+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Comorbidity and outcomes of coronary artery bypass graft surgery at cardiac specialty hospitals versus general hospitals

Comorbidity and outcomes of coronary artery bypass graft surgery at cardiac specialty hospitals versus general hospitals

Medical Care 45(8): 720-728

Cardiac specialty hospitals assert better patient outcomes and efficiency, whereas general hospitals contend they attract healthier patients. To ascertain whether increased cardiac specialization of a hospital's services is associated with improved outcomes for coronary artery bypass graft (CABG) surgery and whether patients with and without comorbid disease have equivalent outcomes to their counterparts at general hospitals. We conducted a retrospective cohort study of a 5% sample of Medicare beneficiaries undergoing CABG procedures from 2001 to 2003. Using multivariate analyses, we assessed the hospital degree of cardiac specialization on mortality, length of stay, hospital readmissions, and emergency room visits leading to rehospitalization for all patients and those with more comorbidities. Patients at cardiac specialty hospitals had less comorbid disease (29.7% with Charlson scores > or =2) than those at moderately (37.2%) and least specialized hospitals (36.6%, P = 0.001). Overall, CABG outcomes in all 3 groups were similar for inpatient mortality (P = 0.78), 30-day postdischarge mortality (P = 0.69), emergency room visit leading to rehospitalization (P = 0.35), and hospital readmission within 30 days postdischarge (P = 0.70). However, for patients with greater comorbidity, 30-day postdischarge mortality was worse at cardiac specialty hospitals compared with least specialized hospitals from across the United States (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32; P = 0.001). Results were robust when hospitals were compared within metropolitan statistical areas. Favorable patient selection may occur at cardiac specialty hospitals. Although healthier patients fare comparably across types of hospitals, patients with greater comorbid disease seem to experience worse 30-day postdischarge mortality at specialty hospitals.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 052206291

Download citation: RISBibTeXText

PMID: 17667305

DOI: 10.1097/mlr.0b013e3180537192

Related references

Comorbidity and Outcomes of Coronary Artery Bypass Graft Surgery at Cardiac Specialty Hospitals versus General Hospitals. Medical Care 45(8): 720-728, 2007

Longitudinal comparison of outcomes for coronary artery bypass surgery at University Hospitals, managed care hospitals and other hospitals in California. Circulation 92(8 SUPPL ): I119, 1995

Acute myocardial infarction and coronary artery bypass grafting outcomes in specialty and general hospitals: analysis of state inpatient data. Health Services Research 45(1): 62-78, 2010

In-hospital outcomes of primary percutaneous coronary interventions performed at hospitals with and without on-site coronary artery bypass graft surgery. Circulation Journal 71(8): 1208-1212, 2007

Outcomes of concomitant aortic valve replacement and coronary artery bypass grafting at teaching hospitals versus nonteaching hospitals. Journal of Thoracic and Cardiovascular Surgery 143(3): 648-655, 2012

Outcomes for patients with ST-elevation myocardial infarction in hospitals with and without onsite coronary artery bypass graft surgery: the New York State experience. Circulation. Cardiovascular Interventions 2(6): 519-527, 2010

Coronary revascularization at specialty cardiac hospitals and peer general hospitals in black Medicare beneficiaries. Circulation. Cardiovascular Quality and Outcomes 1(2): 116-122, 2010

Treatment of Coronary Artery Disease and Acute Myocardial Infarction in Hospitals With and Without On-Site Coronary Artery Bypass Graft Surgery. Circulation. Cardiovascular Interventions 12(1): E007097-E007097, 2019

Impact of diabetes on 12-month outcomes following coronary artery bypass graft surgery Results from the routine versus selective exercise treadmill testing after coronary artery bypass grafting Registry. Journal of the American College of Cardiology 43(5 Suppl. A): 268A, March 3, 2004

Differences in mortality from coronary artery bypass graft surgery at five teaching hospitals. JAMA 266(6): 810-815, 1991

The future of specialty hospitals, and lying-in hospitals in particular. Hospitals with specialized interests, if not merged into general hospitals, must affiliate closely with other hospitals in ambulatory, diagnostic, special care, and emergency room services. Rhode Island Medical Journal 49(1): 47-50, 1966

Preoperative correlates of the cost of coronary artery bypass graft surgery: comparison of results from three hospitals. American Journal of Medical Quality 16(3): 87-92, 2001

Impact of Medicare's payment policy on mediastinitis following coronary artery bypass graft surgery in US hospitals. Infection Control and Hospital Epidemiology 35(2): 144-151, 2014

How Pennsylvania hospitals have responded to publicly released reports on coronary artery bypass graft surgery. Joint Commission Journal on Quality Improvement 24(1): 40-49, 1998

Clinical profiles of patients undergoing off-pump coronary artery bypass graft surgery: The california coronary artery bypass graft surgery outcomes reporting program. 2007