Relationship between patient safety and hospital surgical volume

Abstract

Objective: To examine the relationship between hospital volume and in-hospital adverse events.

Data sources: Patient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008.

Study design: In this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure.

Principal findings: Overall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05).

Conclusion: These data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events.

Figure 1

Percentage of Patients with One or More Patient Safety Indicator (PSI) (2005–2008), According to Tercile of Total Hospital Volume for Abdominal Aortic Aneurysm (AAA), Roux-en-Y Gastric Bypass (RNYGB), and Coronary Artery Bypass Graft (CABG) Notes. p < .0001 for all procedures. Values above the bars are the percent of patients with one or more PSI.