Does government regulation enhance quality of cardiovascular procedures?

Cardiovascular specialists encumbered with excessive intrusion into the patient-doctor relationship will likely agree with the conclusion of DiSesa et al1 that the coronary artery bypass grafting (CABG) mortality rate was not different between the 26 states with certificate-ofneed (CON) programs and the 24 states without CON regulation. Data from the Society of Thoracic Surgeons’ (STS) National Cardiac Database (NCD) on 595 200 patients undergoing isolated CABG procedures for 4 consecutive years ending in 2003 used the STS NCD risk-stratification algorithm to predict an equivalent occurrence of death after CABG during hospitalization or within 30 days for both the 280 512 patients treated in non-CON states and the 314 710 patients treated CON states (Table 5 in DiSesa et al1). The observed perioperative CABG mortality rate was 2.52% for CON states and 2.62% for states without CON regulations (odds ratio [OR] 0.97, P 0.32).