HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Checchia, P. A. Search for Related Content PubMed Articles by Checchia, P. A. Related Collections Congenital - cyanotic Related Article

J Thorac Cardiovasc Surg 2005;130:1731-1732
© 2005 The American Association for Thoracic Surgery

Letter to the Editor

Washington University School of Medicine, St Louis Children's Hospital, Campus Box 8116, One Children's Place, Suite 5S20, St Louis, MO 63110

Reply to the Editor:

My associates and I appreciate the comments made by Dr MacDonald and colleagues regarding our article examining the effect of surgical case volume on outcome after the Norwood procedure. ¹ They raise interesting points.

We agree that individual institutions can achieve outstanding outcomes regardless of volume. As they appropriately comment, the variability in survival outcome is greater in low-volume institutions. This variability highlights one of our conclusions: that the Norwood procedure is a rare operation, even in the highest-volume centers. Low-volume institutions might be unduly affected by 1 or 2 outcomes. This, however, adds credence to the efforts of an institution to improve the delivery of care in a way that will be applicable to each case.

Additionally, MacDonald and colleagues raise the pertinent issue of regional programs. Our analysis was not able to assess the effect of associations between institutions in a region. The effect on lower-volume institutions from the exposure of programs and practices developed at high-volume institutions likely has a positive effect.

Finally, we agree, as reported by Mavroudis and Jacobs, ² that many lower-volume surgeons and centers have excellent results. This highlights the need to develop processes and practices that can be adapted across institutions, regardless of the number of cases. What are the best institutions doing, and how can we learn from them? What can high-volume centers learn from the practices at low-volume centers? Sharing the details of these successful processes is essential.

	References

Top References

 

1. Checchia PA, McCollegan J, Daher N, et al. The effect of surgical case volume on outcome after the Norwood procedure. J Thorac Cardiovasc Surg 2005;129:754-759.[Abstract/Free Full Text]
   
2. Mavroudis C, Jacobs JP. Congenital heart disease outcome analysis: methodology and rationale. J Thorac Cardiovasc Surg 2002;123:6-7.[Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Checchia, P. A. Search for Related Content PubMed Articles by Checchia, P. A. Related Collections Congenital - cyanotic Related Article