title: Institutional variation of coronary artery bypass graft surgery: emphasis on myocardial protection.
abstract: There are institutional variations in the operative mortality of coronary artery bypass graft surgery (CABG). Patient selection, based on clinical and angiographic criteria, is a significant factor. Even after adjustment for patient selection, institutional differences remain. Operative experience and volume of cases are also related to institutional variations. Recent attention to the technique of myocardial preservation has highlighted its significance in reducing the incidence of perioperative myocardial infarction and operative mortality. Institutional heterogeneity also exists in the nonoperative management of ischemic heart disease. However, undetected factors probably significantly affect the outcome. These institutional variations emphasize a major advantage of randomized clinical trials--that they should equalize these unknown factors.
mesh_terms: D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011897:Random Allocation