Comparison of percutaneous transluminal coronary angioplasty outcome and hospital costs for low-volume and high-volume operators

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Abstract

Whether higher operator case volume is associated with improved percutaneous transluminal coronary angioplasty (PTCA) clinical and cost outcomes is the subject of this study. Hospital volume-related improvement in clinical outcomes has been shown for coronary artery bypass grafting (CABG) and PTCA. Physician case volume-related differences in clinical outcomes have not been clearly demonstrated, and differences in hospital costs have not been examined. For clinical and cost outcomes, risk-adjusted analysis of differences in PTCA outcomes has not been reported. In addition, controversy exists about the appropriate annual case volume considered adequate to maintain skills and achieve optimal clinical outcomes in performing PTCA procedures. We studied 2,350 PTCAs performed between March 1, 1991, and February 28, 1994. Physicians were divided into 2 volume groups: high (≥50 cases/year) and low (<50 cases/year). The rate of emergency CABG after PTCA was 2.1% for high- and 3.9% for low-volume operators (p = 0.009). Hospital morbidity associated with PTCA was lower in high- than in low-volume operators (6.46% vs 10.73%, p < 0.001). The risk-adjusted ratios for emergency CABG and morbidity were 2.05 (p = 0.005) and 1.79 (p < 0.001), respectively. The length of stay averaged 4.07 ± 4.54 days for high- and 4.49 ± 4.33 days for low-volume operators (p = 0.003). Hospital costs averaged $7,977 ± $7,269 for high- and $8,278 ± $6,289 for low-volume operators (p = 0.065). The risk-adjusted ratio was 1.091 (p = 0.004) for length of stay and 1.050 (p = 0.029) for cost. Thus, PTCA performed by high-volume operators is significantly less likely to require emergency CABG and is also significantly associated with lower hospital morbidity, shorter hospital length of stay, and lower hospital costs.

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The results, analyses, and opinions reported herein are those of the authors and in no way reflect on the opinions or judgments of the hospital, the B.C. McCabe Foundation, or The Los Angeles Thoracic and Cardiovascular Foundation.

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Dr. Sun is partially supported by the B.C. McCabe Foundation, Whittier, California, and The Los Angeles Thoracic and Cardiovascular Foundation.

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