Volume and mortality in coronary artery bypass grafting

BMJ 1995;311:1304-1305 (11 November)

Letters

Volume and mortality in coronary artery bypass grafting

EDITOR,--Amanda J Sowden and colleagues' meta-analysis of sixstudies of the relation between the volume of coronary bypassgraft surgery performed and mortality concludes that the relationis less apparent with better adjustment for case mix and hasbecomne attenuated over time.¹ Unfortunately, in the one studywith clinical risk factors, which was also the most recent oneand was carried out in New York, 96.7% of all patients weretreated in the 26 (out of 30) hospitals with >200 cases.This makes it difficult to detect a volume effect in this study.Without additional studies with clinical risk factor modelsfrom other times and places it is impossible to test the authors'hypotheses.

We have addressed the question of a time trend, looking at Californiandata for 1983-9. Adjusted death rates by volume of coronaryartery bypass grafting were estimated with a risk model basedon data from discharge . . . [Full text of this article]

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Volume and outcome in coronary artery bypass graft surgery: true association or artefact?: Amanda J Sowden, Jonathan J Deeks, and Trevor A Sheldon
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