We appreciate the interest shown in our article1 by Gualis Cardona et al., and we agree that the outcomes of coronary intervention should be public and transparent. While we agree on this principle, we would also like to discuss some of the methodological points raised by Gualis Cardona et al.
- 1.
Our study did not analyze the existence of a proportional a relationship between the volume of interventions and outcomes. We found a marked dispersion and an association between volume and outcomes (risk-adjusted in-hospital mortality and readmissions) when we compared hospitals by volume (“high-volume” vs “low-volume”).
- 2.
The differences in the crude mortality rate in isolated coronary artery bypass grafting (CABG) between our study and the administrative register (3% vs 2.8%) do not appear to be relevant, as there are differences in the patient selection and not all hospitals are included in the Spanish Society of Cardiothoracic Surgery register.
- 3.
Unlike the reference cited by Gualis Cardona et al.,2 more recent articles show the validity of administrative databases for predicting mortality risk in CABG.3 However, the validity of using the National Minimum Dataset for predicting outcomes in CABG must be studied, as has been done for acute coronary syndrome.4
- 4.
As described in our article, we excluded CABG procedures performed during an episode of acute myocardial infarction, to select, as far as possible, for elective surgery.
- 5.
Our study listed the cardiac surgical procedures associated with non-isolated CABG: 35.*; 37.32-4;37.5*; 37.60; 37.63-68 and 37.90.
Concentrating CABG programs may help us reach the minimum volumes established by the international scientific societies (references 5 and 6 in our original article). The risk-adjusted outcomes should be a guide for both planning the health care resources required and choosing the most appropriate procedure in each patient. Analyzing the causes of apparently suboptimal outcome markers of health (for coronary intervention or any other healthcare activity) in different hospitals is an ethical obligation for all those involved in health care.
FUNDINGFundación Interhospitalaria de Investigación Cardiovascular (FIC), Spain. FIC 1/19.