Much of Heart Surgery Done in U.S. Deemed Unnecessary

U.S. doctors may perform unnecessary coronary bypass operations more often than previously thought, while British doctors apparently conduct the surgery too infrequently, says a RAND Corp. study.

The findings, published in today’s issue of the British medical journal Lancet, suggest that the United States could cut health care costs without having to ration needed cardiac care, while Britain already is rationing such care, said Dr. Robert H. Brook, the RAND researcher who headed the study.

Brook and his American and British colleagues conducted their study by organizing two panels of doctors, one with nine U.S. physicians and the other with nine from Britain. Each panel then rated the “appropriateness,” or necessity, of two procedures for a series of hypothetical heart patients.

One procedure was coronary bypass, in which doctors try to prevent heart attacks and heart pain by surgically attaching new blood vessels to the heart to replace clogged arteries. The second procedure was coronary angiography, in which doctors search for blockages in coronary arteries by injecting them with dye and then X-raying them.

The panels’ review of hypothetical patients produced criteria for determining when bypass surgery and angiography are necessary or unnecessary.

The researchers then applied those criteria to 386 coronary bypass operations performed on real Medicare patients in Washington state. The criteria used by British doctors meant 35% of the operations were unnecessary, while the U.S. doctors’ criteria meant only 13% were rated as unnecessary.

More than 200,000 Americans undergo coronary bypass surgery each year, and some American studies suggest at least 25,000 of them, or about 13%, are unnecessary, the Journal of the American Medical Assn. reported last year.