The role of hospital volume in coronary artery bypass grafting: is more always better?11>Presented, in part, at the Annual Meeting of the American Heart Association in New Orleans, Louisiana, on November 13, 2000.
Journal of the American College of CardiologyPublished 1 December 2001
Brahmajee K. Nallamothu, Sanjay Saint, Scott D. Ramsey, Timothy P. Hofer, Sandeep Vijan, Kim A. Eagle
Citations107
SJR quartileQ1
SJR score9.02
SNIP6.30
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TL;DR
Targeted regionalization of subjects at moderate risk or higher to high-volume hospitals would have resulted in an estimated 370 transfers and avoided 16 deaths; in contrast, full regionalization would have led to 2,029 transfers and prevented 20 deaths.
Abstract
Targeted regionalization might be a feasible strategy for balancing the clinical benefits of regionalization with patients' desires for choice and access.
Keywords
Medicine
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