(Stroke. 1998;29:2292-2297.)
© 1998 American Heart Association, Inc.
Original Contributions |
Relationship Between Provider Volume and Mortality for Carotid Endarterectomies in New York State
From the Department of Health Policy, Management, and Behavior, State University of New York, University at Albany School of Public Health (E.L.H.), and the Divisions of Neurosurgery (A.J.P., B.T., P.F., J.W.) and General Surgery (D.S.), Department of Surgery, Albany Medical College, Albany, NY.
Correspondence to Edward L. Hannan, PhD, Professor and Chair, Department of Health Policy, Management, and Behavior, SUNY-Albany School of Public Health, One University Place, Rensselaer, NY 12144. E-mail elh03{at}albnydh2.health.state.ny.us
Background and Purpose—The objective of this study was to assess the relationship between each of 2 provider volume measures for carotid endarterectomies (CEs) (annual hospital volume and annual surgeon volume) and in-hospital mortality. New York's Statewide Planning and Research (SPARCS) administrative database was used to identify all 28 207 patients for whom carotid endarterectomy was the principal procedure performed in New York State hospitals between January 1, 1990, and December 31, 1995.
Methods—A statistical model was developed to predict in-hospital mortality using age, admission status, and several conditions found to be associated with higher-than-average mortality. This model was then used to calculate risk-adjusted mortality rates for various intersections of hospital and surgeon volume ranges.
Results—Risk-adjusted in-hospital mortality ranged from 1.96%
(95%confidence interval, 1.47 to 2.57) for patients having surgeons
with annual CE volumes of <5 in hospitals with annual CE volumes of
100 to 0.94% (95% confidence interval, 0.73 to 1.19) for patients
having surgeons with annual volumes of 
5 in hospitals with annual CE
volumes of >100. These 2 rates were statistically different.
Conclusions—We conclude that the in-hospital mortality rates for
carotid endarterectomies performed by surgeons with extremely low
annual volumes (<5) and for hospitals with low volumes (100) are
significantly higher than the in-hospital rates of higher-volume
surgeons and hospitals, even after taking preprocedural patient
severity of illness into account.
Key Words: carotid endarterectomy • models, statistical • mortality • quality of health care
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