Dr Pittman raises some interesting practical issues arising from our article on the relationship between low surgeon case volumes and poor outcomes for carotid endarterectomy. Others too have considered this issue1 and have failed to develop policy recommendations because the problem is not straightforward. Although most people would agree that surgeons should not perform just 1 or 2 endarterectomies per year, it would be difficult to get a consensus on a higher limit. Nevertheless, change is possible, as shown by the reduction in the number of low-volume cardiac surgeons in New York State after attention was focused on the problem through public release of the outcomes of coronary bypass surgery by program and surgeon.2,3 Perhaps the public release of outcome results might have a similar beneficial effect in carotid endarterectomy.
Feasby TE, Quan H, Ghali WA. Carotid Endarterectomy: Turning Up the Volume?—Reply. Arch Neurol. 2004;61(2):296-297. doi:10.1001/archneur.61.2.296-d