The relation between quantity and quality with coronary artery bypass graft (CABG) surgery.

Many technical procedures may be done with better quality at higher volumes. In this paper, we examine the experience with coronary artery bypass graft (CABG) surgery. Immediate death rates (death during the hospital admission) with CABG vary widely, from lows of 1 percent or so to highs approaching 15 percent and perhaps higher. Research from the United States demonstrates clearly that there is a volume effect. Centres and surgeons with higher volumes have lower immediate mortality. The volume effect persists even at relatively high levels, that is, above 650 procedures a year for a hospital and above 116 procedures a year for a physician. This fact strongly supports regulation to centralize CABG facilities. In The Netherlands and Sweden, CABG is so regulated. No other European countries have strong regulation to centralize CABG provisions. Outcomes could be improved by such regulation.