This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Edward L. Hannan, PhD; Michael Racz, MA; Thomas J. Ryan, MD; Ben D. McCallister, MD; Lewis W. Johnson, MD; Djavad T. Arani, MD; Alan D. Guerci, MD; Julio Sosa, MD; Eric J. Topol, MD

JAMA. 1997;277(11):892-898.

Abstract
Objective.
—To assess the relationship between each of 2 provider volume measures (annual hospital volume and annual cardiologist volume) for percutaneous transluminal coronary angioplasty (PTCA) and 2 outcomes of PTCA (in-hospital mortality and same-stay coronary artery bypass graft [CABG] surgery).

Design.
—Cohort study, using data from January 1,1991, through December 31, 1994, from the Coronary Angioplasty Reporting System of the New York State Department of Health.

Setting.
—Thirty-one hospitals in New York State in which PTCA was performed during 1991-1994.

Patients.
—All 62 670 patients discharged after undergoing PTCA in these hospitals during 1991-1994.

Main Outcome Measures.
—Rates of in-hospital mortality and CABG surgery during the same stay as the PTCA.

Results.
—The overall in-hospital mortality rate for patients undergoing PTCA in New York during 1991-1994 was 0.90%, and the same-stay CABG surgery rate was 3.43%. Patients undergoing PTCA in hospitals with annual PTCA volumes less than 600 experienced a significantly higher risk-adjusted in-hospital mortality rate of 0.96% (95% confidence interval [CI], 0.91%-1.01%) and risk-adjusted same-stay CABG surgery rate of 3.92% (95% CI, 3.76%-4.08%). Patients undergoing PTCA by cardiologists with annual PTCA volumes less than 75 had mortality rates of 1.03% (95% CI, 0.91%-1.17%) and same-stay CABG surgery rates of 3.93% (95% CI, 3.65%-4.24%); both of these rates were also significantly higher than the rates for all patients. Also, same-stay CABG surgery rates for patients undergoing PTCA in hospitals with annual volumes of 600 to 999 performed by cardiologists with annual volumes of 75 to 174 (2.99%; 95% CI, 2.69%-3.31%) and 175 or more (2.84%; 95% CI, 2.57%-3.14%) were significantly lower than the overall statewide rate (3.43%).

Conclusions.
—In New York State, both hospital PTCA volume and cardiologist PTCA volume are significantly inversely related to in-hospital mortality rate and same-stay CABG surgery rate for patients undergoing PTCA.

Author Affiliations
From the State University of New York at Albany (Dr Hannan and Mr Racz); Boston University School of Medicine, Boston, Mass (Dr Ryan); Mid-America Heart Institute, Kansas City, Mo (Dr McCallister); State University of New York Health Science Center and St Joseph's Hospital, Syracuse, NY (Dr Johnson); State University of New York at Buffalo, and the Buffalo General Hospital (Dr Arani); St Francis Hospital, Roslyn, NY (Dr Guerci); Albany Associates in Cardiology (Dr Sosa); and the Cleveland Clinic Foundation, Cleveland, Ohio (Dr Topol).

Footnotes
Reprints: Edward L. Hannan, PhD, Department of Health Policy, State University of New York at Albany, One University Place, Rensselaer, NY 12144-3456.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The impact of center volume on survival in lung transplantation: an analysis of more than 10,000 cases.
Weiss et al.
Ann. Thorac. Surg. 2009;88:1062-1070.
ABSTRACT | FULL TEXT  

Evaluating Obstetrical Residency Programs Using Patient Outcomes
Asch et al.
JAMA 2009;302:1277-1283.
ABSTRACT | FULL TEXT  

Outcomes of a System-Wide Protocol for Elective and Nonelective Coronary Angioplasty at Sites Without On-site Surgery: The Mayo Clinic Experience
Singh et al.
Mayo Clin Proc. 2009;84:501-508.
ABSTRACT | FULL TEXT  

Assessing Changes in High-Volume Hospital Use: Hospitals, Payers, and Aggregate Volume Trends
Kronebusch
Med Care Res Rev 2009;66:197-218.
ABSTRACT  

Assessing the risks of percutaneous coronary intervention: do we have an equivalent of the EuroSCORE?
Ludman
Heart 2008;94:1366-1369.
FULL TEXT  

Increased Mortality at Low-Volume Orthotopic Heart Transplantation Centers: Should Current Standards Change?
Weiss et al.
Ann. Thorac. Surg. 2008;86:1250-1260.
ABSTRACT | FULL TEXT  

Validation of the Mayo Clinic Risk Score for In-Hospital Mortality After Percutaneous Coronary Interventions Using the National Cardiovascular Data Registry
Singh et al.
Circ Cardiovasc Interv 2008;1:36-44.
ABSTRACT | FULL TEXT  

External validation of established risk adjustment models for procedural complications after percutaneous coronary intervention
Kunadian et al.
Heart 2008;94:1012-1018.
ABSTRACT | FULL TEXT  

Physician's Case Volume of Intensive Care Unit Pneumonia Admissions and In-Hospital Mortality
Lin et al.
Am. J. Respir. Crit. Care Med. 2008;177:989-994.
ABSTRACT | FULL TEXT  

Cumulative funnel plots for the early detection of interoperator variation: retrospective database analysis of observed versus predicted results of percutaneous coronary intervention
Kunadian et al.
BMJ 2008;336:931-934.
ABSTRACT | FULL TEXT  

Volume-outcome relation for contemporary percutaneous coronary interventions (PCI) in daily clinical practice: is it limited to high-risk patients? Results from the Registry of Percutaneous Coronary Interventions of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte (ALKK)
Zahn et al.
Heart 2008;94:329-335.
ABSTRACT | FULL TEXT  

ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Update the 1998 Clinical Competence Statement on Recommendations for the Assessment and Maintenance of Proficiency in Coronary Interventional Procedures)
King et al.
J Am Coll Cardiol 2007;50:82-108.
FULL TEXT  

Bedside Estimation of Risk From Percutaneous Coronary Intervention: The New Mayo Clinic Risk Scores
Singh et al.
Mayo Clin Proc. 2007;82:701-708.
ABSTRACT | FULL TEXT  

Contemporary Impact of State Certificate-of-Need Regulations for Cardiac Surgery: An Analysis Using the Society of Thoracic Surgeons' National Cardiac Surgery Database
DiSesa et al.
Circulation 2006;114:2122-2129.
ABSTRACT | FULL TEXT  

Certificate of need regulations and use of coronary revascularization after acute myocardial infarction.
Popescu et al.
JAMA 2006;295:2141-2147.
ABSTRACT | FULL TEXT  

Is the volume-outcome relation still an issue in the era of PCI with systematic stenting? Results of the greater Paris area PCI registry
Spaulding et al.
Eur Heart J 2006;27:1054-1060.
ABSTRACT | FULL TEXT  

A Risk Score to Predict In-Hospital Mortality for Percutaneous Coronary Interventions
Wu et al.
J Am Coll Cardiol 2006;47:654-660.
ABSTRACT | FULL TEXT  

Impact of Hospital Volume on Racial Disparities in Cardiovascular Procedure Mortality
Trivedi et al.
J Am Coll Cardiol 2006;47:417-424.
ABSTRACT | FULL TEXT  

The Case for Community Hospital Angioplasty
Wharton et al.
Circulation 2005;112:3509-3534.
FULL TEXT  

Hospital Volume-Outcome Relationships Among Medical Admissions to ICUs
Durairaj et al.
Chest 2005;128:1682-1689.
ABSTRACT | FULL TEXT  

Measuring Percutaneous Coronary Intervention Quality by Simple Case Volume
Kuntz and Normand
Circulation 2005;112:1088-1091.
FULL TEXT  

Volume-Outcome Relationships for Percutaneous Coronary Interventions in the Stent Era
Hannan et al.
Circulation 2005;112:1171-1179.
ABSTRACT | FULL TEXT  

Relationship Between Operator Volume and Adverse Outcome in Contemporary Percutaneous Coronary Intervention Practice: An Analysis of a Quality-Controlled Multicenter Percutaneous Coronary Intervention Clinical Database
Moscucci et al.
J Am Coll Cardiol 2005;46:625-632.
ABSTRACT | FULL TEXT  

Preventing in-hospital cardiac and renal complications in high-risk PCI patients
Brinker et al.
Eur Heart J Suppl 2005;7:G13-G24.
ABSTRACT | FULL TEXT  

Physician Predictors of Mammographic Accuracy
Smith-Bindman et al.
JNCI J Natl Cancer Inst 2005;97:358-367.
ABSTRACT | FULL TEXT  

Outcomes of Percutaneous Coronary Interventions Performed at Centers Without and With Onsite Coronary Artery Bypass Graft Surgery
Wennberg et al.
JAMA 2004;292:1961-1968.
ABSTRACT | FULL TEXT  

Is Onsite Surgery Backup Necessary for Percutaneous Coronary Interventions?
Weaver
JAMA 2004;292:2014-2016.
FULL TEXT  

Regionalization of Percutaneous Transluminal Coronary Angioplasty and Implications for Patient Travel Distance
Kansagra et al.
JAMA 2004;292:1717-1723.
ABSTRACT | FULL TEXT  

Exploration of a Bayesian Updating Methodology to Monitor the Safety of Interventional Cardiovascular Procedures
Resnic et al.
Med Decis Making 2004;24:399-407.
ABSTRACT  

Comparison of Mayo Clinic risk score and American College of Cardiology/American Heart Association lesion classification in the prediction of adverse cardiovascular outcome following percutaneous coronary interventions
Singh et al.
J Am Coll Cardiol 2004;44:357-361.
ABSTRACT | FULL TEXT  

The Relationship Between Surgeon and Hospital Volume and Outcomes for Shoulder Arthroplasty
Jain et al.
JBJS 2004;86:496-505.
ABSTRACT | FULL TEXT  

Risk assessment for percutaneous coronary intervention: our version of the weather report?
Cutlip et al.
J Am Coll Cardiol 2003;42:1896-1899.
FULL TEXT  

Validation of Mayo clinic risk adjustment model for in-hospital complications after percutaneous coronary interventions, using the National Heart, Lung, and Blood Institute dynamic registry
Singh et al.
J Am Coll Cardiol 2003;42:1722-1728.
ABSTRACT | FULL TEXT  

The Effect of Clustering of Outcomes on the Association of Procedure Volume and Surgical Outcomes
Panageas et al.
ANN INTERN MED 2003;139:658-665.
ABSTRACT | FULL TEXT  

Provider Volume of Total Knee Arthroplasties and Patient Outcomes in the HCUP-Nationwide Inpatient Sample
Hervey et al.
JBJS 2003;85:1775-1783.
ABSTRACT | FULL TEXT  

In-Hospital Morbidity and Mortality after Endovascular Treatment of Unruptured Intracranial Aneurysms in the United States, 1996-2000: Effect of Hospital and Physician Volume
Hoh et al.
Am. J. Neuroradiol. 2003;24:1409-1420.
ABSTRACT | FULL TEXT  

The volume-outcome relationship: from Luft to Leapfrog
Shahian and Normand
Ann. Thorac. Surg. 2003;75:1048-1058.
ABSTRACT | FULL TEXT  

From Physician to Consumer: The Effectiveness of Strategies to Manage Health Care Utilization
Flynn et al.
Med Care Res Rev 2002;59:455-481.
ABSTRACT  

Improving health behaviors and outcomes after angioplasty: using economic theory to inform intervention
Charlson et al.
Health Educ Res 2002;17:606-618.
ABSTRACT | FULL TEXT  

Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature
Halm et al.
ANN INTERN MED 2002;137:511-520.
ABSTRACT | FULL TEXT  

Female Sex as a Risk Factor for In-Hospital Mortality Among Children Undergoing Cardiac Surgery
Chang et al.
Circulation 2002;106:1514-1522.
ABSTRACT | FULL TEXT  

Correlates of procedural complicationsand a simple integer risk scorefor percutaneous coronary intervention
Singh et al.
J Am Coll Cardiol 2002;40:387-393.
ABSTRACT | FULL TEXT  

Improving the Accuracy of Mammography: Volume and Outcome Relationships
Esserman et al.
JNCI J Natl Cancer Inst 2002;94:369-375.
ABSTRACT | FULL TEXT  

Hidden Barriers to Improvement in the Quality of Care
McNeil
NEJM 2001;345:1612-1620.
FULL TEXT  

Association Between Hospital and Surgeon Procedure Volume and Outcomes of Total Hip Replacement in the United States Medicare Population
Katz et al.
JBJS 2001;83:1622-1629.
ABSTRACT | FULL TEXT  

Volume-Outcome Relation for Physicians and Hospitals Performing Angioplasty for Acute Myocardial Infarction in New York State
Vakili et al.
Circulation 2001;104:2171-2176.
ABSTRACT | FULL TEXT  

Prognostic Value of a Normal or Nonspecific Initial Electrocardiogram in Acute Myocardial Infarction
Welch et al.
JAMA 2001;286:1977-1984.
ABSTRACT | FULL TEXT  

Simple Bedside Additive Tool for Prediction of In-Hospital Mortality After Percutaneous Coronary Interventions
Moscucci et al.
Circulation 2001;104:263-268.
ABSTRACT | FULL TEXT  

Relationship Between Annual Volume of Patients Treated by Admitting Physician and Mortality After Acute Myocardial Infarction
Tu et al.
JAMA 2001;285:3116-3122.
ABSTRACT | FULL TEXT  

American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on Cardiac Catheterization Laboratory Standards: A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents endorsed by the American Heart Association and the Diagnostic and Interventional Catheterization Committee of the Council on Clinical Cardiology of the AHA
Bashore et al.
J Am Coll Cardiol 2001;37:2170-2214.
FULL TEXT  

ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions
Smith et al.
J Am Coll Cardiol 2001;37:2239-2239.
FULL TEXT  

A case study of hospital closure and centralization of coronary revascularization procedures
Hemmelgarn et al.
CMAJ 2001;164:1431-1435.
ABSTRACT | FULL TEXT  

Complications of Elbow Arthroscopy
Kelly et al.
JBJS 2001;83:25-25.
ABSTRACT | FULL TEXT  

Relation Between Hospital Primary Angioplasty Volume and Mortality for Patients With Acute MI Treated With Primary Angioplasty vs Thrombolytic Therapy
Magid et al.
JAMA 2000;284:3131-3138.
ABSTRACT | FULL TEXT  

Relation Between Operator and Hospital Volume and Outcomes Following Percutaneous Coronary Interventions in the Era of the Coronary Stent
McGrath et al.
JAMA 2000;284:3139-3144.
ABSTRACT | FULL TEXT  

Volume-Outcome Relationship in Acute Myocardial Infarction: The Balloon and the Needle
Jollis and Romano
JAMA 2000;284:3169-3171.
FULL TEXT  

Influence of Hospital Procedure Volume on Outcomes Following Surgery for Colon Cancer
Schrag et al.
JAMA 2000;284:3028-3035.
ABSTRACT | FULL TEXT  

A comparison of short- and long-term outcomes for balloon angioplasty and coronary stent placement
Hannan et al.
J Am Coll Cardiol 2000;36:395-403.
ABSTRACT | FULL TEXT  

Application of the New York State PTCA Mortality Model in Patients Undergoing Stent Implantation
Holmes et al.
Circulation 2000;102:517-522.
ABSTRACT | FULL TEXT  

Reply
Wharton et al.
J Am Coll Cardiol 2000;36:301-303.
FULL TEXT  

Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time With Mortality in Patients Undergoing Angioplasty for Acute Myocardial Infarction
Cannon et al.
JAMA 2000;283:2941-2947.
ABSTRACT | FULL TEXT  

Improved Clinical Outcome after Widespread Use of Coronary-Artery Stenting in Canada
Brophy
NEJM 2000;342:1448-1449.
FULL TEXT  

Evolution of the Volume-Outcome Relation for Hospitals Performing Coronary Angioplasty
Ho
Circulation 2000;101:1806-1811.
ABSTRACT | FULL TEXT  

Selective Referral to High-Volume Hospitals: Estimating Potentially Avoidable Deaths
Dudley et al.
JAMA 2000;283:1159-1166.
ABSTRACT | FULL TEXT  

Coronary angioplasty: guidelines for good practice and training
Joint Working Group on Coronary Angioplasty of the and British Cardiovascular Intervention Society
Heart 2000;83:224-235.
FULL TEXT  

Using administrative data to assess health care outcomes
Ayanian
Eur Heart J 1999;20:1689-1691.
 

American College of Cardiology training statement on recommendations for the structure of an optimal adult interventional cardiology training program: A report of the American College of Cardiology Task Force on Clinical Expert Consensus documents
Hirshfeld et al.
J Am Coll Cardiol 1999;34:2141-2147.
FULL TEXT  

Changing outcomes in percutaneous coronary interventions: A study of 34,752 procedures in Northern New England, 1990 to 1997
McGrath et al.
J Am Coll Cardiol 1999;34:674-680.
ABSTRACT | FULL TEXT  

Validation of risk adjustment models for in-hospital percutaneous transluminal coronary angioplasty mortality on an independent data set
Moscucci et al.
J Am Coll Cardiol 1999;34:692-697.
ABSTRACT | FULL TEXT  

Practice of Coronary Angioplasty in California in 1995 : Comparison to 1989 and Impact of Coronary Stenting
Rill and Brown
Circulation 1999;99 :e12-e12.
ABSTRACT | FULL TEXT  

The Association between Hospital Volume and Survival after Acute Myocardial Infarction in Elderly Patients
Thiemann et al.
NEJM 1999;340:1640-1648.
ABSTRACT | FULL TEXT  

Interventional cardiology in Europe 1995
Windecker et al.
Eur Heart J 1999;20:484-495.
ABSTRACT  

Length of Stay for Specialized Pediatric Urologic Care
Kogan et al.
Arch Pediatr Adolesc Med 1998;152:1126-1131.
ABSTRACT | FULL TEXT  

Operator volume and outcome of patients undergoing coronary stent placement
Kastrati et al.
J Am Coll Cardiol 1998;32:970-976.
ABSTRACT | FULL TEXT  

Comparing Generalist and Specialty Care: Discrepancies, Deficiencies, and Excesses
Donohoe
Arch Intern Med 1998;158:1596-1608.
ABSTRACT | FULL TEXT  

Cerebral Angiography Practices at US Teaching Hospitals : Implications for Carotid Endarterectomy
Chaturvedi et al.
Stroke 1997;28:1895-1897.
ABSTRACT | FULL TEXT