Evaluation of risk-adjusted hospital mortality after coronary artery bypass graft surgery in the Catalan public healthcare system. Influence of hospital management type (ARCA study)

Aida Ribera, Ignacio Ferreira-González, Purificación Cascant, Joan M.V. Pons, Gaietà Permanyer-Miralda, M. Murtra, C. Sureda, M. A. Castro, X. Ruyra, B. Romero, F. Callejo, A. Arís, C. Martínez-Useros, J. Mulet, M. Sanz, O. Solé

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12 Citations (Scopus)

Abstract

Introduction and objectives. Previous studies suggest that the effectiveness of coronary surgery is influenced by the type of management at the healthcare centre where the intervention is performed. The present study assessed the risk-adjusted hospital mortality of coronary surgery in the Catalan healthcare system in hospitals under either private or public management. Methods. We carried out a prospect ive study of all consecutive patients receiving a first coronary artery bypass graft, with public financial support, in a period of 2 years at 5 hospitals under either public or private management. Preoperative risk was assessed using the EuroSCORE and Catalan Agency for Health Technology Assessment (CAHTA) predictive models. Results. Overall, 1605 patients underwent interventions, 21% of which were at private hospitals. The percentage of patients undergoing non-elective surgery was higher at private hospitals (64% vs 50%), as was the percentage needing intravenous nitrates (17% vs 11%) and the percentage in functional class IV (20% vs 11%). The odds ratio for in-hospital mortality in private compared with public hospitals was 0.56 (95% Cl, 0.29-1.06) when adjusted for EuroSCORE, 0.56 (95% Cl, 0.29-1.07) when adjusted for CAHTA score, and 0.43 (95% Cl, 0.21-0.87) when adjusted for patient characteristics. The mortality observed, 4.8% (95% Cl 3.8-5.6), was not significantly higher than, that predicted. Conclusions. a) Hospital mortality was equivalent to or lower than that expected after adjustment for the 2 risk scores; b) after adjustment for baseline patient characteristics, the results favored privately managed centers; and c) comparison with previous results suggests that coronary surgery effectiveness has improved in recent years.
Original languageEnglish
Pages (from-to)431-440
JournalRevista Espanola de Cardiologia
Volume59
Issue number5
DOIs
Publication statusPublished - 1 Jan 2006

Keywords

  • Coronary artery bypass graft
  • Hospital mortality
  • Risk assessment

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