Low-Risk Bypass Patients Do Well in Smaller Hospitals

A new study shows that patients who need bypass surgery and are in overall good health do just as well in a small hospital that performs less than 200 bypass procedures a year, but that moderate- and high-risk patients should seek out a major medical center whose surgical teams do many hundreds of bypasses a year. Conducted by researchers at the University of Michigan Health System (Ann Arbor, USA), the study was published in the December 2001 issue of the Journal of the American College of Cardiology.

The researchers reviewed data on 13,644 patients over the age of 35 who had non-emergency coronary artery bypass grafts at 56 US hospitals. The cutoff point that separated low-volume hospitals from high-volume hospitals was 200 procedures. Based on age, gender, the severity of disease, and other health risks, the patients were assigned a minimal, low, moderate, high, or severe risk of dying during surgery or in the hospital. In all, 2,029 patients had their operations at one of 25 hospitals performing fewer than 200 bypasses in 1997, while the other 11,615 went to 31 hospitals that performed 200 or more procedures that year.

Those patients whose risk was minimal or low did as well at the low-volume hospitals as at the high-volume ones. However, those with moderate or high risk were about twice as likely to die in the hospital if they had their operations at low-volume hospitals. The results were inconclusive as to those patients with severe risk, whose survival was about the same at both types of hospital. The new study challenges the perception, bolstered by several studies in recent years, that all bypass surgery patients will have the best outcome at a major medical center that annually handles a large volume of bypass procedures.

"While higher-risk patients should find the most experienced team they can, those with low risk can rest assured that a smaller hospital closer to home can care for them very well, with similar costs and time in the hospital,” said Kim Eagle, M.D., professor of internal medicine and senior author of the study.




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