Has the Publication of Cardiac Surgery Outcome Data Been Associated with Changes in Practice in Northwest England: an Analysis of 25,730 Patients Undergoing CABG Surgery Under 30 Surgeons over Eight Years

Overview

Journal Heart

Date 2007 Jan 24

PMID 17237128

Citations 32

Authors

Ben Bridgewater

Antony D Grayson

Nicholas Brooks

Geir Grotte

Brian M Fabri

John Au

Tim Hooper

Mark Jones

Bruce Keogh

Affiliations

Soon will be listed here.

Abstract

Objectives: To study changes in coronary artery surgery practice in the years spanning publication of cardiac surgery mortality data in the UK.

Methods: A retrospective analysis of prospectively collected data from all National Health Service centres undertaking adult cardiac surgery in northwest England was carried out. Patients undergoing coronary artery surgery for the first time between April 1997 and March 2005 were included. Changes in observed, predicted and risk adjusted mortality (EuroSCORE) were studied. Evidence of risk-averse behaviour was looked for by examining the number of patients at low risk (EuroSCORE 0-5), high risk (6-10), and very high risk (11 or more), before and after public disclosure.

Results: 25,730 patients underwent coronary artery surgery during the study period. The observed mortality decreased from 2.4% in 1997-8 to 1.8% in 2004-5 (p = 0.014). The expected mortality (EuroSCORE) increased from 3.0 to 3.5 (p<0.001). The observed to expected mortality ratio decreased from 0.8 to 0.51 (p<0.05). The total number and percentage of patients who were at low risk, high risk and very high risk was 2694 (84.6%), 449 (14.1%) and 41 (1.3%) before and 2654 (81.7%), 547 (16.8%) and 47 (1.4%) after public disclosure, respectively, demonstrating a significant increase in the number and proportion of high risk patients undergoing surgery (p<0.001).

Conclusions: Publication of cardiac surgery mortality data in the UK has been associated with decreased risk adjusted mortality on retrospective analysis of a large patient database. There is no evidence that fewer high risk patients are undergoing surgery because mortality rates are published.

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References

Werner R, Asch D . The unintended consequences of publicly reporting quality information. JAMA. 2005; 293(10):1239-44. DOI: 10.1001/jama.293.10.1239. View

Chassin M, Hannan E, Debuono B . Benefits and hazards of reporting medical outcomes publicly. N Engl J Med. 1996; 334(6):394-8. DOI: 10.1056/NEJM199602083340611. View

Moscucci M, Rogers E, Montoye C, Smith D, Share D, ODonnell M . Association of a continuous quality improvement initiative with practice and outcome variations of contemporary percutaneous coronary interventions. Circulation. 2006; 113(6):814-22. DOI: 10.1161/CIRCULATIONAHA.105.541995. View

Burack J, Impellizzeri P, Homel P, Cunningham Jr J . Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons. Ann Thorac Surg. 1999; 68(4):1195-200; discussion 1201-2. DOI: 10.1016/s0003-4975(99)00907-8. View

Grover F, Shroyer A, Hammermeister K, EDWARDS F, Ferguson Jr T, Dziuban Jr S . A decade's experience with quality improvement in cardiac surgery using the Veterans Affairs and Society of Thoracic Surgeons national databases. Ann Surg. 2001; 234(4):464-72; discussion 472-4. PMC: 1422070. DOI: 10.1097/00000658-200110000-00006. View

Bridgewater B, Grayson A, Jackson M, Brooks N, Grotte G, Keenan D . Surgeon specific mortality in adult cardiac surgery: comparison between crude and risk stratified data. BMJ. 2003; 327(7405):13-7. PMC: 164230. DOI: 10.1136/bmj.327.7405.13. View

Hannan E, Kilburn Jr H, Racz M, Shields E, Chassin M . Improving the outcomes of coronary artery bypass surgery in New York State. JAMA. 1994; 271(10):761-6. View

Hammermeister K, Johnson R, Marshall G, Grover F . Continuous assessment and improvement in quality of care. A model from the Department of Veterans Affairs Cardiac Surgery. Ann Surg. 1994; 219(3):281-90. PMC: 1243136. DOI: 10.1097/00000658-199403000-00008. View

Peterson E, Jollis J, Bebchuk J, DeLong E, Muhlbaier L, Mark D . Changes in mortality after myocardial revascularization in the elderly. The national Medicare experience. Ann Intern Med. 1994; 121(12):919-27. DOI: 10.7326/0003-4819-121-12-199412150-00003. View

10.

Omoigui N, Miller D, Brown K, Annan K, Cosgrove 3rd D, Lytle B . Outmigration for coronary bypass surgery in an era of public dissemination of clinical outcomes. Circulation. 1996; 93(1):27-33. DOI: 10.1161/01.cir.93.1.27. View

11.

Bhatti F, Grayson A, Grotte G, Fabri B, Au J, Jones M . The logistic EuroSCORE in cardiac surgery: how well does it predict operative risk?. Heart. 2006; 92(12):1817-20. PMC: 1861312. DOI: 10.1136/hrt.2005.083204. View

12.

Schneider E, Epstein A . Influence of cardiac-surgery performance reports on referral practices and access to care. A survey of cardiovascular specialists. N Engl J Med. 1996; 335(4):251-6. DOI: 10.1056/NEJM199607253350406. View

13.

Hannan E, Siu A, Kumar D, Racz M, Pryor D, Chassin M . Assessment of coronary artery bypass graft surgery performance in New York. Is there a bias against taking high-risk patients?. Med Care. 1997; 35(1):49-56. DOI: 10.1097/00005650-199701000-00004. View

14.

Ghali W, Ash A, Hall R, Moskowitz M . Statewide quality improvement initiatives and mortality after cardiac surgery. JAMA. 1997; 277(5):379-82. View

15.

Roques F, Nashef S, Michel P, Gauducheau E, De Vincentiis C, Baudet E . Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999; 15(6):816-22; discussion 822-3. DOI: 10.1016/s1010-7940(99)00106-2. View

16.

Nashef S, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R . European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999; 16(1):9-13. DOI: 10.1016/s1010-7940(99)00134-7. View

17.

Narins C, Dozier A, Ling F, Zareba W . The influence of public reporting of outcome data on medical decision making by physicians. Arch Intern Med. 2005; 165(1):83-7. DOI: 10.1001/archinte.165.1.83. View

18.

Werner R, Asch D, Polsky D . Racial profiling: the unintended consequences of coronary artery bypass graft report cards. Circulation. 2005; 111(10):1257-63. DOI: 10.1161/01.CIR.0000157729.59754.09. View

19.

Turi Z . The big chill: the deleterious effects of public reporting on access to health care for the sickest patients. J Am Coll Cardiol. 2005; 45(11):1766-8. DOI: 10.1016/j.jacc.2005.03.003. View