To the Editor.
— article by Williams et al1 is a fascinating exploration of a complex and important topic. Mortality was not adequately explained by the methods typically used to justify hospital mortality differences. There did, however, seem to be some correlation between operating surgeon and mortality for diagnosis related group 106. Since all these procedures were done at teaching hospitals in the city of Philadelphia, and since it is well known that some attending physicians allow house staff to participate more actively in the care of some patients than of others, I wonder whether the degree of involvement of the house staff either in the operative or the postoperative phase might help explain the mortality rates. In addition, might the economic or referral status of the patients be important in explaining variations in mortality? For example, if the patient was referred by a cardiologist on staff who had
Maher JC. Differences in Mortality From Coronary Artery Bypass Graft Surgery. JAMA. 1991;266(24):3426. doi:10.1001/jama.1991.03470240048028
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