Evaluating quality, cost-effective health care: Vascular database predicated on hospital discharge abstracts

William H. Edwards, John A. Morris, Judith M. Jenkins, Sue M. Bass, Ellen J. Mackenzie

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


This population-based study examines all carotid endarterectomies (CE) performed by all surgeons in a single state over a 10-year period. The methodology is designed to determine morbidity rate, mortality rate, cost, and length of stay, as well as to understand the effect of pre-existing chronic disease, physician, and hospital volume on these outcome variables. The data source consisted of hospital discharge abstract data uniformly collected on all admissions (N = 5.9 million) to acute care hospitals in the state. In the decade 1979 to 1988, 11,199 patients underwent CE. Mortality rate from CE was 2.1%, and the postoperative stroke rate was 3.7% over this period. High physician volume decreased the mortality rate (p < 0.05) and stroke rate (p < 0.01) by 50% and significantly (p < 0.001) reduced hospital cost and length of stay independent of patient complexity. Examination of cost data, adjusted for inflation, showed a decrease in mean cost for CE over the decade. Thus physicians are providing better care for less hospital dollars. Both patient and payor outcome is improved by concentrating CE patients in the hands of high-volume surgeons. Although the data suggests this trend is already evolving, the pace of this evolution can be expected to increase as payers recognize that regionalization of this procedure lowers costs.

Original languageEnglish (US)
Pages (from-to)433-438
Number of pages6
JournalAnnals of surgery
Issue number5
StatePublished - May 1991

ASJC Scopus subject areas

  • Surgery


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