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Article
July 22, 1988

The Appropriateness of Performing Coronary Artery Bypass Surgery

Author Affiliations

From the Departments of Medicine (Drs Winslow, Kosecoff, and Brook) and Public Health (Drs Kosecoff and Brook), UCLA Center for the Health Sciences, Los Angeles; Health Sciences Program (Drs Chassin and Brook) and Behavioral Sciences Department (Dr Kanouse), The RAND Corp, Santa Monica, Calif; and Fink and Kosecoff Inc, Santa Monica (Dr Kosecoff). Dr Winslow was a Robert Wood Johnson Clinical Scholar when this study was conducted.

From the Departments of Medicine (Drs Winslow, Kosecoff, and Brook) and Public Health (Drs Kosecoff and Brook), UCLA Center for the Health Sciences, Los Angeles; Health Sciences Program (Drs Chassin and Brook) and Behavioral Sciences Department (Dr Kanouse), The RAND Corp, Santa Monica, Calif; and Fink and Kosecoff Inc, Santa Monica (Dr Kosecoff). Dr Winslow was a Robert Wood Johnson Clinical Scholar when this study was conducted.

JAMA. 1988;260(4):505-509. doi:10.1001/jama.1988.03410040077031
Abstract

Information about how appropriately procedures are performed is vital to the understanding of the impact of technology and to the success of efforts to channel its use appropriately. While the efficacy of coronary artery bypass surgery has been addressed in several large-scale, randomized trials, there is little information about how appropriately the procedure is actually being used in the community. We determined the appropriateness of coronary artery bypass surgeries performed in three randomly chosen hospitals in a western state. We determined appropriateness by comparing data obtained from a detailed medical record review with a list of 488 indications. This list, developed by a national panel of physicians, covered all possible reasons for performing the procedure. Three hundred eighty-six cases from the years 1979, 1980, and 1982 were examined. Fifty-six percent of the surgeries were performed for appropriate reasons, 30% for equivocal reasons, and 14% for inappropriate reasons. The percentage of appropriate surgeries varied by hospital, from 37% to 78%, but did not vary by patient age. Eliminating the performance of inappropriate procedures may lead to reductions in health care expenditures or to improved patient outcomes.

(JAMA 1988;260:505-509)

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