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  1. The decline in coronary artery bypass graft surgery mortality in New York State : the role of surgeon volume.

    Article - En anglais

    Objective

    - To examine the longitudinal relationship between surgeon volume and in-hospital mortality for coronary artery bypass graft (CABG) surgery in New York State and to explain changes in mortality that occurred over time.

    Design

    - Observation of clinically risk-adjusted operative mortality over time.

    Setting

    - Ali 30 New York State hospitals in which CABG surgery was performed for 1989 through 1992.

    Patients

    - All 57187 patients undergoing isolated CABG surgery in New York State in 1989 through 1992 in the 30 hospitals.

    Main Outcome Measures

    - Actual, expected, and risk-adjusted mortality.

    Results

    - Risk-adjusted in-hospital mortality decreased for all categories of surgeons.

    Low-volume surgeons (¾50 operations per year) experienced a 60% reduction in risk-adjusted mortality in the 4-year period, whereas the highest-volume surgeons (>150 operations per year) experienced a 34% reduction.

    The percentage of patients undergoing CABG surgery by low-volume surgeons decreased from 7.6% in 1989 to 5.7% in 1992, a 25% decrease.

    Conclusions

    - The overall decline in risk-adjusted mortality could not be explained by shifts in patients away from low-volume surgeons to high-volume surgeons.

    The proportionately larger decrease in risk-adjusted mortality for low-volume surgeons could not be explained by changes in patient case mix or by improvements in the performance of surgeons with persistently low volumes.

    Mots-clés Pascal : Appareil circulatoire pathologie, Cardiopathie coronaire, Mortalité, Traitement, Homme, Chirurgie, Dérivation, Chirurgien, Aortocoronaire, Charge travail, Performance, New York, Etats Unis, Amérique du Nord, Amérique

    Mots-clés Pascal anglais : Cardiovascular disease, Coronary heart disease, Mortality, Treatment, Human, Surgery, Bypass, Surgeon, Aortocoronary, Workload, Performance, New York, United States, North America, America

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 95-0175541

    Code Inist : 002B25E. Création : 09/06/1995.