Impact of hospital volume on resource use after elective cardiac surgery: A contemporary analysis

Surgery. 2021 Sep;170(3):682-688. doi: 10.1016/j.surg.2021.03.004. Epub 2021 Apr 10.


Background: Institutional experience has been associated with reduced mortality after coronary artery bypass grafting and valve operations. Using a contemporary, national cohort, we examined the impact of hospital volume on hospitalization costs and postdischarge resource utilization after these operations.

Methods: Adults undergoing elective coronary artery bypass grafting or valve operations were identified in the 2016 to 2017 Nationwide Readmissions Database. Institutions were grouped into volume quartiles based on annual elective cardiac surgery caseload, and comparisons were made between the lowest and highest quartiles, using generalized linear models.

Results: Of an estimated 296,510 patients, 24.8% were treated at low-volume hospitals and 25.2% at high-volume hospitals. Compared with patients treated at low-volume hospitals, patients managed at high-volume hospitals were younger, had more comorbidities, and more frequently underwent combined coronary artery bypass grafting valve (13.0% vs 12.3%, P < .001) and multivalve operations (6.2% vs 3.1%, P < .001). After adjustment, operations at high-volume hospitals were associated with a $7,600 reduction (95% confidence interval $4,700-$10,500) in costs. High-volume hospitals were also associated with reduced odds of mortality, non-home discharge, and 30-day non-elective readmission compared to low-volume hospitals.

Conclusion: Despite increased complexity at high-volume centers, greater operative volume was independently associated with reduced hospitalization costs and mortality after elective cardiac operations. Reduction in non-home discharge and readmissions suggests this effect to extend beyond acute hospitalization, which may guide value-based care paradigms.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Cardiac Surgical Procedures / economics
  • Cardiac Surgical Procedures / mortality*
  • Data Management / methods*
  • Elective Surgical Procedures / economics
  • Elective Surgical Procedures / mortality*
  • Female
  • Follow-Up Studies
  • Hospital Costs / trends
  • Hospital Mortality / trends
  • Hospitals, High-Volume / statistics & numerical data*
  • Hospitals, Low-Volume / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Patient Readmission / trends
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Survival Rate / trends
  • United States / epidemiology