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Invited Critique
April 2008

Volume-Outcome Relationship for Coronary Artery Bypass Grafting in an Era of Decreasing Volume—Invited Critique

Arch Surg. 2008;143(4):344. doi:10.1001/archsurg.143.4.344

It has been assumed by many, based on previous studies,1,2 that there is a linkage between hospital cardiac surgical case volumes and outcomes, whereby improved outcomes are associated with high-volume centers. Regionalization strategies and recommendations, adopted by state certificate of need regulations and health care industry consortia (eg, the Leapfrog Group), are largely predicated on these assumptions in that they espouse concentrating bypass surgery procedural volumes in the interest of improving quality and outcomes. Findings from this article suggest that such traditional volume-outcome tenets may be overly simplistic and inaccurate in assessing current CABG practices. In an analysis of the Society of Thoracic Surgeons' National Cardiac Surgery Database, DiSesa et al3 recently reported that, although certificate of need regulations have been successful in increasing hospital CABG volumes, their effect on procedural mortality or morbidity seems to be negligible. There is growing experiential evidence that hospital-based quality control, monitoring, and best-practice programs may have a more significant effect on outcomes.

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