Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • Classified ads
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

Centralizing coronary artery bypass grafting surgery

Richard Alvarez and Charlyn Black
CMAJ May 28, 2002 166 (11) 1398;
Richard Alvarez
*President and CEO, Canadian Institute for Health Information, Toronto, Ont.; †Director, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, B.C.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Charlyn Black
*President and CEO, Canadian Institute for Health Information, Toronto, Ont.; †Director, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, B.C.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Kalant and Shrier discuss findings regarding low-volume surgical procedures in a recent report by the Canadian Institute for Health Information.1 We agree with their position that health care policymakers must base their decisions on careful review of the entire body of evidence.

In evaluating research findings, we believe that rigorous, systematic lit- erature reviews are important. Well- established methods exist for conducting such reviews (e.g., the QUORUM statement2 referenced by major journals). Use of similarly rigorous standards to synthesize the research literature minimizes the possibility of random or systematic error biasing conclusions.

In Health Care in Canada 2001, we cite several early articles in the field plus the only published recent broad systematic review of the literature on the relationship between volume and mortality. This review, published in JAMA in 2000,3 summarized research on the relationship between hospital caseload and outcomes for 40 conditions based on findings from 72 studies that were evaluated for scientific merit and relevance according to explicit, pre-determined criteria. Eleven published studies on coronary artery bypass graft surgery (CABG) met these criteria. All showed better outcomes with higher volumes; the difference was statistically significant in 9 of them.

In Canada, the number of both rare and common surgical procedures currently performed by individual hospitals varies, often significantly. Some types of care are becoming concentrated over time. For example, as of 1998/99, no Canadian hospital performing CABG surgery had less than 200 cases per year, down from 5 hospitals in 1996/97.1

Volume-outcome relationships are clearly an area of current clinical and policy interest. Indeed, the recent Sinclair inquest found that “the limited number of cases [of pediatric cardiac surgery] that can be undertaken in a province like Manitoba with a population of just over 1 million increases the risk of morbidity and mortality.”4

Based on current evidence, we stand by our original conclusion that “deciding how much to centralize care requires us to strike a balance across [a variety of] issues. This balance is likely to vary from procedure to procedure and place to place.” In this context, systematic reviews of the research literature, an understanding of current Canadian volume patterns, and better information about patient outcomes at individual hospitals can all provide evidence to support decisions about how best to organize health services and distribute health care resources.

Richard Alvarez President and CEO Canadian Institute for Health Information Toronto, Ont. Charlyn Black Director, Centre for Health Services and Policy Research University of British Columbia Vancouver, B.C.

References

  1. 1.↵
    Canadian Institute for Health Information. Health care in Canada. Ottawa: The Institute; 2001.
  2. 2.↵
    Moher D, et al, for the QUORUM Group. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUORUM statement. Lancet 1999; 354(9193):1896-900.
    OpenUrlCrossRefPubMed
  3. 3.↵
    Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000; 283(9):1159-66.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Provincial Court of Manitoba. The report of the Manitoba pediatric cardiac surgery inquest: an inquiry into twelve deaths at the Winnipeg Health Sciences Centre in 1994. Available: http://www.pediatriccardiacinquest.mb.ca (accessed 2002 Apr 12).
PreviousNext
Back to top

In this issue

CMAJ
Vol. 166, Issue 11
28 May 2002
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Centralizing coronary artery bypass grafting surgery
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Centralizing coronary artery bypass grafting surgery
Richard Alvarez, Charlyn Black
CMAJ May 2002, 166 (11) 1398;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Centralizing coronary artery bypass grafting surgery
Richard Alvarez, Charlyn Black
CMAJ May 2002, 166 (11) 1398;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Moving surgical care out of hospitals to reduce wait times
  • Coexisting failures do not diminish the stature of a giant
  • Dare we hope
Show more Letters

Similar Articles

Collections

  • Topics
    • Health policy
    • Cardiothoracic surgery

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire