Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 1997 Oct;87(10):1645–1648. doi: 10.2105/ajph.87.10.1645

Are the best coronary artery bypass surgeons identified by physician surveys?

A J Hartz 1, J S Pulido 1, E M Kuhn 1
PMCID: PMC1381127  PMID: 9357346

Abstract

OBJECTIVES: This study assessed the validity of surveys for identifying the best coronary artery bypass surgeons. METHODS: Data on physicians who performed coronary artery bypass surgery were available from New York, Pennsylvania, and Wisconsin. Data on physicians' reputation were obtained from one national and five city surveys. The measure of surgical performance was the mortality ratio (MR), that is, the ratio of the observed to the predicted patient mortality rate. RESULTS: Mortality ratios were very similar for the 10,722 patients treated by the 31 surgeons defined as "best" doctors in the surveys (MR = 98) and for the 74,854 patients treated by 243 other surgeons who had more than a minimal number of cases (MR = .96). The mortality ratio was 1.34 for the patients treated by surgeons with the lowest volumes and .87 for the surgeons who performed more than 400 coronary artery bypass surgeries in 3 years. CONCLUSIONS: These results suggest that the quality of a coronary artery bypass surgeon may be more closely associated with patient volume than with the surgeon's reputation among peers.

Full text

PDF
1645

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Flood A. B., Scott W. R., Ewy W. Does practice make perfect? Part I: The relation between hospital volume and outcomes for selected diagnostic categories. Med Care. 1984 Feb;22(2):98–114. [PubMed] [Google Scholar]
  2. Green J., Wintfeld N. Report cards on cardiac surgeons. Assessing New York State's approach. N Engl J Med. 1995 May 4;332(18):1229–1232. doi: 10.1056/NEJM199505043321812. [DOI] [PubMed] [Google Scholar]
  3. Hannan E. L., Kilburn H., Jr, Bernard H., O'Donnell J. F., Lukacik G., Shields E. P. Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors. Med Care. 1991 Nov;29(11):1094–1107. [PubMed] [Google Scholar]
  4. Hannan E. L., Kilburn H., Jr, Racz M., Shields E., Chassin M. R. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA. 1994 Mar 9;271(10):761–766. [PubMed] [Google Scholar]
  5. Hannan E. L., Kumar D., Racz M., Siu A. L., Chassin M. R. New York State's Cardiac Surgery Reporting System: four years later. Ann Thorac Surg. 1994 Dec;58(6):1852–1857. doi: 10.1016/0003-4975(94)91726-4. [DOI] [PubMed] [Google Scholar]
  6. Hannan E. L., Siu A. L., Kumar D., Kilburn H., Jr, Chassin M. R. The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume. JAMA. 1995 Jan 18;273(3):209–213. [PubMed] [Google Scholar]
  7. Hartz A. J., Kuhn E. M. Comparing hospitals that perform coronary artery bypass surgery: the effect of outcome measures and data sources. Am J Public Health. 1994 Oct;84(10):1609–1614. doi: 10.2105/ajph.84.10.1609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hartz A. J., Kuhn E. M., Kayser K. L., Pryor D. P., Green R., Rimm A. A. Assessing providers of coronary revascularization: a method for peer review organizations. Am J Public Health. 1992 Dec;82(12):1631–1640. doi: 10.2105/ajph.82.12.1631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Landon B., Iezzoni L. I., Ash A. S., Shwartz M., Daley J., Hughes J. S., Mackiernan Y. D. Judging hospitals by severity-adjusted mortality rates: the case of CABG surgery. Inquiry. 1996 Summer;33(2):155–166. [PubMed] [Google Scholar]
  10. Luft H. S., Bunker J. P., Enthoven A. C. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979 Dec 20;301(25):1364–1369. doi: 10.1056/NEJM197912203012503. [DOI] [PubMed] [Google Scholar]
  11. Luft H. S., Hunt S. S., Maerki S. C. The volume-outcome relationship: practice-makes-perfect or selective-referral patterns? Health Serv Res. 1987 Jun;22(2):157–182. [PMC free article] [PubMed] [Google Scholar]
  12. Luft H. S. The relation between surgical volume and mortality: an exploration of causal factors and alternative models. Med Care. 1980 Sep;18(9):940–959. doi: 10.1097/00005650-198009000-00006. [DOI] [PubMed] [Google Scholar]
  13. Omoigui N. A., Miller D. P., Brown K. J., Annan K., Cosgrove D., 3rd, Lytle B., Loop F., Topol E. J. Outmigration for coronary bypass surgery in an era of public dissemination of clinical outcomes. Circulation. 1996 Jan 1;93(1):27–33. doi: 10.1161/01.cir.93.1.27. [DOI] [PubMed] [Google Scholar]
  14. Showstack J. A., Rosenfeld K. E., Garnick D. W., Luft H. S., Schaffarzick R. W., Fowles J. Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs nonscheduled operations. JAMA. 1987 Feb 13;257(6):785–789. [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES