There are certain procedures for which surgical outcomes may be related to the volume of procedures carried out by the provider. Here we look at the volumes of two types of procedure by provider, categorised as high or low volume, and how these have changed over time.
The concentration of certain surgical procedures or treatments in selected sites is commonly cited as an important way to ensure better quality care and in a number of areas there are moves to minimise, where possible, occasions when trusts perform a certain operation only infrequently. In practice this means identifying some threshold minimum number of operations per year. Each year there are approximately 20,000 coronary artery bypass grafts (CABGs) performed and the National Service Framework for Coronary Heart Disease has recommended a minimum of 400 CABGs should be carried out each year by a single institution. Using hospital admissions data we can estimate by year the number of people in each hospital with codes indicating CABG surgery. These data suggest that the number of trusts performing 400 or more CABG procedures a year has remained fairly constant since April 2001 with approximately 45% of trusts meeting this standard. The majority of trusts not meeting the standard, however, perform fewer than 5 CABG operations within the year and so a caveat must be added around the potential accuracy of coding data: without access to full medical records it is impossible to assess if these small numbers are genuine, or a result of incorrectly submitted data.
The National Service Framework for Coronary Heart Disease recommends a minimum of 200 coronary angioplastys should be carried out each year by a single institution. The number of trusts performing 200 or more percutaneous transluminal coronary angioplasty (PTCAs) a year has increased markedly since 2001/02 with fewer than 23% of providers not meeting this standard in 2012/13. This has also been accompanied by a dramatic fall in the absolute number of trusts performing fewer operations than the recommended threshold. There is a particularly sharp increase in the number of providers meeting the standard in 2006/07 which is driven by a dramatic increase in the number of PTCAs being performed in hospitals nationally, rising from approximately 4,600 PTCAs in 2005/06 to approximately 44,900 in 2006/07. After this spike the number of PTCAs has increased steadily to approximately 69,100 in 2012/13. The majority of trusts not meeting the standard, however, perform fewer than 5 PTCA operations within the year and so a caveat must be added around the accuracy of coding data: without access to full medical records it is impossible to assess if these small numbers are genuine, or a result of incorrectly submitted data.