Volume and Outcome of Coronary Artery Bypass Graft Surgery

James M. Wilson, MD; Paul Menkhaus, MD; Byron W. Gustin, MD
JAMA. 1987;257(18):2434. doi:10.1001/jama.1987.03390180052010.
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To the Editor.—  The recent article entitled "Association of Volume With Outcome of Coronary Artery Bypass Graft Surgery" by Showstack et al1 was an interesting analysis of coronary artery bypass graft (CABG) surgical results. Several conclusions were drawn from this analysis that require further comment.The major conclusion of this article, based on statistical analysis of the discharge abstracts for 18 986 CABG operations at 77 hospitals, was that the greatest improvement in mortality rates for CABG surgery would result from the closure of low-volume surgery units. To support this premise, the authors reported that CABG surgical programs performing 20 to 100 operations per year had a mortality rate of 5.2%, those programs performing 101 to 200 operations had a mortality rate of 3.9%, and those performing greater than 350 operations per year had a mortality rate of 3.1%. The numbers are certainly suggestive. However, as the authors acknowledge,


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