Hospital death on a cardiac surgical service: negative influence of changing practice patterns.
From January 1982 through December 1985, 3,772 patients underwent a cardiac surgical procedure for coronary or acquired heart disease. Operative mortality increased from 4% in 1982 to 7% in 1985 (p less than 0.001 by chi 2 analysis). There was an increase over time of patients older than 70 years (p less than 0.001). Female patients increased from 31% in 1982 to 35% in 1985 (p less than 0.001). The percentage of patients having isolated coronary artery bypass grafting decreased from 69% in 1983 to 60% in 1985 (p less than 0.001), and hospital mortality after this procedure increased (p = 0.058). Patients requiring more complex procedures including multiple-valve operations or combined valve replacement or repair plus bypass grafting increased from 1982 through 1985 (p = 0.005). Reoperations for multiple-valve procedures or combined valve repair or replacement plus coronary artery bypass grafting also increased (p = 0.02), particularly for patients more than 70 years of age (p less than 0.001). Changing practice patterns have had a negative impact on surgical results. This evolution in cardiac surgical practice has important implications related to peer review and quality-assurance screening, diagnosis-related group reimbursement, and reporting of surgical outcomes to governmental agencies.
McGrath
L B
LB
Department of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015.
Laub
G W
GW
Graf
D
D
Gonzalez-Lavin
L
L
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D006748:Hospital Departments / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*