Among these patients, 1,082,218 underwent cardiac bypass surgery.
Over the course of the 16-year study period, the rate of cardiac bypass surgeries increased from 7.2 cases per 1,000 patients in 1988 to 12.2 cases per 1,000 patients in 1997, before dropping back to 9.1 per 1,000 patients by 2003. During that same time span, the number of angioplasties tripled.
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Copyright © 2008 ScoutNews, LLC. All rights reserved.
Last updated 4/22/2008
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SOURCES: Rocco Ricciardi, M.D., Lahey Clinic, Burlington, Mass., and Tufts University School of Medicine, Boston; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Samin Sharma, M.D., director of interventional cardiology, Mount Sinai Medical Center, New York City; April 2008 Archives of Surgery
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