The appropriateness of use of coronary artery bypass graft surgery in New York State

Article Abstract:

The inappropriate use of coronary artery bypass graft (CABG) surgery is very low in New York State. CABG surgery is used to treat patients suffering from angina (chest pain) or coronary artery disease. Among 1,338 patients who underwent CABG surgery in New York State during 1990, 43% were suffering from chronic stable angina, 28% had suffered a heart attack and 22% were suffering from unstable angina. Ninety-one percent of the surgeries were performed for appropriate indications (signs) of disease, 7% for uncertain indications and only 2.4% for inappropriate indications. The number of appropriate or inappropriate surgeries did not differ significantly among hospitals. The number of inappropriate surgeries in New York State was less than in 1979, 1980 or 1982. The largest decrease in inappropriate surgeries occurred among the patients undergoing a CABG for one- or two-vessel coronary artery disease.

Health aspects, Surgery, Coronary heart disease, New York, Angina pectoris, New York (State)

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The appropriateness of coronary artery bypass graft surgery in academic medical centers

Article Abstract:

Academic medical centers appear to do very few unnecessary coronary artery bypass graft (CABG) surgeries. The Academic Medical Center Consortium, a consortium of 12 teaching hospitals, reviewed the records of 1,156 patients who had had a CABG in a single year. Only 1.6% of the surgeries were deemed inappropriate and 7% were deemed uncertain when judged according to criteria developed by an expert panel. Cardiac surgeons practicing at the 12 hospitals developed a revised set of criteria, and while they disagreed on individual cases, the overall percentage for inappropriate surgery was still only 1.9%.

Management, Statistics, Hospitals, University, University hospitals, Surgery, Unnecessary, Unnecessary surgery

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The reproducibility of a method to identify the overuse and underuse of medical procedures

Article Abstract:

Methods to determine whether a medical procedure is appropriate may be effective when applied to large populations but should not be used on individual patients. Three nine-member panels of experts rated the appropriateness of coronary revascularization and hysterectomy. Over 90% agreed that coronary revascularization was underused in some cases and overused in others. There was less agreement on the appropriateness of hysterectomy. When applied to real patients, there was great variability among the experts as to whether the procedures were underused or overused.

Evaluation, Medical care, Medical care utilization

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