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Clement J. McDonald, MD; John F. Fitzgerald, MD
Indiana University School of Medicine Indianapolis

JAMA. 1992;267(7):932-933.

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

To the Editor.

—After examining community-wide data, O'Connor et al¹ and Williams et al² reported that coronary artery bypass graft (CABG) surgery has a perioperative mortality of 4% and 8%, respectively. These mortality estimates approximate those from other reports of community-wide studies³ but are twofold higher than the mortality reported in studies of CABG surgery done in referral centers.^4,5 At least two other surgical procedures for which communitybased mortality data are available show a similar pattern. One study of carotid endarterectomy showed a perioperative mortality of 3.4%,⁶ far exceeding the 0.6% mortality rate reported in a recent multicenter clinical trial of the efficacy of carotid endarterectomy.⁷ Similarly, in a community-wide study of prostatectomy, Wennberg et al⁸ observed a short-term mortality rate of 3.7%, in contrast to the accepted short-term mortality rate of 1.0%.⁹

A number of biases or distortions could account for . . . [Full Text PDF of this Article]

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