Variation in hospital rates of intraaortic balloon pump use in coronary artery bypass operations

Background. Little is known about regional patterns of intraaortic balloon pump (IABP) use in coronary artery bypass graft (CABG) operations. Our obje ctives were (1) to identify clinical variables associated with IABP use, an d (2) to examine risk-adjusted rates of IABP use or 12 Massachusetts hospit als performing CABG operations. Methods. We used hospital discharge data to identify 6944 CABG surgical cas es. Logistic regression was used to identify clinical variables associated with IABP use, and the resulting multivariate model was then used to risk a djust hospital rates of IABP use. Results. The IABP was used in 13.4% of the CABG surgical cases. The clinica l variables independently associated with IABP use were cardiogenic shock, same admission angioplasty, prior CABG operation, cardiac arrest, congestiv e heart failure, recent myocardial infarction, and urgent admission status. Risk-adjusted rates of IABP use varied widely across hospitals from 7.8% t o 20.8% (p < 0.0001). Conclusions. Hospital rates of IABP use vary considerably in Massachusetts. This practice variation may be related to the persistent uncertainty regar ding the precise clinical indications for the IABP in this patient populati on. (C) 1999 by The Society of Thoracic Surgeons.