Results of a regional study of modes of death associated with coronary artery bypass grafting. Northern New England Cardiovascular Disease Study Group.
BACKGROUND
It is well known that surgeon-specific in-hospital mortality rates for coronary artery bypass grafting vary, but this aggregate measure does not suggest specific opportunities for improvement.


METHODS
We performed a regional prospective study of 8,641 consecutive patients undergoing isolated coronary artery bypass grafting by all of the 23 cardiothoracic surgeons practicing in northern New England during the study period. Mode of death was assigned by an end points committee using predetermined definitions. Surgeons were ranked according to risk-adjusted mortality rates and grouped in terciles, and cause-specific mortality rates were determined.


RESULTS
The mortality rate was 3.3% in the lowest surgeon mortality tercile and 5.8% in the highest tercile. Fatal heart failure accounted for 80.0% of the difference in aggregate mortality rates, ranging from 1.9% in lowest surgeon mortality tercile to 4.0% in the highest tercile (p < 0.001). Rates of other causes did not differ significantly across surgeon mortality terciles. Differences in rates of fatal heart failure could not be explained by differences in preoperative left ventricular dysfunction or other patient characteristics.


CONCLUSIONS
Most of the difference in observed mortality rates across surgeons is attributable to differences in rates of heart failure.
O'Connor
G T
GT
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. gerald.t.o'connor@dartmouth.edu
Birkmeyer
J D
JD
Dacey
L J
LJ
Quinton
H B
HB
Marrin
C A
CA
Birkmeyer
N J
NJ
Morton
J R
JR
Leavitt
B J
BJ
Maloney
C T
CT
Hernandez
F
F
Clough
R A
RA
Nugent
W C
WC
Olmstead
E M
EM
Charlesworth
D C
DC
Plume
S K
SK
D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate