{"id":2102,"date":"1995-10-25T00:00:00","date_gmt":"1995-10-25T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/regionalization-of-cardiac-surgery-in-the-united-states-and-canada-geographic-access-choice-and-outcomes\/"},"modified":"2023-06-14T19:31:48","modified_gmt":"2023-06-14T23:31:48","slug":"regionalization-of-cardiac-surgery-in-the-united-states-and-canada-geographic-access-choice-and-outcomes","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/regionalization-of-cardiac-surgery-in-the-united-states-and-canada-geographic-access-choice-and-outcomes\/","title":{"rendered":"Regionalization of cardiac surgery in the United States and Canada: geographic access, choice, and outcomes"},"content":{"rendered":"<p><strong>Objective<\/strong> &#x2014; To determine how regionalization of facilities for coronary artery bypass surgery (CABS) affects geographic access to CABS and surgical outcomes.<\/p>\n<p><strong>Design<\/strong> &#x2014; Computerized hospital discharge records were used to measure hospital CABS volume and in-hospital post-CABS mortality rates. Relationships between surgical volume and age- and sex-adjusted mortality rates were compared using Chi-squared tests. Small-area analysis of the association between CABS rates and distances to nearest CABS hospital was performed using multivariate linear regression methods.<\/p>\n<p><strong>Setting<\/strong> &#x2014; All nonfederal hospitals in New York, California, Ontario, Manitoba, and British Columbia.<\/p>\n<p><strong>Patients<\/strong> &#x2014; All adult residents of the five jurisdictions who underwent CABS in a hospital in their jurisdiction from 1987 through 1989.<\/p>\n<p><strong>Results<\/strong> &#x2014; In New York and Canada, approximately 60% of all CABS operations took place in hospitals performing 500 or more CABS operations per year, compared with only 26% in California. The highest mortality rates were found among California hospitals performing fewer than 100 CABS operations per year (adjusted 14-day in-hospital mortality was 4.7% compared with 2.4% in high-volume California hospitals, P&lt;.001). The percentage of the population residing within 25 miles of a CABS hospital was 91% in California, 82% in New York, and less than 60% in Canada. Eliminating very low-volume (&lt;100 cases per year) CABS hospitals in California would increase travel distances to a CABS hospital only slightly for a small number of residents. The Canadian degree of regionalization was not associated with lower CABS rates within provinces for populations living at more remote distances from the nearest CABS hospital.<\/p>\n<p><strong>Conclusion <\/strong>&#x2014; Regionalization of CABS facilities in New York and Canada largely avoids the problem of low-volume outlier hospitals with high postoperative mortality rates found in California. New York has avoided the redundancy of facilities that exists in California while still providing residents a geographically convenient selection of CABS hospitals. Stricter regionalization in Canada may leave residents with a more narrow choice of facilities, but does not disproportionately affect access to surgery for populations living at remote distances from CABS facilities.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Objective &#x2014; To determine how regionalization of facilities for coronary artery bypass surgery (CABS) affects geographic access to CABS and surgical outcomes. Design &#x2014; Computerized hospital discharge records were used to measure hospital CABS volume and in-hospital post-CABS mortality rates. Relationships between surgical volume and age- and sex-adjusted mortality rates were compared using Chi-squared tests. [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[40,19,25],"migration-helper-qa-sample-set":[],"class_list":["post-2102","journal_article","type-journal_article","status-publish","hentry","topic-cardiovascular-disease","topic-marginalized-populations","topic-surgery"],"acf":{"citation":"Grumbach K, Anderson GM, Luft HS, Roos LL, Brook R. <em>JAMA<\/em>. 1995; 274(16):1282-8.","source_url":"","ices_scientist":[1382],"site":[6735],"research_program":[6740],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"10E2CCC5-878C-45F8-9909-3E14FB95321B","sitecore_item_name":"Regionalization-of-cardiac-surgery-in-the-United-States-and-Canada-geographic-access-choice-and","sitecore_field_values":"{\n  \"Title\": \"Regionalization of cardiac surgery in the United States and Canada: geographic access, choice, and outcomes\",\n  \"Citation\": \"<p>Grumbach K, Anderson GM, Luft HS, Roos LL, Brook R. <em>JAMA<\/em>. 1995; 274(16):1282-8.<\/p>\",\n  \"Abstract\": \"<p><strong>Objective<\/strong> &mdash; To determine how regionalization of facilities for coronary artery bypass surgery (CABS) affects geographic access to CABS and surgical outcomes.<\/p>rn<p><strong>Design<\/strong> &mdash; Computerized hospital discharge records were used to measure hospital CABS volume and in-hospital post-CABS mortality rates. Relationships between surgical volume and age- and sex-adjusted mortality rates were compared using Chi-squared tests. Small-area analysis of the association between CABS rates and distances to nearest CABS hospital was performed using multivariate linear regression methods.<\/p>rn<p><strong>Setting<\/strong> &mdash; All nonfederal hospitals in New York, California, Ontario, Manitoba, and British Columbia.<\/p>rn<p><strong>Patients<\/strong> &mdash; All adult residents of the five jurisdictions who underwent CABS in a hospital in their jurisdiction from 1987 through 1989.<\/p>rn<p><strong>Results<\/strong> &mdash; In New York and Canada, approximately 60% of all CABS operations took place in hospitals performing 500 or more CABS operations per year, compared with only 26% in California. The highest mortality rates were found among California hospitals performing fewer than 100 CABS operations per year (adjusted 14-day in-hospital mortality was 4.7% compared with 2.4% in high-volume California hospitals, P&lt;.001). The percentage of the population residing within 25 miles of a CABS hospital was 91% in California, 82% in New York, and less than 60% in Canada. Eliminating very low-volume (&lt;100 cases per year) CABS hospitals in California would increase travel distances to a CABS hospital only slightly for a small number of residents. The Canadian degree of regionalization was not associated with lower CABS rates within provinces for populations living at more remote distances from the nearest CABS hospital.<\/p>rn<p><strong>Conclusion <\/strong>&mdash; Regionalization of CABS facilities in New York and Canada largely avoids the problem of low-volume outlier hospitals with high postoperative mortality rates found in California. New York has avoided the redundancy of facilities that exists in California while still providing residents a geographically convenient selection of CABS hospitals. Stricter regionalization in Canada may leave residents with a more narrow choice of facilities, but does not disproportionately affect access to surgery for populations living at remote distances from CABS facilities.<\/p>\",\n  \"Keywords\": \"{9F514AF9-2526-48FE-8414-54C443CF99AD}|{02F5036F-CDC8-4D25-8BAE-056C8070AC69}|{C854EE01-6CCA-41CE-9A24-52AA5AFA4C3F}|{92E2791D-5DAB-4244-8A85-434D524D9A12}\",\n  \"Research Programs\": \"{46DF28D2-EDE8-4DF2-8CC0-87CEF464E435}\",\n  \"ICES Locations\": \"{FBE2D1B1-C0BA-423F-8D16-39466B6C1424}\",\n  \"ICES Scientists\": \"{38899D1B-38E7-4517-8DA3-0BDDF1F9944D}\",\n  \"Posted Date\": \"19951025T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/1995\/January\/Regionalization-of-cardiac-surgery-in-the-United-States-and-Canada-geographic-access-choice-and"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Regionalization of cardiac surgery in the United States and Canada: geographic access, choice, and outcomes<\/title>\n<meta name=\"description\" content=\"Objective &#x2014; 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