Research Activities, July 2012: Feature Story: High-volume hospitals have low rates of adverse events for high-risk surgeries

Research Activities, July 2012: Feature Story: High-volume hospitals have low rates of adverse events for high-risk surgeries

High-volume hospitals have low rates of adverse events for high-risk surgeries

Several surgical procedures, such as heart and gastric bypass surgeries and abdominal aortic aneurysm repair, have lower mortality and better outcomes if they are performed at hospitals that conduct a high volume of such procedures. Do these hospitals also have lower rates of surgical adverse events for these procedures as well? A new study suggests the answer is "yes." It found that high-volume hospitals had significantly lower rates of adverse events compared to low-volume hospitals.
Researchers collected data from the Nationwide Inpatient Sample discharge database from 2005 through 2008. Patients undergoing one of the three procedures were categorized according to their type of hospital: high-, mid-, or low-volume. A set of patient safety indicators (PSIs), established by the Agency for Healthcare Research and Quality (AHRQ), were used to determine the occurrence of surgical adverse events.
Patients undergoing surgery for abdominal aneurysm at high-volume hospitals had lower rates for a number of PSIs compared to patients at low-volume hospitals. These included lower rates of sepsis, blood clots, and bloodstream infections. In similar fashion, patients undergoing heart bypass surgery at high-volume hospitals experienced lower rates of in-hospital death, bloodstream infections, postoperative hemorrhage, postoperative respiratory failure, and other adverse events. Patients undergoing gastric bypass surgery at high-volume hospitals had lower rates on all PSIs except for sepsis, for which mid-volume hospitals had lower rates. Overall, low-volume hospitals had four times more gastric bypass adverse events compared to high-volume hospitals. The study was supported in part by AHRQ (HS18558).
See "Relationship between patient safety and hospital surgical volume," by Tina Hernandez-Boussard, Ph.D., M.P.H., John R. Downey, M.D., M.P.H., Kathryn McDonald, M.S., and John M. Morton, M.D., M.P.H., in the April 2012 Health Services Research 47(2), pp. 756-769.