Use of coronary artery bypass surgery in the United States and Canada: influence of age and income

Article Abstract:

The rate of coronary artery bypass surgery (CABS) among the elderly appears to have increased dramatically both in Canada and the US between 1983 and 1989 while rates among the non-elderly have declined or remained the same. Rates of CABS were compared at hospitals in New York, California, Ontario, British Columbia and Manitoba. In the six-year period, California had the highest rates of CABS and the Canadian provinces had the lowest. Among people over age 75, the rates in California were 72% higher than those in New York and more than three times greater than the rates in any Canadian province. Among the non-elderly, the CABS rates increased with income in New York and California. In Canada, the highest CABS rates were among those living in the areas with the lowest incomes. The incidence of heart disease and death rate from heart disease is similar in both countries, but Canada has a universal health insurance system and the US does not. This suggests that the difference in CABS rates is due not to disease prevalence but differences in financial resources.

Aged, Elderly, Usage, Canada, Surgery, Poor

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Regionalization of cardiac surgery in the United States and Canada: geographic access, choice, and outcomes

Article Abstract:

Geographic areas that have regionalized facilities for coronary artery bypass (CABS) tend to produce better surgical outcomes than geographic areas where many low-volume hospitals are performing these procedures. Researchers studied hospital discharge records to assess post-CABS mortality rates and to calculate CABS volume in New York, California, Ontario, British Columbia, and Manitoba hospitals. They found the highest mortality rates in California hospitals that performed less than 100 CABS operations a year. Conversely, in New York and Canada where CABS operations were more often performed in hospitals with volumes of 500 or more CABS operations a year, mortality rates were significantly lower. In California between 1987 and 1989, one third of CABS operations were performed in hospitals with CABS volumes under 200 per year. In New York and Canada, 60% of CABS operations were performed in hospitals performing CABS in large volumes because of strict regulations on the number of CABS facilities.

Laws, regulations and rules, Hospitals, Quality management, Medical policy, Health policy

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