Volume and mortality in coronary artery bypass grafting

doi:10.1136/bmj.311.7015.1304b

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Harold S Luft,
Jennifer D Parker

Professor of health economics Pew postdoctoral fellow Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94109, USA

EDITOR,--Amanda J Sowden and colleagues' meta-analysis of six studies of the relation between the volume of coronary bypass graft surgery performed and mortality concludes that the relation is less apparent with better adjustment for case mix and has becomne attenuated over time.1 Unfortunately, in the one study with clinical risk factors, which was also the most recent one and was carried out in New York, 96.7% of all patients were treated in the 26 (out of 30) hospitals with >200 cases. This makes it difficult to detect a volume effect …