We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Evaluation of the Complication Rate as a Measure of Quality of Care in Coronary Artery Bypass Graft Surgery

Jeffrey H. Silber, MD, PhD; Paul R. Rosenbaum, PhD; J. Sanford Schwartz, MD; Richard N. Ross, MS; Sankey V. Williams, MD
JAMA. 1995;274(4):317-323. doi:10.1001/jama.1995.03530040045039.
Text Size: A A A
Published online


Objective.  —To determine whether hospital rankings based on complication rates provide the same information as hospital rankings based on mortality rates.

Design.  —A retrospective study of in-hospital death, complication, and death following complication (failure to rescue). Hospitals were ranked using residuals based on the difference between the observed and the expected number of events (from logistic regression models); rankings were compared using Spearman rank correlations.

Setting.  —Hospitals performing coronary artery bypass graft (CABG) surgery in the 1991 and 1992 MedisGroups National Comparative Data Bases.

Patients and Data Sets.  —Record abstraction data for 16 673 patients who underwent CABG procedures at 57 hospitals, linked with data from the 1991 American Hospital Association Annual Survey.

Results.  —After adjusting for patient admission severity of illness, there were low correlations between hospital rankings based on death or failure to rescue and those rankings based on complication (death vs complication, r=0.07, P=.58; failure to rescue vs complication, r=-0.22, P=.11). In addition, many hospital characteristics that are generally associated with a higher quality of care were associated with higher complication rates but with expected or lower-than-expected mortality rates.

Conclusions.  —Hospital rankings based on complication rates provide different information than those based on mortality rates. Until more is known about these differences, complication rates should not be used to judge hospital quality of care in CABG surgery.(JAMA. 1995;274:317-323)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.