Surgery volume, quality of care and operative mortality in coronary artery bypass graft surgery: a re-examination using fixed-effects regression
UMass Chan Affiliations
Department of Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2010-06-01Keywords
Hospital volumeSurgeon volume
Fixed effects
Random effects
Biostatistics
Health Services Administration
Health Services Research
Surgery
Metadata
Show full item recordAbstract
For many surgical procedures, apparent volume–outcome relationships may reflect differences in patient risk-profiles as well as quality of care. As some important patient profile differences may be unobserved, we use fixed effects (FE) regression to estimate the relationship between operative mortality and surgeon and hospital volumes, and compare this method with the more commonly used random effects (RE) regression approach. The 1998 and 1999 Medicare Inpatient and Denominator files for Medicare Fee for Service enrollees aged 65–99. Operative mortality rates are estimated for different surgeon and hospital volume tertiles (high, medium, low) using FE and RE regression methods, adjusted for patient demographics and morbidities. The data were collected by the Centers for Medicare and Medicaid Services (CMS). FE regression estimates that lowest volume tertile hospitals have 1.4 and lowest volume tertile surgeons have 1.6 additional operative deaths (for every 100 CABG surgeries) compared to their highest volume tertile counterparts. The corresponding RE estimates are 0.5 and 1.4 respectively. The substantially higher FE hospital volume effect compared to RE indicates the presence of unobserved “protective” characteristics in lower volume providers, including a less complicated patient profile. Lower hospital and surgeon volumes are associated with substantially higher excess operative mortality from CABG surgeries than previously estimated.Source
Hanchate AD, Stukel TA, Birkmeyer JD, Ash AS. Surgery Volume, Quality of Care and Operative Mortality in Coronary Artery Bypass Graft Surgery: A Re-Examination Using Fixed-Effects Regression. Health Services and Outcomes Research Methodology. 2010. 10(1-2):16-32. DOI 10.1007/s10742-010-0063-1DOI
10.1007/s10742-010-0063-1Permanent Link to this Item
http://hdl.handle.net/20.500.14038/46658ae974a485f413a2113503eed53cd6c53
10.1007/s10742-010-0063-1