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Dr Pittman raises some interesting practical issues arising from our article on the relationship between low surgeon case volumes and poor outcomes for carotid endarterectomy. Others too have considered this issue¹ and have failed to develop policy recommendations because the problem is not straightforward. Although most people would agree that surgeons should not perform just 1 or 2 endarterectomies per year, it would be difficult to get a consensus on a higher limit. Nevertheless, change is possible, as shown by the reduction in the number of low-volume cardiac surgeons in New York State after attention was focused on the problem through public release of the outcomes of coronary bypass surgery by program and surgeon.^2-3 Perhaps the public release of outcome results might have a similar beneficial effect in carotid endarterectomy.

Concern was raised about the difficulty of young surgeons gaining enough experience to reach an adequate volume threshold. . . . [Full Text of this Article]

Thomas E. Feasby, MD
Edmonton, Alberta

Hude Quan, MD, PhD; William A. Ghali, MD, MPH
Calgary, Alberta

RELATED ARTICLE

Carotid Endarterectomy: Turning Up the Volume?
Gregory Pittman
Arch Neurol. 2004;61(2):296.
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