This Article  • References  • Full text PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (224)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Scheduled vs Nonscheduled Operations

Jonathan A. Showstack, MPH; Kenneth E. Rosenfeld; Deborah W. Garnick, ScD; Harold S. Luft, PhD; Ralph W. Schaffarzick, MD; Jinnet Fowles, PhD

JAMA. 1987;257(6):785-789.

Abstract
Empirical evidence suggests that mortality rates for coronary artery bypass graft (CABG) surgery are lower in hospitals that perform a higher volume of the procedure. In recent years, the criteria for CABG surgery have been expanded to include patients with a wide variety of co-morbidities. To address the question of whether the volume-outcome relationship continues to exist for this new group of patients, discharge abstracts for 18986 CABG operations at 77 hospitals in California in 1983 were analyzed using multiple-regression techniques. Higher-volume hospitals had lower in-hospital mortality (adjusted for case mix); this effect was greatest in patients who might be characterized as having "non-scheduled" CABG surgery. Higher-volume hospitals also had shorter average postoperative lengths of stay and fewer patients with extremely long stays. The results of this study suggest that the greatest improvement in average outcomes for CABG surgery would result from the closure of low-volume surgery units.

(JAMA 1987;257:785-789)

Author Affiliations
From the Institute for Health Policy Studies, School of Medicine, University of California at San Francisco (Mssrs Showstack and Rosenfeld and Drs Garnick and Luft); Blue Shield of California, San Francisco (Dr Schaffarzick); and Health Services Research Center, Park-Nicollet Medical Foundation, St Louis Park, Minn (Dr Fowles).

Footnotes
Reprint requests to Institute for Health Policy Studies, University of California at San Francisco, 1326 Third Ave, San Francisco, CA 94143 (Mr Showstack).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: Does it matter?
Konety et al.
J. Thorac. Cardiovasc. Surg. 2009;137:1116-23.e1.
ABSTRACT | FULL TEXT  

Get With the Guidelines-Stroke Is Associated With Sustained Improvement in Care for Patients Hospitalized With Acute Stroke or Transient Ischemic Attack
Schwamm et al.
Circulation 2009;119:107-115.
ABSTRACT | FULL TEXT  

Case volume and mortality in haematological patients with acute respiratory failure
Lecuyer et al.
Eur Respir J 2008;32:748-754.
ABSTRACT | FULL TEXT  

Volume-outcome relationships in coronary artery bypass graft surgery patients: 5-year major cardiovascular event outcomes.
Lin et al.
J. Thorac. Cardiovasc. Surg. 2008;135:923-930.
ABSTRACT | FULL TEXT  

Volume-Outcome Relationship for Coronary Artery Bypass Grafting in an Era of Decreasing Volume
Ricciardi et al.
Arch Surg 2008;143:338-344.
ABSTRACT | FULL TEXT  

Risk Stratification and Comorbidity
Ferraris et al.
Card Surg Adult 2008;3:199-246.
FULL TEXT  

How Physicians Can Change the Future of Health Care
Porter and Teisberg
JAMA 2007;297:1103-1111.
ABSTRACT | FULL TEXT  

Disparities in the utilization of high-volume hospitals for complex surgery.
Liu et al.
JAMA 2006;296:1973-1980.
ABSTRACT | FULL TEXT  

Association Between Surgeon and Hospital Volume in Coronary Artery Bypass Graft Surgery Outcomes: A Population-Based Study
Wen et al.
Ann. Thorac. Surg. 2006;81:835-842.
ABSTRACT | FULL TEXT  

The Relation Between Surgeon Volume and Outcome Following Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery
Glance et al.
Chest 2005;128:829-837.
ABSTRACT | FULL TEXT  

Is Hospital Procedure Volume a Reliable Marker of Quality for Coronary Artery Bypass Surgery? A Comparison of Risk and Propensity Adjusted Operative and Midterm Outcomes
Zacharias et al.
Ann. Thorac. Surg. 2005;79:1961-1969.
ABSTRACT | FULL TEXT  

Are Young Surgeons Competent to Perform Alimentary Tract Surgery?
Prystowsky
Arch Surg 2005;140:495-502.
ABSTRACT | FULL TEXT  

Impact of Patient Risk on the Hospital Volume-Outcome Relationship in Coronary Artery Bypass Grafting
Nallamothu et al.
Arch Intern Med 2005;165:333-337.
ABSTRACT | FULL TEXT  

Evidence, Economics, And Emphysema: Medicare's Long Journey With Lung Volume Reduction Surgery
Ramsey and Sullivan
Health Aff (Millwood) 2005;24:55-66.
ABSTRACT | FULL TEXT  

Effects of Hospitalist Attending Physicians on Trainee Satisfaction With Teaching and With Internal Medicine Rotations
Hauer et al.
Arch Intern Med 2004;164:1866-1871.
ABSTRACT | FULL TEXT  

Is the Impact of Hospital and Surgeon Volumes on the In-Hospital Mortality Rate for Coronary Artery Bypass Graft Surgery Limited to Patients at High Risk?
Wu et al.
Circulation 2004;110:784-789.
ABSTRACT | FULL TEXT  

The Relationship Between Surgeon and Hospital Volume and Outcomes for Shoulder Arthroplasty
Jain et al.
JBJS 2004;86:496-505.
ABSTRACT | FULL TEXT  

Procedural Volume as a Marker of Quality for CABG Surgery
Peterson et al.
JAMA 2004;291:195-201.
ABSTRACT | FULL TEXT  

Surgeon Experience and Clinical and Economic Outcomes for Shoulder Arthroplasty
Hammond et al.
JBJS 2003;85:2318-2324.
ABSTRACT | FULL TEXT  

Is the hospital volume-mortality relationship in coronary artery bypass surgery the same for low-risk versus high-risk patients?
Glance et al.
Ann. Thorac. Surg. 2003;76:1155-1162.
ABSTRACT | FULL TEXT  

Do Hospitals and Surgeons With Higher Coronary Artery Bypass Graft Surgery Volumes Still Have Lower Risk-Adjusted Mortality Rates?
Hannan et al.
Circulation 2003;108:795-801.
ABSTRACT | FULL TEXT  

The volume-outcome relationship: from Luft to Leapfrog
Shahian and Normand
Ann. Thorac. Surg. 2003;75:1048-1058.
ABSTRACT | FULL TEXT  

Risk Stratification and Comorbidity
Ferraris and Ferraris
Card Surg Adult 2003;2:187-224.
FULL TEXT  

Mortality in Medicare Beneficiaries Following Coronary Artery Bypass Graft Surgery in States With and Without Certificate of Need Regulation
Vaughan-Sarrazin et al.
JAMA 2002;288:1859-1866.
ABSTRACT | FULL TEXT  

Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature
Halm et al.
ANN INTERN MED 2002;137:511-520.
ABSTRACT | FULL TEXT  

Association Between Subarachnoid Hemorrhage Outcomes and Number of Cases Treated at California Hospitals * Editorial Comment
Bardach et al.
Stroke 2002;33:1851-1856.
ABSTRACT | FULL TEXT  

Centralizing coronary artery bypass grafting surgery
Kalant and Shrier
CMAJ 2002;166:1397-1398.
FULL TEXT  

Survival of unselected stroke patients in a stroke unit compared with conventional care
Stavem and Ronning
QJM 2002;95:143-152.
ABSTRACT | FULL TEXT  

The role of hospital volume in coronary artery bypass grafting: is more always better?
Nallamothu et al.
J Am Coll Cardiol 2001;38:1923-1930.
ABSTRACT | FULL TEXT  

Better for whom? Policy implications of acting on the relation between volume and outcome in coronary artery bypass grafting
Luft
J Am Coll Cardiol 2001;38:1931-1933.
FULL TEXT  

Volume versus Outcomes in Orthopaedic Surgery: A Proper Perspective is Paramount
Clark and Heckman
JBJS 2001;83:1619-1621.
FULL TEXT  

Association Between Hospital and Surgeon Procedure Volume and Outcomes of Total Hip Replacement in the United States Medicare Population
Katz et al.
JBJS 2001;83:1622-1629.
ABSTRACT | FULL TEXT  

Comparing clinical outcomes in high-volume and low-volume off-pump coronary bypass operation programs
Brown et al.
Ann. Thorac. Surg. 2001;72:S1009-1015.
ABSTRACT | FULL TEXT  

Relationship of hospital size, case volume, and cost for coronary artery bypass surgery: Analysis of 12,774 patients operated on in Massachusetts during fiscal years 1995 and 1996
Shahian et al.
J. Thorac. Cardiovasc. Surg. 2001;122:53-64.
ABSTRACT | FULL TEXT  

Relation Between Operator and Hospital Volume and Outcomes Following Percutaneous Coronary Interventions in the Era of the Coronary Stent
McGrath et al.
JAMA 2000;284:3139-3144.
ABSTRACT | FULL TEXT  

Mortality after aortic valve replacement: results from a nationally representative database
Astor et al.
Ann. Thorac. Surg. 2000;70:1939-1945.
ABSTRACT | FULL TEXT  

Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy
O'Neill et al.
Neurology 2000;55:773-781.
ABSTRACT | FULL TEXT  

Managed Care Insurance and Use of Higher-Mortality Hospitals
Ensor et al.
JAMA 2000;284:829-831.
FULL TEXT  

Excellence and low case volume: an example of the inapplicability of volume-based credentialing
Early and Roberts
Ann. Thorac. Surg. 2000;69:146-150.
ABSTRACT | FULL TEXT  

Alabama Coronary Artery Bypass Grafting Cooperative Project: baseline data
Holman et al.
Ann. Thorac. Surg. 1999;68:1592-1598.
ABSTRACT | FULL TEXT  

Health Maintenance Organizations and Hospital Quality for Coronary Artery Bypass Surgery
Escarce et al.
Med Care Res Rev 1999;56:340-362.
ABSTRACT  

The Association between Hospital Volume and Survival after Acute Myocardial Infarction in Elderly Patients
Thiemann et al.
NEJM 1999;340:1640-1648.
ABSTRACT | FULL TEXT  

The Relationship Between Hospital Volume and Outcomes of Hepatic Resection for Hepatocellular Carcinoma
Glasgow et al.
Arch Surg 1999;134:30-35.
ABSTRACT | FULL TEXT  

Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction
Casale et al.
J Am Coll Cardiol 1998;32:885-889.
ABSTRACT | FULL TEXT  

Operator volume and outcome of patients undergoing coronary stent placement
Kastrati et al.
J Am Coll Cardiol 1998;32:970-976.
ABSTRACT | FULL TEXT  

What Patients Should Ask of Consumers' Guides to Health Care Quality
Rosenthal et al.
Eval Health Prof 1998;21:316-331.
ABSTRACT  

Pennsylvania's Focus on Heart Attack -- Grading the Scorecard
Jollis and Romano
NEJM 1998;338:983-987.
FULL TEXT  

Protecting Patient Welfare in Managed Care: Six Safeguards
Emanuel and Goldman
Journal of Health Politics, Policy and Law 1998;23:635-659.
ABSTRACT  

Relation of Operator Volume and Experience to Procedural Outcome of Percutaneous Coronary Revascularization at Hospitals With High Interventional Volumes
Ellis et al.
Circulation 1997;95:2479-2484.
ABSTRACT | FULL TEXT  

Relationship Between Physician and Hospital Coronary Angioplasty Volume and Outcome in Elderly Patients
Jollis et al.
Circulation 1997;95:2485-2491.
ABSTRACT | FULL TEXT  

Relationship between the Volume of Total Hip Replacements Performed by Providers and the Rates of Postoperative Complications in the State of Washington
KREDER et al.
JBJS 1997;79:485-94.
ABSTRACT | FULL TEXT  

Coronary Angioplasty Volume-Outcome Relationships for Hospitals and Cardiologists
Hannan et al.
JAMA 1997;277:892-898.
ABSTRACT  

Should Health Insurance Cover IVF? Issues and Options
Neumann
Journal of Health Politics, Policy and Law 1997;22:1215-1239.
ABSTRACT  

Coronary Artery Bypass Grafting Volume and Mortality
Pett et al.
Ann. Thorac. Surg. 1996;62:941-943.
FULL TEXT  

Users' Guides to the Medical Literature: X. How to Use an Article Reporting Variations in the Outcomes of Health Services
Naylor et al.
JAMA 1996;275:554-558.
ABSTRACT  

Relationship Between the Volume of Craniotomies for Cerebral Aneurysm Performed at New York State Hospitals and In-Hospital Mortality
Solomon et al.
Stroke 1996;27:13-17.
ABSTRACT | FULL TEXT  

Integrated Cardiac Care
Hallman and Edmonds
Ann. Thorac. Surg. 1995;60:1486-1489.
ABSTRACT | FULL TEXT  

The Relationship Between Coronary Angioplasty Procedure Volume and Major Complications
Kimmel et al.
JAMA 1995;274:1137-1142.
ABSTRACT  

Evaluation of the Complication Rate as a Measure of Quality of Care in Coronary Artery Bypass Graft Surgery
Silber et al.
JAMA 1995;274:317-323.
ABSTRACT  

Volume and outcome in coronary artery bypass graft surgery: true association or artefact?
Sowden et al.
BMJ 1995;311:151-155.
ABSTRACT | FULL TEXT  

The Relation between Universal Health Insurance and Cost Control
Goldberg and Marmor
NEJM 1995;332:742-745.
FULL TEXT  

Trauma Systems: A Model for Regionalized Care
Trunkey
JAMA 1995;273:421-422.
ABSTRACT  

The Decline in Coronary Artery Bypass Graft Surgery Mortality in New York State: The Role of Surgeon Volume
Hannan et al.
JAMA 1995;273:209-213.
ABSTRACT  

The Relation between the Volume of Coronary Angioplasty Procedures at Hospitals Treating Medicare Beneficiaries and Short-Term Mortality
Jollis et al.
NEJM 1994;331:1625-1629.
ABSTRACT | FULL TEXT  

The Impact of Organizational and Managerial Factors on the Quality of Care in Health Care Organizations
Flood
Med Care Res Rev 1994;51:381-428.
 

Temporary Firms in Community Hospitals: Elements of a Managerial Theory of Clinical Efficiency
Chilingerian and Glavin
Med Care Res Rev 1994;51:289-335.
 

Does More Intensive Treatment of Acute Myocardial Infarction in the Elderly Reduce Mortality? Analysis Using Instrumental Variables
McClellan et al.
JAMA 1994;272:859-866.
ABSTRACT  

Eleven Worthy Aims for Clinical Leadership of Health System Reform
Berwick
JAMA 1994;272:797-802.
ABSTRACT  

Chance, Continuity, and Change in Hospital Mortality Rates: Coronary Artery Bypass Graft Patients in California Hospitals, 1983 to 1989
Luft and Romano
JAMA 1993;270:331-337.
ABSTRACT  

Differences in Mortality From Coronary Artery Bypass Graft Surgery at Five Teaching Hospitals
Williams et al.
JAMA 1991;266:810-815.
ABSTRACT  

Adult Open Heart Surgery in New York State: An Analysis of Risk Factors and Hospital Mortality Rates
Hannan et al.
JAMA 1990;264:2768-2774.
ABSTRACT  

Postsurgical Mortality in Manitoba and New England
Roos et al.
JAMA 1990;263:2453-2458.
ABSTRACT  

Costs, Quality, and the Volume of Surgical Oncology Procedures
Munoz et al.
Arch Surg 1990;125:360-363.
ABSTRACT  

Academic Medicine as a Public Trust
Schroeder et al.
JAMA 1989;262:803-812.
ABSTRACT  

Investigation of the Relationship Between Volume and Mortality for Surgical Procedures Performed in New York State Hospitals
Hannan et al.
JAMA 1989;262:503-510.
ABSTRACT  

Is There a Rationale for Regionalizing Organ Transplantation Services?
Sloan et al.
Journal of Health Politics, Policy and Law 1989;14:115-167.
ABSTRACT  

Uses of the Peer Review Organization Medicare Database
Kelly et al.
American Journal of Medical Quality 1988;3:53-56.
ABSTRACT  

Comparison of Survival in Cardiac Surgery at a Veterans Administration Hospital and Its Affiliated University Hospital
Kress et al.
Arch Surg 1988;123:439-443.
ABSTRACT  

Effects of Formaldehyde on the Mucous Membranes and Lungs: A Study of an Industrial Population
Horvath et al.
JAMA 1988;259:701-707.
ABSTRACT  

Volume and Outcome of Coronary Artery Bypass Graft Surgery
Wilson et al.
JAMA 1987;257:2434-2434.
ABSTRACT