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 objectives were (1) to identify clinical variables associated with IABP use, and (2) to examine risk-adjusted rates of IABP use for 12 Massachusetts hospitals performing CABG operations.


METHODS
We used hospital discharge data to identify 6944 CABG surgical cases. Logistic regression was used to identify clinical variables associated with IABP use, and the resulting multivariate model was then used to risk adjust hospital rates of IABP use.


RESULTS
The IABP was used in 13.4% of the CABG surgical cases. The clinical variables independently associated with IABP use were cardiogenic shock, same admission angioplasty, prior CABG operation, cardiac arrest, congestive heart failure, recent myocardial infarction, and urgent admission status. Risk-adjusted rates of IABP use varied widely across hospitals from 7.8% to 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 regarding the precise clinical indications for the IABP in this patient population.
Ghali
W A
WA
Evans Department of Medicine, Boston University School of Medicine, Massachusetts, USA. wghali@ucalgary.ca
Ash
A S
AS
Hall
R E
RE
Moskowitz
M A
MA
D000368:Aged; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment