Choosing a high volume heart hospital could save your life

123 out of 128 studies involving 40 different procedures found lower mortality at high volume hospitals

U.S. News & World Report
Advertorial Insert
May 6, 2002

Coronary artery bypass. Abdominal aortic aneurysm repair. Heart valve replacement. When faced with these or other procedures, choosing the right hospital is just as critical as choosing the right physician. How do you choose the hospital that offers the best opportunity for good outcomes? Guidelines recently published and supported by a leading health care patient safety advocacy group and the medical community serve as a valuable tool to evaluate heart programs.

Volume is key criteria

If every state published mortality rates for heart care procedures, choosing a hospital would be easy and straightforward. However, this information is not available for most procedures, so other factors need to be considered. In the absence of mortality data, there is one criteria strongly linked to better outcomes: volume. High volume, which refers to the number of times a procedure is performed each year, has been linked to better outcomes for cardiovascular surgery and other procedures in over 100 studies.

According to an article recently published in the New England Journal of Medicine, 123 out of 128 studies involving 40 different procedures found lower mortality at high volume hospitals. The physician authors of the article conclude, "... most patients facing...surgery have no way of knowing the relative quality of the hospitals near them. In the absence of other information...patients undergoing selected cardiovascular or cancer procedures can significantly reduce their risk of operative death by selecting a high volume hospital."

The Leapfrog Group, a national patient safety advocacy group, has gone so far as to use this data to establish minimum volume criteria for 10 specific procedures. For example, the group recommends that referrals for coronary artery bypass should be made only to hospitals that meet or exceed the standard of performing greater than 500 bypass surgeries a year. The group's standards are utilized by over 100 Fortune 500 companies in an effort to improve patient outcomes.

In 2000, Aurora St. Luke's Medical Center performed 10,261 cardiac procedures - more than three times the number at any other hospital in the Milwaukee area. In fact, St. Luke's exceeded The Leapfrog Group's volume standards for the three cardiac procedures for which criteria were established, some by as much as 8 times.*

The link between volume and outcomes

Although the exact reason why volume impacts outcomes is not clear, several proposed factors account for the strong relationship. The New England Journal of Medicine offers this hypothesis:

. . .high-volume hospitals may have more surgeons who specialize in specific procedures, more consistent processes for postoperative care, better-staffed intensive care units, and greater resources, in general, for dealing with postoperative complications.

New England Journal of Medicine
April 11, 2002

In support of this hypothesis, more cardiac surgeons -- over 120 -- choose to practice at Aurora St. Luke's Medical Center than at any other hospital in Milwaukee, and St. Luke's has had 25 cardiac "firsts," including the first laser-assisted angioplasty in Wisconsin and the first heart transplant in the Midwest.

David Kress, MD, a St. Luke's cardiothoracic surgeon concurs with the New England Journal of Medicine. "At St. Luke's there is an emphasis and support of innovation which attracts highly skilled surgeons and cardiologists. As a high volume center with innovative technology, we get the tougher cases. It creates a positive cycle. The greater the volume of cutting edge procedures performed, the more streamlined the cardiac pathways become and it trickles down to the easier cases. It is a win-win for doctors and their patients."

With the high number of cardiac procedures performed annually at St. Luke's, the entire cardiac care team, from the anesthesiologist to the intensive care nurses, functions seamlessly with consistent procedures developed over years of experience. Bernard Staller, MD, an interventional cardiologist on staff at St. Luke's sees how volume impacts outcomes for even non-surgical procedures, such as angioplasty.

He explains, "It is easy to see why St. Luke's good outcomes are related to our volume. Our cardiac care teams have seen it all and have learned how to act and react in almost any cardiac situation, in or out of surgery. Because of their broad experience, what might be considered a 'rare' situation becomes commonplace for them."

A second opinion

Volume should be one of the key criteria when selecting a hospital for certain high-risk procedures. The New England Journal of Medicine article re-iterates, "... in the absence of better information about surgical quality, patients...can substantially improve their odds of survival by selecting a high-volume hospital near them."

Most medical experts would recommend obtaining a second opinion before undergoing any surgical or non-surgical elective heart procedure. To find out more about St. Luke's Heart Care Second Opinion Program, call 414-385-2663.