Effect of hospital volume on in-hospital mortality for renal artery bypass.
BACKGROUND
A recent report determined that the nationwide mortality for renal artery bypass (RAB) is surprisingly high-10%. We hypothesized that operative mortality for RAB is related to the volume of such operations performed in each center.


METHODS
The Nationwide Inpatient Sample was analyzed to identify patients undergoing RAB for the years 2000-2005. In-hospital mortality for RAB was compared between hospitals.


RESULTS
During the study period, RAB was performed on 7413 patients with an overall in-hospital mortality of 9.6%. The multivariate logistic regression analyses revealed that after adjusting for surgical risk, increasing hospital volume was significantly associated with decreased in-hospital mortality for RAB (odds ratio 0.98; 95% confidence interval, 0.96-0.99; P=.015).


CONCLUSIONS
Patient risk profile and hospital volume are critical determinants of in-hospital mortality for RAB, which should be factored into decision making for patients requiring intervention for renovascular disease.
Modrall
J Gregory
JG
Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas Veterans Affairs Medical Center, Dallas, Texas 75390, USA. greg.modrall@utsouthwestern.edu
Rosero
Eric B
EB
Smith
Stephen T
ST
Arko
Frank R
FR
Valentine
R James
RJ
Clagett
G Patrick
GP
Timaran
Carlos H
CH
D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D019992:Databases as Topic; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D018579:Patient Selection; D012078:Renal Artery Obstruction / Q000401:mortality* / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data*