Key Findings: FY 2014 Report

Posted February 13, 2017 More

Below is a summary of the key findings from the fiscal year 2014 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, 2013 through September 30, 2014 (fiscal year 2014), there were 7,546 hospital admissions in Massachusetts in which at least one cardiac surgery was performed.
    • 40.59% (3,063) of the admissions involved isolated coronary artery bypass graft (CABG) surgery.
  • In the 14 hospitals that performed cardiac surgery during fiscal year 2014, the number of isolated CABG surgery admissions ranged from 87 to 376.
  • The unadjusted 30-day all-cause mortality rate in Massachusetts during fiscal year 2014 was 1.57%. This percent is the number of patients who died for any reason within 30 days of surgery divided by the number of isolated CABG surgery admissions. This corresponded to 48 deaths out of 3,063 isolated CABG admissions.
  • After adjusting for patient risk based on age, diabetes, and other factors, the risk of 30-day mortality was 1.75 times higher in a hospital one standard deviation above the state 30-day mortality average than that of a hospital one standard deviation below the state average.
  • In fiscal year 2014, 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.

PCI In-hospital Mortality Report

  • In the period October 1, 2013 through September 30, 2014 (fiscal year 2014), there were 12,439 Massachusetts hospital admissions (excluding patients considered to have exceptionally high risk for death), in which at least one percutaneous coronary intervention (PCI) was performed.
  • 20.60% (2,562) 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. The remaining 79.40% (9,877) of these admissions were no shock and no STEMI admissions.
  • Twenty-four hospitals performed at least one PCI during the period October 1, 2013 through September 30, 2014. All hospitals, with the exception of Beverly Hospital, were permitted to perform elective and primary (shock or STEMI) PCI procedures. Beverly Hospital was permitted to only perform primary PCI procedures in shock or STEMI patients 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 based on age, diabetes, and other factors 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 1.8 times that of a hospital one standard deviation below the Massachusetts average.
  • After adjusting for patient risk based on age, diabetes, and other factors for those having shock or STEMI, the odds of in-hospital mortality in a hospital one standard deviation above the Massachusetts average was 3.8 times that of a hospital one standard deviation below the Massachusetts average.
  • The observed in-hospital all cause mortality for fiscal year 2014 in the no shock and no STEMI cohort is 0.40% (40 deaths) based on analysis of 9,877 (excludes Exceptional Risk) admissions.
  • The observed in-hospital all cause mortality for fiscal year 2014 in the shock or STEMI cohort is 5.04% (129 deaths) based on analysis of 2,562 (excludes Exceptional Risk) admissions.
  • In FY 2014, no hospital was identified as a statistical outlier in the no shock and no STEMI cohort.
  • In FY 2014, Boston Medical Center was identified as a worse than expected statistical outlier in the shock or STEMI cohort. Mass-DAC notified the Massachusetts Department of Public Health (MDPH) of the hospital outlier. MDPH directed Boston Medical Center to undergo an independent peer review of the deaths that occurred during FY 2014. The independent review was completed and found no quality of care issues.
No Shock and No STEMI 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. 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.

Shock or STEMI Cohort

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.

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Category: Report