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Little Difference in Death Rates Seen in High Vs. Low Hospital Volume for Angioplasty
Among the findings, compared with low- and medium-volume centers, median (midpoint) DTB times were the lowest in high-volume centers (98 vs. 90 vs. 88 minutes, respectively). The proportion of patients meeting ACC/AHA guidelines of DTB time of 90 minutes or less was highest in the high-volume centers. Compared with high-volume hospitals, patients presenting to low-volume hospitals but not medium-volume hospitals were less likely to achieve a DTB time of 90 minutes or less.
Average (4.6 vs. 4.5 vs. 4.7 days) and median (3 days each) lengths of stay were similar between low-, medium-, and high-volume hospitals, respectively. High-volume centers were more likely than low-volume centers to follow evidence-based guidelines at discharge.
The researchers found that overall in-hospital mortality was 3.2 percent (incidence rate, 3.9 percent vs. 3.2 percent vs. 3.0 percent for low-, medium-, and high-volume centers, respectively), with analysis indicating no statistically significant difference between the three groups and the adjusted mortality.
"Our results, especially with respect to in-hospital mortality, are contrary to other published registry studies in patients with STEMI. One of the main differences is that our study reflects more contemporary practice. Angioplasty techniques and adjunctive pharmacotherapy have seen substantial improvements over the past few years, and there has been a significant standardization of these practices nationwide. In addition, evidence-based therapies are much more widely adopted and practiced," the authors write.
The authors add that one of the reasons their findings are important is that procedural volume is increasingly being used as a surrogate for quality of care. "Some organizations have set standards for urban hospitals to meet before they would contract the care of their employees with them. These include minimum volumes for several procedures including angioplasty. Our study makes a case against such volume criteria."
Source-Eurekalert
RAS
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