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

This study analyzes data from New York State's new Cardiac Surgery Reporting System, which contains information about cardiac preoperative risk factors, postoperative complications, and hospital discharge. The purposes of the study were to determine the set of significant clinical risk factors and to identify cardiac surgical centers most likely to have serious quality-of-care problems. Significant risk factors for in-hospital death were age, gender, ejection fraction, previous myocardial infarction, number of open heart operations in previous admissions, diabetes requiring medication, dialysis dependence, disasters (acute structural defect, renal failure, cardiogenic shock, gunshot), unstable angina, intractable congestive heart failure, left main trunk narrowed more than 90%, and type of operation performed. Four of the 28 hospitals had significantly higher mortality rates than expected, given the risk factors of their patients. Subsequent site visits and medical record reviews confirmed that these facilities had high percentages of quality-of-care problems among cases resulting in mortality.

[1]  E. Blackstone,et al.  Death and other time-related events after valve replacement. , 1985, Circulation.

[2]  J. V. Richardson,et al.  Reduced efficacy of coronary artery bypass grafting in women. , 1986, The Annals of thoracic surgery.

[3]  W. Copes,et al.  Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. , 1987, The Journal of trauma.

[4]  E. Blackstone.  Analysis of death (survival analysis) and other time-related events , 1986 .

[5]  F. Loop,et al.  Mortality and results after cardiac surgery in patients with end-stage renal disease. , 1988, Cleveland Clinic journal of medicine.

[6]  D. K. Williams,et al.  Assessing hospital-associated deaths from discharge data. The role of length of stay and comorbidities. , 1988, JAMA.

[7]  H. Horst,et al.  The relationship of scoring systems and mortality in the surgical intensive care unit. , 1987, The American surgeon.

[8]  L. Mickleborough,et al.  Increased risk of urgent revascularization. , 1987, The Journal of thoracic and cardiovascular surgery.

[9]  J. Wright,et al.  Multivariate discriminant analysis of risk factors for operative mortality following isolated coronary artery bypass graft. Loyola University Medical Center experience, 1970 to 1984. , 1987, Chest.

[10]  R. Gillum,et al.  Coronary heart disease and related procedures. National Hospital Discharge Survey data. , 1989, Circulation.

[11]  E. Passamani,et al.  Coronary artery surgery study (CASS): a randomized trial of coronary bypass surgery. Eight years follow-up and survival in patients with reduced ejection fraction. , 1985, Circulation.

[12]  G. Dorros,et al.  Coronary artery bypass surgery in patients over age 70 years: Report from the milwaukee cardiovascular data registry , 1987, Clinical cardiology.

[13]  F. Harrell,et al.  The evolution of medical and surgical therapy for coronary artery disease. A 15-year perspective. , 1989, JAMA.

[14]  P. Sergeant,et al.  Is the outcome of coronary artery bypass graft surgery predictable in patients with severe ventricular function impairment? , 1986, The Journal of cardiovascular surgery.

[15]  M A Hlatky,et al.  Comparison of predictions based on observational data with the results of randomized controlled clinical trials of coronary artery bypass surgery. , 1988, Journal of the American College of Cardiology.

[16]  W. Knaus,et al.  An evaluation of outcome from intensive care in major medical centers. , 1986, Annals of internal medicine.

[17]  A. Epstein,et al.  Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts. , 1989, JAMA.

[18]  E. Hannan,et al.  Interracial Access to Selected Cardiac Procedures for Patients Hospitalized with Coronary Artery Disease in New York State , 1991, Medical care.

[19]  Edward L. Hannan,et al.  Investigation of the Relationship Between Volume and Mortality for Surgical Procedures Performed in New York State Hospitals , 1989 .

[20]  S. Ellis,et al.  In-hospital cardiac mortality after acute closure after coronary angioplasty: analysis of risk factors from 8,207 procedures. , 1988, Journal of the American College of Cardiology.

[21]  P. B. Kelly,et al.  Preoperative risk assessment in cardiac surgery: comparison of predicted and observed results. , 1987, The Annals of thoracic surgery.

[22]  W. Knaus,et al.  APACHE II: a severity of disease classification system. , 1985 .

[23]  F. Harrell,et al.  Predicting outcome in coronary disease. Statistical models versus expert clinicians. , 1986, The American journal of medicine.

[24]  D. Kanouse,et al.  The appropriateness of performing coronary artery bypass surgery. , 1988, JAMA.

[25]  R. S. Mitchell,et al.  Determinants of operative mortality for patients undergoing aortic valve replacement. Discriminant analysis of 1,479 operations. , 1985, The Journal of thoracic and cardiovascular surgery.

[26]  A. Bernstein,et al.  A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. , 1989, Circulation.

[27]  Harold S. Luft,et al.  Association of volume with outcome of coronary artery bypass graft surgery —scheduled vs nonscheduled operations , 1987, JAMA.

[28]  R. A. Johnson,et al.  Prognostic value of a coronary artery jeopardy score. , 1985, Journal of the American College of Cardiology.