Comorbidity and outcomes of coronary artery bypass graft surgery at cardiac specialty hospitals versus general hospitals.
BACKGROUND
Cardiac specialty hospitals assert better patient outcomes and efficiency, whereas general hospitals contend they attract healthier patients.


OBJECTIVE
To ascertain whether increased cardiac specialization of a hospital's services is associated with improved outcomes for coronary artery bypass graft (CABG) surgery and whether patients with and without comorbid disease have equivalent outcomes to their counterparts at general hospitals.


METHODS
We conducted a retrospective cohort study of a 5% sample of Medicare beneficiaries undergoing CABG procedures from 2001 to 2003. Using multivariate analyses, we assessed the hospital degree of cardiac specialization on mortality, length of stay, hospital readmissions, and emergency room visits leading to rehospitalization for all patients and those with more comorbidities.


RESULTS
Patients at cardiac specialty hospitals had less comorbid disease (29.7% with Charlson scores > or =2) than those at moderately (37.2%) and least specialized hospitals (36.6%, P = 0.001). Overall, CABG outcomes in all 3 groups were similar for inpatient mortality (P = 0.78), 30-day postdischarge mortality (P = 0.69), emergency room visit leading to rehospitalization (P = 0.35), and hospital readmission within 30 days postdischarge (P = 0.70). However, for patients with greater comorbidity, 30-day postdischarge mortality was worse at cardiac specialty hospitals compared with least specialized hospitals from across the United States (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32; P = 0.001). Results were robust when hospitals were compared within metropolitan statistical areas.


CONCLUSIONS
Favorable patient selection may occur at cardiac specialty hospitals. Although healthier patients fare comparably across types of hospitals, patients with greater comorbid disease seem to experience worse 30-day postdischarge mortality at specialty hospitals.
Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. cwhwang@jhmi.edu
Constance W
CW
Hwang
Gerard F
GF
Anderson
Marie
M
Diener-West
Neil R
NR
Powe
D000368:Aged; D000369:Aged, 80 and over; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data*; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006769:Hospitals, General / Q000706:statistics & numerical data*; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome