A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting

Article Abstract:

The surgical technique of coronary artery bypass grafting is performed in many medical centers to replace important heart arteries that have been affected by arteriosclerosis. The death rate of patients varies widely among these hospitals. However, this does not necessarily mean that hospitals with better survival rates are better hospitals. Some hospitals with lower survival rates may treat a higher proportion of patients who are older or frail, or may cater to poorer patients who have suffered from a lifetime of inferior medical care. Nevertheless, any suggestion that death rates might be higher than necessary must be investigated carefully. For this reason, the results of bypass graft surgery performed on 3,055 patients at five medical centers were compared with careful reference to all factors that might potentially influence the outcome such as age, sex, body size, and general condition of the heart. It was found that the five medical centers, all located in New England, included in the present study treated a mix of patients that was relatively comparable. This contrasts with some other studies of more widely distributed medical centers. While the overall rate of mortality from the grafting procedure was 4.3 percent, from center to center the rate ranged from 3.1 percent to 6.3 percent. The variation among the 18 surgeons involved was even greater, ranging from 1.9 percent to 9.2 percent mortality. These differences cannot be completely accounted for simply on the basis of patient differences, and seem to be the result of differences that have not yet been identified. Although the present study found that the variations in mortality rates among the medical centers could not be accounted for by patient differences, it cannot be concluded that the overall mortality rate of a medical center is an accurate measure of the center's quality of treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Surgery, Hospitals, Aorta, Hospital services, Cardiovascular services

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A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery

Article Abstract:

A continuous quality improvement program could reduce mortality rates from coronary artery bypass graft (CABG) surgery. Researchers affiliated with the Northern New England Cardiovascular Disease Study Group implemented a program to give cardiovascular surgeons regular feedback on patient outcomes, teach them the principles of continuous quality improvement and encourage them to visit other sites. Twenty-three cardiovascular surgeons at five medical centers in Maine, New Hampshire and Vermont participated. Mortality rates among the 15,095 patients undergoing CABG surgery dropped 24% in the 27-month period following the implementation of the program between July, 1990 and April 1991. The reductions occurred in every hospital except the one with the lowest mortality rates at the start of the study. Male and female patients alike benefitted from the program.

Patient outcomes, Mortality, Total quality management

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Geographic Variation in the Treatment of Acute Myocardial Infarction The Cooperative Cardiovascular Project

Article Abstract:

Many doctors are not giving heart attack patients treatments that have been proven to be effective. Researchers reviewed the medical records of 186,800 Medicare patients hospitalized nationwide for a heart attack. Most received aspirin during their hospital stay and after they were discharged. Many did not receive ACE inhibitors, drugs that break up blood clots, or angioplasty to open up clogged arteries. Many also did not receive beta blockers or advice to give up smoking. There were large regional differences in the care received by these patients.

Care and treatment, Heart attack, Cardiac patients

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