Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun;51(6):518-529.
doi: 10.4070/kcj.2020.0443. Epub 2021 Mar 2.

Hospital Case Volume, Health Care Providers, and Mortality in Patients Undergoing Coronary Artery Bypass Grafting: a Nationwide Cohort Study in South Korea

Tak Kyu Oh  1 , In Ae Song  2
Affiliations

Hospital Case Volume, Health Care Providers, and Mortality in Patients Undergoing Coronary Artery Bypass Grafting: a Nationwide Cohort Study in South Korea

Tak Kyu Oh et al. Korean Circ J. 2021 Jun.

Abstract

Background and objectives: Surgical quality is evaluated by measuring the annual hospital case volume; a higher case volume is associated with better survival after various surgeries. We aimed to investigate if the annual hospital case volume and the health care providers were associated with a 90-day mortality after coronary artery bypass grafting (CABG).

Methods: For this population-based cohort study, we used data from a National Health Insurance Service database in South Korea. We included all adult patients diagnosed with ischemic heart disease who underwent isolated CABG between January 2012 and December 2017. Data on the annual surgical volume for CABG in each hospital where the patients received CABG and the total number of health care providers (including physicians [trainees and specialists] from all department of the hospitals, nurses, and pharmacists) were collected.

Results: The final analysis included 15,790 adult patients; of these, 1,039 (6.6%) died within 90 days. The annual CABG volume was divided into 4 groups (Q1: ≤33, Q2: 34-86, Q3: 87-223, and Q4: ≥224). Multivariable Cox regression analysis revealed that the 90-day mortality rates in the Q4, Q3, Q2 groups were 75%, 32%, and 31% lower than that in the Q1 group, respectively. Additionally, an increase in the ratio of the total number of specialist physicians to 100 hospital beds was associated with a 4% decrease in the 90-day mortality after CABG.

Conclusion: Both, a higher annual hospital case volume and overall specialist physician volume were associated with better 90-day mortality rates after isolated CABG.

Keywords: Coronary artery bypass; General surgery; Mortality; Population; Safety.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Flowchart of the study design.
CABG = coronary artery bypass grafting; IHD = ischemic heart disease.
Figure 2
Figure 2. Analysis of survival after isolated CABG surgery according to the annual case-volume of hospital. The plot of survival probability after CABG was derived from a multivariable Cox regression model.
CABG = coronary artery bypass grafting.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia A. Epidemiology of coronary heart disease and acute coronary syndrome. Ann Transl Med. 2016;4:256. - PMC - PubMed
    1. Epstein AJ, Polsky D, Yang F, Yang L, Groeneveld PW. Coronary revascularization trends in the United States, 2001-2008. JAMA. 2011;305:1769–1776. - PMC - PubMed
    1. Head SJ, Milojevic M, Daemen J, et al. Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data. Lancet. 2018;391:939–948. - PubMed
    1. Alexander JH, Smith PK. Coronary-artery bypass grafting. N Engl J Med. 2016;374:1954–1964. - PubMed
    1. Adelborg K, Horváth-Puhó E, Schmidt M, et al. Thirty-year mortality after coronary artery bypass graft surgery: a Danish nationwide population-based cohort study. Circ Cardiovasc Qual Outcomes. 2017;10:e002708. - PubMed

LinkOut - more resources