Angioplasty Outcomes May Vary Little Between Hospitals

Nov. 25 -- TUESDAY, Nov. 24 (HealthDay News) -- Do hospitals that conduct the most angioplasties necessarily produce the best results for patients? Maybe not.

Prior research had suggested that "practice makes perfect" when it comes to artery-opening procedures, but a new study involving over 30,000 patients finds low- and high-volume hospitals performing more or less equally.

The study included patients with what are called primary angioplasties, cared for at 166 hospitals across the United States between 2001 and 2007.

The researchers found no significant difference in outcome between medical centers that did high volumes of such procedures and those that didn't do all that many.

"The message here is that volume alone is not a sufficient target marker for outcome," said study senior author Dr. Deepak Bhatt, chief of cardiology at the VA Boston Healthcare System and associate professor of medicine at Harvard Medical School. His team reported the findings in the Nov. 25 issue of the Journal of the American Medical Association.

Studies done several years ago did find better results at high-volume hospitals, "but I think things have changed," Bhatt said. "Devices and techniques, and overall results have improved."

Hospitals were classified in three groups: low-volume, with fewer than 36 primary angioplasties a year; middle-volume, between 36 and 70 procedures; and high-volume, with 70 or more procedures a year.

The in-hospital death rate was 3 percent for high-volume hospitals, 3.2 percent for medium-volume hospitals and 3.9 percent for low-volume hospitals, a difference that is not statistically significant, the report said.

The length of hospital stays was virtually the same for all hospitals: 4.6 days for low-volume, 4.5 days for medium-volume, 4.7 days for high-volume. But there was a difference in the interval between arrival at the hospital and beginning of angioplasty: 98 minutes for low-volume hospitals, 90 minutes for medium-volume and 88 minutes for high-volume. And high-volume hospitals were more likely to fulfill the guideline recommending start of an angioplasty within 90 minutes of arrival at a hospital.