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David M. Shahian, MD

JAMA. 2004;291:246-248.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In this issue of THE JOURNAL, Peterson and colleagues¹ use data from the Society of Thoracic Surgeons National Cardiac Database (STS NCD), the largest clinical cardiac surgery database in the world, to enhance current understanding of the volume-outcome relationship for coronary artery bypass graft (CABG) surgery. This large national study also will contribute to the ongoing debate regarding the relative merits of volume-based referral strategies, outcome reporting, and process-improvement initiatives to promote cardiac surgery quality.^2-5

Since the pioneering work of Luft and colleagues in 1979,⁶ hundreds of studies have investigated the association between volume (a structural characteristic of health care providers) and outcome for complex surgical procedures and for the management of certain medical conditions.^{2, 7-15} The overwhelming majority of studies have shown a direct relationship between volume and outcome for both hospitals and individual practitioners. There is also important synergy between these 2 provider levels. High-volume . . . [Full Text of this Article]

Author Affiliation: Lahey Clinic, Burlington, Mass.

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