To the Editor.
—Dr Silber and colleagues1 strongly recommend that complication rates in coronary artery bypass graft (CABG) surgery should not be used to judge hospital quality of care. We have serious concerns about the validity of this conclusion because of several limitations in their study.First, we question both the definitions and rates of complications noted in the study. Their conceptualization of postoperative complications for CABG surgery appears flawed. It is important to distinguish between complications that are common sequelae of patients' illness (eg, congestive heart failure) and those that are more likely to result from substandard care (eg, deep wound infection). Despite the authors' definition of a complication as "a finding not noted on admission, but present after the second hospital day or during or after surgery," clinical conditions present before CABG surgery (eg, hypotension, congestive heart failure, and cardiac emergency) that are preoperative risk factors could
Daley J, Iezzoni LI, Khuri SF. Complication Rates as a Measure of Quality of Care. JAMA. 1995;274(21):1674. doi:10.1001/jama.1995.03530210028019