What question did this study set out to answer?

To compare the appropriateness of coronary artery bypass graft (CABG) surgery using expert panel criteria, consortium surgeon-revised criteria, and individual case reviews by operating surgeons.

July 1, 1996Annals of Internal Medicine

The Appropriateness of Coronary Artery Bypass Graft Surgery in Academic Medical Centers

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Population

Random sample of 1,156 patients who had isolated coronary artery bypass graft surgery in 1990 at 12 Academic…

Design

Cross-sectional, Random sample of medical records

Authors

LLLucian L. LeapeHarvard University

Discussion

Member takes

Implication

Low inappropriate CABG rates in academic centers support appropriateness criteria; leaves open contemporary relevance and generalizability beyond 1990 data.

Key Points

To compare the appropriateness of coronary artery bypass graft (CABG) surgery using expert panel criteria, consortium surgeon-revised criteria, and individual case reviews by operating surgeons.
Retrospective, randomized medical record review of a random sample of N=1156 patients who underwent isolated CABG surgery in 1990 across 12 Academic Medical Center Consortium hospitals.
Trained abstractors retrieved clinical data using explicit collection tools, followed by surgeon reviews of cases classified as inappropriate or of uncertain appropriateness.
Expert panel criteria classified 83% of CABG surgeries (95% CI, 81% to 85%) as necessary, 9% (95% CI, 8% to 10%) as appropriate, 7% (95% CI, 5% to 8%) as uncertain, and 1.6% (95% CI, 0.6% to 2.5%) as inappropriate.
Inappropriate procedure rates ranged from 0% to 5% across member hospitals (P=0.02), and surgeon revisions of indications shifted the inappropriate rate only slightly from 1.6% to 1.9%.
Local surgeon reviews identified data collection errors that caused erroneous classifications in 12.5% of 64 inappropriate or uncertain cases.

Structured PICO

Population

Random sample of 1,156 patients who had isolated coronary artery bypass graft (CABG) surgery in 1990 at 12 Academic Medical Center Consortium hospitals.

Intervention

Coronary artery bypass graft (CABG) surgery

Outcome

Percentage of patients with indications for which CABG surgery was classified as appropriate, inappropriate, or of uncertain appropriateness

Academic Medical Center Consortium hospitals demonstrated very low rates of inappropriate CABG surgery, though local physician review is recommended to correct data collection errors in appropriateness audits.

Limitations

Potential data collection errors causing erroneous ratings in appropriateness criteria

Cite This Study

Lucian L. Leape (1996) studied this question.

synapsesocial.com/papers/6a85aba9b451cea71dae73bd https://doi.org/10.7326/0003-4819-125-1-199607010-00003

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Implication

Low inappropriate CABG rates in academic centers support appropriateness criteria; leaves open contemporary relevance and generalizability beyond 1990 data.

The Appropriateness of Coronary Artery Bypass Graft Surgery in Academic Medical Centers

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

The Appropriateness of Coronary Artery Bypass Graft Surgery in Academic Medical Centers

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider