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 (kappa50 cases/year) and low (<50 cases/year).
The rate of emergency CABG after PTCA was 2.1% for high-and 3.9% r 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 rhô 4.54 days for high-and 4.49 rhô 4.33 days for low-volume operators (p=0.003).
Hospital costs averaged $7,977 rhô $7,269 for high-and $8,278 rhô $6,289 for low-volume operators (p=0.065).
Mots-clés Pascal : Dilatation instrumentale, Artère coronaire, Voie percutanée, Coût, Hospitalisation, Economie santé, Durée, Qualité, Soin, Santé, Quantité, Etude comparative, Traitement, Evolution, Homme, Traitement instrumental, Santé publique
Mots-clés Pascal anglais : Instrumental dilatation, Coronary artery, Percutaneous route, Costs, Hospitalization, Health economy, Duration, Quality, Care, Health, Quantity, Comparative study, Treatment, Evolution, Human, Instrumentation therapy
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Cote : 96-0143023
Code Inist : 002B26E. Création : 199608.