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Effect of Hospital Volume on In-Hospital Mortality for Renal Artery Bypass

Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, and Dallas Veterans Affairs Medical Center, Dallas, Texas, greg.modrall{at}utsouthwestern.edu

Eric B. Rosero, MD

Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, and Dallas Veterans Affairs Medical Center, Dallas, Texas

Stephen T. Smith, MD

Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, and Dallas Veterans Affairs Medical Center, Dallas, Texas

Frank R. Arko, MD

Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, and Dallas Veterans Affairs Medical Center, Dallas, Texas

R. James Valentine, MD

Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, and Dallas Veterans Affairs Medical Center, Dallas, Texas

G. Patrick Clagett, MD

Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, and Dallas Veterans Affairs Medical Center, Dallas, Texas

Carlos H. Timaran, MD

Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, and Dallas Veterans Affairs Medical Center, Dallas, Texas

Background: A recent report determined that the nationwide mortality for renal artery bypass (RAB) is surprisingly high—10%. We hypothesized that operative mortality for RAB is related to the volume of such operations performed in each center. Methods: The Nationwide Inpatient Sample was analyzed to identify patients undergoing RAB for the years 2000-2005. In-hospital mortality for RAB was compared between hospitals. Results: During the study period, RAB was performed on 7413 patients with an overall in-hospital mortality of 9.6%. The multivariate logistic regression analyses revealed that after adjusting for surgical risk, increasing hospital volume was significantly associated with decreased in-hospital mortality for RAB (odds ratio 0.98; 95% confidence interval, 0.96-0.99; P = .015). Conclusions: Patient risk profile and hospital volume are critical determinants of in-hospital mortality for RAB, which should be factored into decision making for patients requiring intervention for renovascular disease.

Key Words: renovascular • outcomes • renal artery • bypass

This version was published on August 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 4, 339-345 (2009)
DOI: 10.1177/1538574409335919


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