Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Dr Peterson and colleagues1 reported that quality scores for coronary artery
bypass graft (CABG) surgery were unrelated to the number of such procedures
that hospitals performed. I have 3 concerns about their study.
First, hospitals with low volumes of CABG surgery may have less-stringent
clinical indications, perhaps in an attempt to maintain a certain number of
such procedures. Second, the risk-adjusted mortality rate in hospitals with
150 or fewer procedures per year was 28% greater than in hospitals with 450
or more procedures per year. If patients were able to make an informed choice,
I believe many would opt for the hospital with the higher caseload. Third,
larger health facilities enjoy economies of scale, enabling resources to be
saved and used to improve health care coverage in other sectors.2 These
potential advantages were not assessed by the authors.
Mariotto A. Hospital Volume and Quality. JAMA. 2004;291(17):2077. doi:10.1001/jama.291.17.2077-a