Key Findings: FY 2011 Report

With the fiscal year 2011 report Mass-DAC and the Department of Public Health will no longer publicly report on surgeon-specific coronary artery bypass graft (CABG) mortality rates, to be consistent with the Massachusetts reporting for interventional cardiologists performing percutaneous coronary interventions (PCI). Data on individual cardiac surgeons and PCI operators will continue to be collected and analyzed for internal reviews.

Below is a summary of the key findings from the fiscal year 2011 Cardiac Study annual reports for the CABG surgery and the PCI cohorts. The full version of each report may be downloaded in PDF format from the Cardiac Study-Annual Reports page, or by clicking the links highlighting each section title.

Additional educational material about the reports is available on the main Reports page.  For a brief explanation of the key elements used in the 95% posterior intervals for standardized mortality incidence rates (SMIRs) charts, please view the simplified explanation in the SmirChart-Concepts.pdf document.

CABG 30-Day Mortality Report

  • In the period October 1, 2010 through September 30, 2011 (fiscal year 2011), there were 6,644 hospital admissions in Massachusetts in which at least one cardiac surgery was performed.
    • 42.7% of the admissions involved isolated coronary artery bypass graft (CABG) surgery.
  • In the 14 hospitals that performed cardiac surgery during fiscal year 2011, the number of isolated CABG surgery admissions ranged from 86 to 356.
  • The unadjusted 30-day all-cause mortality rate (defined as the number of patients dying within 30 days of surgery from any cause divided by the number of isolated CABG surgery admissions) in Massachusetts during fiscal year 2011 was 0.99%. This corresponded to 28 deaths out of 2,840 isolated CABG admissions.
  • After adjusting for patient risk, the risk of 30-day mortality in a hospital one standard deviation above the state average was 2.59 times that of a hospital one standard deviation below the state average.
In fiscal year 2011, no hospital was identified as a statistical outlier for isolated coronary artery bypass surgery.

The adjacent image Figure 7.2, extracted from the full report, displays the standardized 30-Day mortality incidence rates (SMIR) and corresponding 95% posterior intervals for all hospitals performing CABGs in Massachusetts. The solid black vertical line in the figure is the unadjusted state 30-day mortality rate of 0.99%. Listed on the left-hand side of the figure are the total number of isolated CABG surgery admissions and the expected 30-day mortality rates for each hospital. The expected mortality rate provides an overall assessment of case mix severity at each program. Increasing values of the expected 30-day mortality rates correspond to increasing admission severity. Listed on the right-hand side are the estimated SMIRs. All 95% posterior intervals (horizontal boxes) include the unadjusted Massachusetts rate.

Select the image to view full size.

FY2011-CABG-SMIR-7-2-660x690

PCI In-hospital Mortality Report

  • In the period October 1, 2010 through September 30, 2011 (fiscal year 2011), there were 12,795 hospital admissions, excluding exceptional risk cases, in Massachusetts in which at least one Percutaneous Coronary Intervention (PCI) was performed.
  • 20.5% (2,618) of these admissions were shock or STEMI admissions – admissions in which the patient had an ST-elevated myocardial infarction (STEMI) within 24 hours of admission or was in shock at the time of the procedure.
  • Twenty-five hospitals performed at least one PCI during the period October 1, 2010 through September 30, 2011; eleven participated in the Massachusetts Primary PCI Pilot Program. Primary PCI Pilot programs are approved for shock or STEMI admissions only.
  • Additional criteria for patients considered exceptionally high risk for death (Exceptional Risk) were collected and adjudicated by Mass-DAC. Approved exceptional risk cases were eliminated from the analysis.
  • After adjusting for patient risk for those having no shock and no STEMI, the risk of in-hospital mortality in a hospital one standard deviation above the Massachusetts average was two times (relative risk of 2.1) that of a hospital one standard deviation below the Massachusetts average.
  • The odds of in-hospital mortality in a hospital one standard deviation above the Massachusetts average was 1.6 times that of a hospital one standard deviation below the Massachusetts average for patients with shock or STEMI.
  • The observed in-hospital all cause mortality for fiscal year 2011 in the no shock and no STEMI cohort is 0.47% (48 deaths) based on analysis of 10,177 admissions, which include Mass-COMM Trial Participants.
  • The observed in-hospital all cause mortality for fiscal year 2011 in the shock or STEMI cohort is 5.04% (132 deaths) based on analysis of 2,618 (excludes Exceptional Risk) admissions.
No Shock and No STEMI Cohort

In fiscal year 2011, no hospital was identified as a statistical outlier for this cohort.

The adjacent image Figure 7.3, extracted from the full report, displays the standardized in-hospital mortality incidence rates (SMIR) and corresponding 95% posterior intervals for Massachusetts hospitals performing PCIs on patients with neither a STEMI nor in shock. The solid black vertical line in the figure is the unadjusted state in-hospital mortality rate of 0.47%. Listed on the left-hand side of the figure are the total number of PCI admissions and the expected in-hospital mortality rates for each hospital. The expected mortality rate provides an overall assessment of case mix severity at each hospital; where higher expected mortality rates represent a more severe case mix. Listed on the right-hand side are the estimated SMIRs. All 95% posterior intervals (horizontal boxes) include the unadjusted Massachusetts rate.

Select the image to view full size.

FY2011-PCI-SMIR-7-3-nss-660x920
Shock or STEMI Cohort

In fiscal year 2011, no hospital was identified as a statistical outlier for this cohort.

The adjacent image Figure 7.5, extracted from the full report, displays the standardized in-hospital mortality incidence rates (SMIR) and corresponding 95% posterior intervals for Massachusetts hospitals performing PCIs on patients with a STEMI or in shock. The solid black vertical line in the figure is the unadjusted state in-hospital mortality rate of 5.04% (excluding Exceptional Risk cases). Listed on the left-hand side of the figure are the total number of PCI admissions and the expected in-hospital mortality rates for each hospital. The expected mortality rate provides an overall assessment of case mix severity at each hospital; where higher expected mortality rates represent a more severe case mix. Listed on the right-hand side are the estimated SMIRs. All 95% posterior intervals (horizontal boxes) include the unadjusted Massachusetts rate.

Select the image to view full size.

FY2011-PCI-SMIR-7-5-ss-660x920