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J Thorac Cardiovasc Surg 2003;125:S76-S77
© 2003 The American Association for Thoracic Surgery

Editorials

Bulk buying [Hospital size, case volume, and cost for coronary artery bypass surgery]

William C. Nugent, MD, Stephen K. Plume, MD

From the Section of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, and the Dartmouth Medical School, Hanover, NH.

Received for publication April 2, 2001. Accepted for publication April 12, 2001. Address for reprints: William C. Nugent, MD, Department of Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756.

The first 20% of the full text of this article appears below.

Conventional wisdom holds that the quality of coronary artery bypass graft (CABG) operations is higher, and the unit cost lower, if performed by high-volume surgeons in high-volume institutions. This belief has led some health care policy advisors, insurance purchasers, and hospital marketers to urge the public to choose surgeons or institutions on the basis of the numbers of cases done annually.

For example, the most recent "Consumers' Guide to Cardiac Surgery in Pennsylvania" advises readers that a surgeon's case volume is an important determinant of risk of perioperative mortality, but it does not specify the magnitude of the effect.Go 1 It is surprising how weak this association is. Linear regression of case-mix-adjusted . . . [Full Text of this Article]






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