[Volume and quality of care in coronary artery bypass grafting in Brazil].
There is often a negative association between the volume of medical procedures and hospital mortality rates. The objective of this study is to determine whether this association is observed in Brazilian hospitals performing coronary artery bypass grafts (CABG) that were financed by the Ministry of Health. CABG surgeries performed from 1996 to 1998 were analyzed. Data were collected from the Ministry of Health Hospital Information System. The statistical procedure utilized was the Cox survival analysis. Hospitals were grouped in classes of volume of CABG performed. The model was adjusted to the severity of cases (risk of dying). From January 1996 to December 1998 the Ministry of Health reimbursed 41,989 CABG procedures in 131 hospitals. The overall hospital mortality rate was 7.2%. A gradient was observed in the mortality rates. The severity-adjusted risk of dying in the group of hospitals performing more procedures was lower than in the group performing fewer operations. It is recommended that the Ministry of Health strongly consider regionalized concentration of services to perform CABG.
Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, 20550-900, Brasil. noronha@uerj.br
José Carvalho
JC
de Noronha
Claudia
C
Travassos
Mônica
M
Martins
Mônica R
MR
Campos
Paula
P
Maia
Rogério
R
Panezzuti
D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate