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Cardiac Surgery in New Jersey 2004, the from the State’S Ninth Consumer Report on Coronary Artery Bypass Graft Commissioner Surgery

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Cardiac Surgery in New Jersey 2004, the from the State’S Ninth Consumer Report on Coronary Artery Bypass Graft Commissioner Surgery Jon S. Corzine Fred M. Jacobs, M.D., J.D. Governor C1076 Commissioner Health Care Quality Assessment Message I am pleased to present Cardiac Surgery in New Jersey 2004, the From The state’s ninth consumer report on coronary artery bypass graft Commissioner surgery. This report summarizes the results of an analysis of mortality among patients who underwent bypass surgery in New Jersey hospitals in 2004. New Jersey’s cardiac bypass surgery mortality rate has continued to decline, according to this latest report. Overall, the state's heart centers have achieved a 54.5 percent reduction in operative mortality between 1994 and 2004. This is a remarkable tribute to the hospitals' and surgeons' commitment to making cardiac surgery safer. In facing cardiac bypass surgery, patients and their families have questions and concerns. We hope this report answers some of those questions and helps patients discuss concerns and treatment options with their physicians. The Department has worked closely with the Cardiovascular Health Advisory Panel (CHAP) to bring consumers and providers the best possible data on cardiac bypass surgery outcomes. For the first time, the report includes information on length of hospital stay after cardiac bypass surgery. It also provides information on the total number of cardiac surgeries physicians perform, including but not limited to bypass surgeries. I would like to thank the CHAP members for their important efforts to support quality improvement in cardiac services in New Jersey. Fred M. Jacobs, M.D., J.D. Commissioner i Health Care Quality Assessment Table of Contents Executive Summary . iv Introduction . 1 Heart Disease and Cardiac Surgery in New Jersey . 1 Treatment Options . 2 Performance Data . 2 Definition of Operative Mortality . 2 Risk-Adjusted Mortality . 2 Performance Reports Lead to Improvement . 3 Hospitals. 3 Surgeons . 3 Volume Affects Quality . 4 Bypass Surgery Volume at New Jersey Hospitals in 2004 . 5 Statewide Performance . 5 Hospital Risk-Adjusted Mortality: 2004 . 5 Statistical Significance . 5 Length of Stay by Hospital. 8 Individual Surgeon Performance . 9 Statewide Trends in Risk-adjusted CABG Surgery Mortality Rates: Pooled Estimates. 17 Figure 1: Number of Isolated Coronary Artery Bypass Graft Surgeries vs. Other Surgeries (2004) . 6 Figure 2: Risk-Adjusted Operative Mortality Rate by Hospital (2004). 7 Figure 3: Risk-Adjusted Operative Bypass Mortality and Length of Stay by Hospital 2004 . 8 Figure 4: Surgeon Risk-Adjusted Operative Mortality Rate (2003-2004). 10 Figure 5: Trends in Statewide CABG Surgery Mortality Rates . 17 Table 1: Patient Risk-Adjusted Mortality Rate and Post-Surgery Length of Stay by Surgeon (2003-2004) . 14 Appendix A: Questions and Answers. 18 Appendix B: NJ’s Cardiovascular Health Advisory Panel Members and NJDHSS, Health Care Quality Assessment Staff . 19 Appendix C: Statewide Observed in-hospital and Operative Mortality Rates . 20 Appendix D: Summary of Methods Used in this Report. 21 References: . 32 iii Cardiac Surgery in New Jersey 2002 Executive Summary New Jersey has declined by 54.5 percent between 1994 and 2004. he Department of Health and Senior Services collected data on patients undergoing open l In 2004, Hackensack University Medical Center Theart surgery at 17 hospitals in 2004. Of these had a significantly lower risk-adjusted mortality patients, 6,177 had coronary artery bypass graft rate than the state average, while Our Lady of (CABG) surgery with no other major surgery during Lourdes Medical Center and UMDNJ-University the same admission. Hospital had significantly higher risk-adjusted mortality rates. Notably, Englewood Hospital The primary goal of this report is to provide New and Medical Center's observed mortality rate in Jersey hospitals and surgeons with data they can use 2004 was zero. However, this rate was not in assessing quality of care related to bypass surgery. statistically significantly lower than the statewide More importantly, this report presents patients and average, when compared on a risk-adjusted basis. families of patients with important information they can use in discussing questions and issues related to l In the period 2003-2004, three surgeons, Dr. bypass surgery with their physicians. Jonathan H. Cilley of Cooper Hospital/University Medical Center, Dr. After subjecting the CABG surgery data to Christopher Derivaux of Our Lady of Lourdes extensive error checks and consulting with an expert Medical Center, and Dr. Raj Kaushik of PBI clinical panel, the Department analyzed the isolated Regional Medical Center had significantly higher CABG surgery data using a statistical procedure to risk-adjusted mortality rates than the statewide assess hospital and surgeon performance. The average. By comparison, Dr. James Dralle of statistical analysis took into account the patient’s AtlantiCare Regional Medical Center, Dr. Mark health status before surgery as well as demographic W. Connolly of Cathedral - St. Michael’s Medical factors. This process is commonly known as “risk- Center, and Dr. Elie Elmann of Hackensack adjustment” and allows for fair comparisons among University Medical Center had significantly lower hospitals and surgeons treating diverse patient risk-adjusted mortality rates than the statewide populations. Some key findings of the 2004 data average. Although these rates were not analysis are as follows: statistically significantly different from the statewide average, it is nevertheless notable that l In 2004, there were 9,872 total open heart Dr. James Klein of Englewood Hospital and surgeries performed in New Jersey by hospitals Medical Center and Dr. Frederic F. Sardari of covered in this report, of which 6,177 were Newark Beth Israel Medical Center had no isolated CABG surgeries. deaths during this two-year period. l Of the 6,177 isolated CABG surgery patients, 122 l As expected, the risk of death from isolated died while in the hospital or within 30 days after CABG surgery increases with age. surgery. l Not surprisingly, sicker patients were at greater l The statewide observed operative mortality rate risk: for isolated CABG surgery patients in 2004 was –– An isolated CABG surgery patient who had 1.98 percent and represents a 15 percent decline cerebrovascular disease prior to the surgery over 2003. When comparing 2003 and 2004 was 1.83 times as likely to die after an mortality rates on a risk-adjusted basis, the isolated CABG surgery compared with a decline was 11.6 percent. This decline was not patient who had no cerebrovascular disease. statistically significant. –– An isolated CABG surgery patient with mild l A review of ten years of pooled data suggests lung disease was more than twice (odds ratio that the risk- adjusted patient mortality in = 2.39) as likely to die after CABG surgery iv Health Care Quality Assessment compared with a patient who had no lung Introduction disease. By comparison, a patient with severe lung disease was about five times (odds ratio his report is for patients and families of = 4.84) as likely to die after isolated CABG patients facing the possibility of coronary surgery as a patient who had no lung disease. Tartery bypass graft (CABG) surgery. It provides mortality rates for the 17 hospitals that –– Previous heart surgery, low ejection fraction, performed cardiac surgery in 2004 and the physicians and renal failure were also significantly associated with higher CABG surgery performing this common cardiac surgical procedure mortality among New Jersey patients*. in 2003-2004. As part of the Department’s continued effort to provide information to consumers, this l The average length of hospital stay for a typical report also includes – for the first time – information CABG surgery patient in 2004 was 6.43 days. on hospital length of stay. The report provides risk- adjusted length of initial hospital stay for CABG l There was a general tendency for high mortality surgery patients, by hospital and by eligible surgeon. hospitals to be associated with increased length of stay but this relationship was not statistically For this study, the Department of Health and significant. Senior Services collected data on the 6,177 patients who had bypass surgery with no other major surgery l There were more pronounced differences in during the same admission in 2004. This is the most length of stay by surgeon. Individual surgeon recent year for which a complete, audited data set is averages ranged from 5.64 days to 7.38 days. available. All data have been “risk-adjusted,” which means that data were adjusted to take into account * More information on risk factors and methods used the patient’s health condition before surgery. This in this report is presented in Appendix D. risk-adjustment allows for fair comparisons among hospitals and surgeons treating diverse patient populations. An important goal of this analysis is to give hospitals data they can use in assessing quality of care related to bypass surgery. There is strong evidence, from the handful of states with similar reports, that this information encourages hospitals to examine their procedures and make changes that can improve quality of care and, ultimately, save lives. New Jersey's mortality rate for bypass surgery has shown a significant decline since public reporting began with 1994 data. For 2004, the observed mortality rate of 1.98 percent is lower than the 2.33 percent mortality rate for 2003, suggesting a downward trend. When data from all years are pooled and analyzed, the resulting 11.6 percent decrease in the risk-adjusted mortality rate from 2003 to 2004 is not statistically significant. Another goal of the report is to give patients and physicians information to use in discussing questions and issues related to bypass surgery. Please 1 Cardiac Surgery in New Jersey 2004 remember that the numbers in this guide are just one angina, which is a warning sign for a heart attack. A factor to consider in deciding where to have cardiac heart attack occurs when a coronary artery is totally surgery.
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