Contemporary impact of state certificate-of-need regulations for cardiac surgery : An analysis using the society of thoracic surgeons' national cardiac surgery database

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-11, Vol.114 (20), p.2122-2129
• Main Authors: DISESA, Verdi J, O'BRIEN, Sean M, WELKE, Karl F, BELAND, Sarah M, HAAN, Constance K, VAUGHAN-SARRAZIN, Mary S, PETERSON, Eric D
• Format: Article
• Language: English
• Subjects: Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Certificate of Need - statistics & numerical data; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Bypass - statistics & numerical data; Databases, Factual; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Humans; Medical sciences; Societies, Medical; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thoracic Surgery; United States; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.591214

Prior research using administrative data associated certificate-of-need (CON) regulation for open heart surgery with higher hospital coronary artery bypass grafting (CABG) volume and lower CABG operative mortality rates in elderly patients. It is unclear whether these findings apply in a general population and after controlling for detailed clinical characteristics and region. Using the Society of Thoracic Surgeons' (STS) National Cardiac Surgery Database, we examined isolated CABG surgery volume, operative mortality, and the composite end point of operative mortality or major morbidity for the years 2000 to 2003. The presence of CON regulations for open heart surgery was ascertained from the National Directory of the American Health Policy Association and by contacting CON administrators. Results were analyzed nationally, by state, and by region (West, Northeast, Midwest, South) and were adjusted for clinical factors and both population density and region with mixed-effects hierarchical logistic regression models. During 2000 to 2003, there were 314,710 isolated CABG surgeries performed at 294 STS hospitals in CON states (n=27, including Washington, DC) and 280 512 procedures at 343 STS hospitals in non-CON states (n=24). Patient clinical characteristics were similar among CON and non-CON hospitals. States with CON regulations tended to have higher population densities and had significantly higher median hospital annual CABG volumes in each of the years 2000 to 2003 (P