RELATIONSHIP BETWEEN PHYSICIAN AND HOSPITAL CORONARY ANGIOPLASTY VOLUME AND OUTCOME IN ELDERLY PATIENTS

Background With the expectation that physicians who perform larger num bers of coronary angioplasty procedures will have better outcomes, the American College of Cardiology/American Heart Association guidelines recommend minimum physician volumes of 75 procedures per year. However , there is little empirical data to support this recommendation. Metho ds and Results We examined in-hospital bypass surgery and death after angioplasty according to 1992 physician and hospital Medicare procedur e volume. In 1992, 6115 physicians performed angioplasty on 97 478 Med icare patients at 984 hospitals. The median numbers of procedures perf ormed per physician and per hospital were 13 (interquartile range, 5 t o 25) and 98 (interquartile range, 40 to 181), respectively. With the assumption that Medicare patients composed one half to one third of al l patients undergoing angioplasty, these median values are consistent with an overall physician volume of 26 to 39 cases per year and an ove rall hospital volume of 196 to 294 cases per year. After adjusting for age, sex, race, acute myocardial infarction, and comorbidity, low-vol ume physicians were associated with higher rates of bypass surgery (P< .001) and low-volume hospitals were associated with higher rates of by pass surgery and death (P<.001). Improving outcomes were seen up to th reshold values of 75 Medicare cases per physician and 200 Medicare cas es per hospital. Conclusions More than 50% of physicians and 25% of ho spitals performing coronary angioplasty in 1992 were unlikely to have met the minimum volume guidelines first published in 1988, and these p atients had worse outcomes. While more recent data are required to det ermine whether the same relationships persist after the introduction o f newer technologies, this study suggests that adherence to minimum vo lume standards by physicians and hospitals will lead to better outcome s for elderly patients undergoing coronary angioplasty.