US RESEARCH: Patients who undergo heart bypass surgery in high-volume hospitals have better outcomes, according to research published yesterday. Dr Muiris Houston, Medical Correspondent, reports.
A study of more than 57,000 bypass patients in New York found that those undergoing routine bypass surgery in hospitals performing at least 200 bypass procedures a year had a 47 per cent lower death rate, compared with those treated at hospitals where fewer than 200 procedures are performed annually.
These significant results reinforce the findings of the Hanly report, which has recommended the health services be reorganised around a core spine of high-volume hospitals. Both Hanly and the Hollywood report on radiotherapy services have come out strongly in favour of the concept of fewer hospitals treating larger volumes of patients to achieve better outcomes.
In addition, The Irish Times reported on a National Cancer Forum document last week which said: "The current arrangements for the delivery of cancer services cannot be recommended to deliver best quality cancer care." It added that there was "insufficient case volume to support the number of consultants and hospitals engaged in oncology surgery".
The document questioned whether geographical considerations were being allowed to compromise the type of care suggested by international best practice.
The US research, published yesterday in the Journal of the American Heart Association, also found that patients treated by surgeons who perform at least 125 procedures per year at high-volume hospitals had a 47 per cent lower risk of death. "For all patients, not just those at high risk of mortality, high-volume providers - both hospitals and surgeons - are associated with a lower risk of death," said lead author Dr Chuntao Wu, assistant professor of epidemiology in the School of Public Health at the State University of New York.
Previous studies on outcomes for bypass surgery had found that the benefit of high-volume hospitals is limited to high-risk patients. "Our findings support applying a volume-based referral to all bypass patients and not just those at high risk," Dr Wu said.
It is estimated that 800 open heart procedures are carried out at the Mater Hospital's cardiothoracic unit each year. The unit in St James's performs about 600 procedures, with Cork University Hospital carrying out 500 each year. The Blackrock Clinic and Mater Private Hospital perform about 1,100 open heart procedures between them. These figures put the State's cardiac surgery units well above the threshold of 200 cardiac bypasses a year, suggested by yesterday's research.
However, in a comment that will encourage those opposed to the centralisation of specialist hospital services, Dr Wu and his colleagues said it would be better to improve the quality of care at all hospitals than to send bypass patients to high-volume medical centres. They note that a volume-based referral could increase the travel difficulties and expenses for many patients.
"Thus, it is preferable to improve outcomes by identifying processes of care associated with superior outcomes and implementing these processes in both high-volume and low-volume hospitals rather than to refer all patients to high-volume centres," Dr Wu said.
The US research found that, overall, 2 per cent of cardiac bypass patients died in hospital, with older people and women at greatest risk of post-operative death.