Excellence and low case volume: an example of the inapplicability of volume-based credentialing.
BACKGROUND
Health care reform, public disclosure of hospital and surgeon-specific results, plus changes in reimbursement patterns have raised the specter of volume-based credentialing.


METHODS
Using The Society of Thoracic Surgeons Cardiac Database, we examined the data for all coronary artery bypass graft-only patients (n = 615) operated on by us from July 1991 to June 1997.


RESULTS
The observed mortality was 0.33% and the observed-to-expected ratio was 0.12 (p<0.005). Morbidity was low as well.


CONCLUSIONS
Excellent results can be obtained for patients undergoing coronary artery bypass grafting in the presence of both low surgeon and low hospital case volume.
Early
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Heartland Regional Medical Center, St. Joseph, Missouri, USA.
Roberts
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SR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000175:diagnosis / Q000601:surgery; D003406:Credentialing; D019992:Databases as Topic; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006780:Hospitals, Rural / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D019982:Organizational Case Studies; D011787:Quality of Health Care; D013249:Sternum / Q000601:surgery; D015996:Survival Rate; D013908:Thoracotomy