Adult open heart surgery in New York State: an analysis of risk factors and hospital mortality rates

Article Abstract:

Two major factors must be evaluated in determining the quality of care received by patients treated for coronary artery disease (disease of the arteries that supply blood to the heart itself): the treatment approach chosen, and the care provided while treatment is underway. To establish a method for assessing the quality of care in cardiac surgical centers, data were analyzed from the Cardiac Surgery Reporting System (CSRS, a system of surgical report forms filled out upon hospital discharge). Results from 7,596 open heart surgery patients discharged in 1989 from 28 hospitals in New York State were evaluated. Half the patients who underwent open heart surgery were under 65; 70 percent were under 70. Almost half had high blood pressure, and one-sixth had diabetes. The overall in-hospital mortality after surgery was 4.9 percent. The proportion of patients who died in the hospital increased with increasing patient age, and women and blacks had higher mortality (6.9 and 7.5 percent) than men and whites (4 and 4.8 percent, respectively). A table of the crude mortality rates for the 28 hospitals is presented: these varied between 2.2 and 14.3 percent. When variation due to different patient populations was taken into account, mortality ranged between 2.8 and 9.3 percent. Four hospitals had fatality rates higher than expected; another four had rates lower than expected. Review of the medical records from 40 of the 44 patients who died in hospitals in the former category indicated that 18 had quality-of-care problems. The results show that the CSRS can be used to evaluate cardiac surgical care for an entire state. A discussion of its potential applications is provided. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Coronary heart disease, Heart, Hospitalization, Hospital care, Heart surgery

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The decline in coronary artery bypass graft surgery mortality in New York State: the role of surgeon volume

Article Abstract:

Patients of surgeons who perform the fewest coronary artery bypass graft (CABG) surgeries may have a higher death rate than patients of surgeons who perform the greatest number of CABG surgeries. Researchers studied the medical data of 57,187 patients who had CABG surgery in one of 30 New York State hospitals between 1989 and 1992. Investigators evaluated the relationship between the quantity of CABG operations performed by surgeons and the in-hospital patient death rate. The number of CABG surgeries increased by 31% from 1989 to 1992. The yearly patient death rate decreased by 21% over the course of the study, although the average severity of patients' illness increased. The number of surgeons who performed 50 or fewer CABG surgeries per year decreased from 39 in 1989 to 33 in 1992 while the number of surgeons who performed more than 150 CABG operations per year increased from 30 to 41. In 1989 patients whose surgeons performed the fewest CABG operations per year were 2.22 times more likely to die in-hospital than patients whose surgeons performed the most operations. However, by the end of the study the gap had narrowed.

Health aspects, Complications and side effects, Cardiac patients

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Investigation of the relationship between volume and mortality for surgical procedures performed in New York state hospitals

Article Abstract:

Recent studies have shown that the more often a hospital or surgeon performs a given surgical procedure the fewer patients die from the procedure. A study which examined the relationship between hospital and physician volume and death rates also investigated the threshold volumes above which the death rate drops. There were significant but different relationships between volume and death rates for five procedures. For surgical removal of the gallbladder, hospital volume had a large effect on the death rate and surgeon volume a small effect. For coronary artery bypass surgery, repairing aneurysms of the abdominal aorta, removal of part of the stomach, and removal of the colon , surgeon volume had a large effect on death rates and hospital volume a small effect. Annual volume thresholds for hospitals are 5 removals of part of the stomach, 40 removals of the colon, and 170 removals of the gall bladder.

Statistics, Surveys, Cholecystectomy, Aortic aneurysms, Aortic aneurysm, Gastrectomy, Colectomy

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