Key Findings: FY 2013 Report

Below is a summary of the key findings from the fiscal year 2013 Massachusetts Cardiac Study annual reports for adult patients undergoing a coronary artery bypass graft surgery (CABG) surgery or a percutaneous coronary intervention (PCI). The full version of each report may be downloaded in PDF format on the Cardiac Study-Annual Reports page, or by clicking the section titles below

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, 2012 through September 30, 2013 (fiscal year 2013), there were 7,151 hospital admissions in Massachusetts in which at least one cardiac surgery was performed.
    • 41.13% (2,941) of the admissions involved isolated coronary artery bypass graft (CABG) surgery.
  • In the 14 hospitals that performed cardiac surgery during fiscal year 2013, the number of isolated CABG surgery admissions ranged from 69 to 413.
  • The unadjusted 30-day all-cause mortality rate (defined as the number of patients dying from any cause within 30 days of surgery divided by the number of isolated CABG surgery admissions) in Massachusetts during fiscal year 2013 was 1.67%. This corresponded to 49 deaths out of 2,941 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 1.7 times that of a hospital one standard deviation below the state average.
In fiscal year 2013, no hospital was identified as a statistical outlier for isolated coronary artery bypass surgery.

The adjacent image Figure 7.3, 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. 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.

FY 2013 CABG SMIR Chart

PCI In-hospital Mortality Report

  • In the period October 1, 2012 through September 30, 2013 (fiscal year 2013), there were 12,132 Massachusetts hospital admissions, excluding patients meeting Exceptional Risk criteria (see definition in Appendix C on page 72 of the report), in which at least one PCI was performed.
  • 77.94% (9,456) of the admissions were no shock and no STEMI admissions. The remaining 22.06% (2,676) of these admissions were shock or STEMI admissions. Shock or STEMI admissions are defined as patients that had an ST-elevated myocardial infarction (STEMI) within 24 hours of admission or were in shock at the time of the procedure.
  • Twenty-four hospitals performed at least one PCI during the period October 1, 2012 through September 30, 2013; ten hospitals participated in the Massachusetts Primary PCI Pilot Program. All pilot hospitals are approved for shock or STEMI PCI admissions. Only pilot hospitals that participated in the MASS-COMM clinical trial were approved by the Massachusetts Department of Public Health to perform elective PCIs with limited restrictions beginning August 2013. Beverly Hospital did not participate in the MASS-COMM clinical trial and is approved to only perform shock or STEMI PCIs.
  • After adjusting for patient risk for those having no shock and no STEMI, the relative risk of in-hospital mortality in a hospital one standard deviation above the Massachusetts average was 2.4 times 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 2.7 times that of a hospital one standard deviation below the Massachusetts average for patients with shock or STEMI.
No Shock and No STEMI Cohort

In fiscal year 2013, no hospital was identified as a statistical outlier for this cohort.

The observed in-hospital all cause mortality in the no shock and no STEMI cohort is 0.53% (50 deaths) based on analysis of 9,456 (excludes Exceptional Risk) admissions.

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. 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.

FY 2013 PCI no shock and no STEMI SMIR Chart
Shock or STEMI Cohort

In fiscal year 2013, South Shore Hospital was identified as better than expected for this cohort.

The observed in-hospital all cause mortality in the shock or STEMI cohort is 5.27% (141 deaths) based on analysis of 2,676 (excludes Exceptional Risk) admissions.

The adjacent image Figure 7.7, 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. 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.

FY 2013 PCI shock or STEMI SMIR Chart