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Hospital closure and coronary revascularization

The effect of hospital closures on health care outcomes is controversial. Brenda Hemmelgarn and colleagues tracked the outcomes of patients undergoing coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) during the 21 months before and the 24 months after the March 1996 closure of a Calgary hospital, which led to the centralization of coronary revascularization procedures at a single location. The rate of CABG rose from 51.6 per 100 000 people before to 67.3 per 100 000 after the hospital closure; the corresponding PTCA rates were 129.8 and 143.6 per 100 000 people. The burden of comorbidity (a disease or problem, such as an infection, resulting from the original operation) was significantly lower after than before the closure for CABG patients (by 1.3 days) and for PTCA patients (by 1.0 days). The adjusted death rates among CABG patients were slightly lower after the closure than before.

The authors conclude that the “experience of hospital closure and centralization of revascularization procedures in Calgary was one of success.” Indeed, in this ear of rapid change it could serve as an example of how to handle such changes without having a negative impact on care.

A case study of hospital closure and centralization of coronary revascularization procedures
— B.R. Hemmelgarn, W.A. Ghali, H. Quann

Contact: Dr. William Ghali, University of Alberta Health Sciences Centre.

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