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January 1, 1997Annals of Internal Medicine

Coronary Artery Bypass Graft Surgery in Ontario and New York State: Which Rate Is Right?

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Why the study?

Are there differences in the rates and clinical characteristics of patients undergoing isolated CABG surgery between New York State and Ontario?

Population

22,207 patients (16,690 in New York and 5,517 in Ontario) who had isolated CABG surgery in 1993.

Comparison

Isolated CABG surgery in New York State vs Isolated CABG surgery in Ontario

Design

Cohort

Authors

JTJack V. TuHeart Failure & TransplantCNC. David NaylorMcMaster UniversityDKDinesh KumarInterventional Cardiology

Discussion

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Implication

Regional CABG rate differences may signal varying appropriateness thresholds; leaves open need for standardized criteria and prospective validation.

Key Points

  • To compare the service context and clinical characteristics of CABG surgery patients in New York and Ontario.
  • Retrospective analysis of cardiac surgery registries data from New York and Ontario.
  • Included 16,690 patients from New York and 5,517 patients from Ontario who underwent isolated CABG surgery in 1993.
  • Measurements focused on clinical characteristics and CABG surgery rates by coronary anatomy.
  • The age-adjusted rate of CABG surgery was 1.79 times higher in New York than in Ontario (95% CI, 1.74 to 1.85).
  • Higher proportion of elderly, female patients, and those with recent myocardial infarction in New York (P < 0.001).
  • CABG surgery rates for left main disease were 2.53 times higher in New York, and 8.97 times higher for patients with limited coronary disease.

Structured PICO

Are there differences in the rates and clinical characteristics of patients undergoing isolated CABG surgery between New York State and Ontario?

P
Population
22,207 patients (16,690 in New York and 5,517 in Ontario) who had isolated CABG surgery in 1993.
I
Intervention
Isolated CABG surgery in New York State
C
Comparator
Isolated CABG surgery in Ontario
O
Outcome
Clinical characteristics of patients having CABG surgery and rates of CABG surgery by coronary anatomy

The significantly higher rate of CABG surgery in New York compared to Ontario is driven by both potential underservicing of severe disease in Ontario and overservicing of limited disease in New York.

Cite This Study

Tu et al. (1997) studied this question.

synapsesocial.com/papers/6a7269adc2d7c309082738ffhttps://doi.org/10.7326/0003-4819-126-1-199701010-00002
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State1994 · 25 citations
  2. 2Coronary Artery Bypass Mortality Rates in Ontario1996 · 69 citations
  3. 3Temporal Trends in the Use of Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery in New York State and Ontario2010 · 83 citations
  4. 4Prevalence and Extent of Obstructive Coronary Artery Disease Among Patients Undergoing Elective Coronary Catheterization in New York State and Ontario2013 · 81 citations
  5. 5The Appropriateness of Use of Coronary Artery Bypass Graft Surgery in New York State1993 · 218 citations