Differences in mortality from coronary artery bypass graft surgery at five teaching hospitals

Article Abstract:

Coronary artery bypass grafting is now a relatively common procedure used to replace critical heart arteries that are defective. A comparison of the mortality rate of this serious surgical procedure among five teaching hospitals in Philadelphia was conducted to identify factors that might be altered to improve the survival rate. The study found that there were significant differences among the medical centers in the death rate. These differences were limited to patients who required catheterization during the surgical procedure. Such patients are, in general, more seriously ill than the patients who do not require catheterization. However, the differences among the hospitals could not be explained by differences in the severity of illness of the patients. Rather, there were indications that the variations may be due to the skills of the surgeons involved. During the course of the study, some of the mortality rates of the medical centers changed, and these changes correlated with the movement of specific surgeons from one medical center to another. There was some indication that hospitals performing an increasing number of grafting procedures may enjoy a decrease in the mortality rate, perhaps as a result of increased experience on the part of the hospital staff. This correlation is not conclusive, however. The results of this study indicated that, although more seriously ill patients were more likely to die, differences in the mortality rates among different hospitals and among different surgeons cannot be attributed to patient differences alone. Further study of these differences may reveal ways in which the mortality rate from coronary artery bypass grafting may be improved. (Consumer Summary produced by Reliance Medical Information, Inc.)

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The double edge of knowledge

Article Abstract:

Two rather surprising articles may be found in the August 14, 1991 issue of The Journal of the American Medical Association. The contents of the articles are less surprising than what they imply about their authors. Both articles compare the mortality rates of coronary bypass operations at different institutions and by different surgeons. The somewhat disturbing result is that some surgeons seem to be much better than others; some surgeons have patient death rates that are three times (or more) as high as their colleagues. The surprising part is that the reports do not come from some agency responsible for overseeing medical care or a patient advocacy organization. The reports come from the institutions and surgeons themselves. The investigation into the death rates among patients undergoing coronary bypass operations result from a desire to improve the success rate of the operation. The identification of surgeons who are performing better, as well as those who are performing worse, is a critical step in learning what can be done to improve the situation, as well as to provide better training for surgeons performing the procedures. The authors know that many people will be upset to learn that some surgeons, perhaps their own, may have a success rate significantly inferior to that of some professional peers. Indeed, the information presented in the reports may even become the fodder for some lawsuits. However, the authors are to be commended for a courageous effort to place knowledge above personal concerns and to take a necessary, if perhaps difficult, step towards improving medical treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery

Article Abstract:

Complication rates do not appear to provide accurate measures of quality of care in hospitals. Fifty-seven hospitals that perform coronary artery bypass graft (CABG) surgery were ranked according to mortality rate, complication rate, and rate of failure to rescue patients who suffer complications. Adjustments were made for severity of illness. Of 16,673 patients studied, 7,173 patients had complications, of which 717 died. The hospitals were ranked according to expected outcomes. Rankings based on complication rates did not correlate with rankings based on death rates and failure-to-rescue rates. Large hospitals with magnetic resonance and bone marrow transplant facilities, lithotripsy machine, high nurse-to-bed ratio and teaching staff had greater complication rates, but their death rates were lower than expected. Death rates are a common measure of quality of care at hospitals.

Mortality, Hospitalization, Hospital care

Similar abstracts:

• Abstracts: A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery

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