RT Journal
A1 Yuh DD
T1 VOlume-outcome relationship for coronary artery bypass grafting in an era of decreasing volume—invited critique
JF Archives of Surgery
JO Archives of Surgery
YR 2008
FD April 1
VO 143
IS 4
SP 344
OP 344
DO 10.1001/archsurg.143.4.344
UL http://dx.doi.org/10.1001/archsurg.143.4.344
AB 
It has been assumed by many, based on previous studies,1- 2 that there is a linkage between hospital cardiac surgical case volumes and outcomes, whereby improved outcomes are associated with high-volume centers. Regionalization strategies and recommendations, adopted by state certificate of need regulations and health care industry consortia (eg, the Leapfrog Group), are largely predicated on these assumptions in that they espouse concentrating bypass surgery procedural volumes in the interest of improving quality and outcomes. Findings from this article suggest that such traditional volume-outcome tenets may be overly simplistic and inaccurate in assessing current CABG practices. In an analysis of the Society of Thoracic Surgeons' National Cardiac Surgery Database, DiSesa et al3 recently reported that, although certificate of need regulations have been successful in increasing hospital CABG volumes, their effect on procedural mortality or morbidity seems to be negligible. There is growing experiential evidence that hospital-based quality control, monitoring, and best-practice programs may have a more significant effect on outcomes.