Massachusetts Reports High Quality Of Cardiac Surgical Care
Data released today show that hospitals in Massachusetts continue to provide a high quality of cardiac surgical care to patients in the Commonwealth.
Two reports, one detailing mortality rates for adults undergoing cardiac bypass surgery, and another documenting mortality rates following patients who have undergone treatment to clear a blocked coronary artery, show that the risk of dying in the immediate aftermath of such procedures has decreased significantly over the past five years.
The data, covering procedures performed during Fiscal Year 2007 were analyzed by Mass-DAC, a data coordinating center operated by Harvard Medical School’s Department of Health Care Policy, and released by the Massachusetts Department of Public Health’s (DPH) Bureau of Health Care Safety and Quality.
“Massachusetts has some of best cardiac surgical care in the nation,” said Paul Dreyer, DPH Director of Health Care Safety and Quality. “The data contained in these reports are good news for patients, and a testament to continued commitment to improved health care quality in our hospitals.”
Percutaneous Coronary Intervention (PCI)
Most Percutaneous Coronary Interventions (PCI) involve inserting a catheter into a coronary artery and inflating a balloon to relieve a blockage that is impeding blood flow needed for healthy heart function. Such a procedure, commonly known as angioplasty, is often performed on patients at high risk of, or who are having, a heart attack.
In Massachusetts, 22 hospitals are licensed to perform PCI. The data released today cover procedures performed on two categories of patients: those who are not in shock or having a major heart attack prior to the procedure, and those who are. Since the first year of data collection in 2003, the death rate for PCI patients not in shock or having a major heart attack has decreased by 34%. And, for seriously ill patients who are in shock or having a major heart attack prior to the procedure, the death rate has decreased by 20% since 2003.
During Fiscal Year 2007 (Oct. 1, 2006 – Sept. 30, 2007) there were 14,063 Massachusetts hospital admissions in which at least one PCI was performed. Of those admissions, nearly 20% of the procedures were performed on patients who had a major heart attack within 24 hours of admission, or who were in shock at the time of the procedure. Of the 14,063 PCI admissions, 209 patients died during the same hospitalization. Of those deaths, 153 mortalities occurred in patients arriving in shock or having a major heart attack, and 56 deaths occurred in patients who were not in shock or having a heart attack.
One hospital, Cape Cod Hospital, was identified as having a lower than expected death rate for patients arriving in shock or who were having a major heart attack. And, two hospitals, the Massachusetts General Hospital in Boston, and St. Vincent Hospital in Worcester, were identified as having higher than expected death rates for PCI patients.
Massachusetts General Hospital’s PCI mortality rates were higher than expected regardless of whether patients arrived in shock or were having a major heart attack. St. Vincent Hospital was identified as having higher mortality for patients arriving in shock or having a major heart attack.
Based on the data, DPH contacted officials at both Mass. General and St. Vincent and requested that the hospitals conduct a review of PCI deaths in FY07 and report their findings back to the Department. Both hospitals immediately conducted those reviews, utilizing experts from outside of their organizations. During the reviews, which occurred in late January, both hospitals, out of an abundance of caution, agreed to institute a second level of review for any patient recommended for PCI, prior to the procedure being performed.
The results of these initial outside reviews revealed that, in both cases, the higher than expected death rates at Mass. General and St. Vincent were attributable to the practices of these two hospitals with respect to the selection of patients.
In addition to reviewing data from FY07, DPH also analyzed the most recent PCI data from each hospital and found that mortality rates for both Mass. General and for St. Vincent have returned to the statewide average in the second quarter of 2008.
The Department has requested that each hospital undergo a more intensive review by an independent national peer review agency, the American Medical Foundation, to confirm the initial review, and to more fully examine the entire continuum of care for PCI patients at Mass. General and St. Vincent. Those reviews will begin in the near future, and DPH will continue working with each hospital throughout the process.
“We appreciate that each hospital took the findings seriously and reacted very quickly to review the circumstances of each PCI death,” said Dreyer. “We want patients to know that we believe the programs operating at Mass. General and St. Vincent are safe, and that we will be closely monitoring both programs to insure the highest quality of care.”
Adult Coronary Artery Bypass Graft Surgery (CABG)
Coronary artery bypass graft, known as CABG, is commonly known as open-heart surgery. The operation involves taking a vein or artery from a different part of the body and using it to create a bypass of a clogged coronary artery in order to provide oxygen-rich blood to the heart. In Massachusetts, there are fourteen hospitals licensed to provide cardiac surgery. In FY07, there were approximately 3,400 hospital admissions that involved isolated CABG surgery, and 50 deaths associated with any cause, dying within 30 days of surgery. That corresponds to a 1.47% death rate for FY07, a 33% decrease in the mortality rate since 2002.
In FY07, no hospital in Massachusetts licensed to perform cardiac surgery was identified as exceeding the expected mortality rate for CABG surgery.
Also included in the report released today is a review of surgeon-specific, risk-standardized, 30-day mortality rates. The rates were based on CABG surgery admissions performed between October 1, 2004 through September 30, 2007. An analysis of 10,701 surgeries performed by 60 surgeons found that no surgeon was identified as having exceeded the expected mortality rate.