Key Findings: FY 2009 Report

Below is a summary of the key findings from the fiscal year 2009 Cardiac Study annual reports for the coronary artery bypass graft (CABG) surgery and the percutaneous coronary intervention (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-Hospital

  • In the period October 1, 2008 through September 30, 2009 (fiscal year 2009), there were 6,901 hospital admissions in Massachusetts in which at least one cardiac surgery was performed. Almost one half (47.6%) of the admissions involved isolated coronary artery bypass graft (CABG) surgery.
  • In the 14 hospitals that performed cardiac surgery during fiscal year 2009, the number of isolated CABG surgery admissions ranged from 89 to 436.
  • 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 2009 was 1.19%. This corresponded to 39 deaths out of 3,284 1 isolated CABG admissions.
  • After adjusting for patient risk, the odds of 30-day mortality in a hospital one standard deviation above the state average was 1.56 times that of a hospital one standard deviation below the state average.
  • In fiscal year 2009, no hospital was identified as a statistical outlier for isolated coronary artery bypass surgery.

 

CABG 30-Day Mortality Report-Surgeon

  • 64 surgeons were identified with 10,018 isolated CABG surgery admissions in Massachusetts over the period October 1, 2006 through September 30, 2009.
  • Before exclusions, the isolated CABG surgery volumes ranged from 2 to 401 across the 64 surgeons.
  • Surgeon analyses were based on 60 surgeons who had 11 or more CABG admissions.
  • While this report contains summaries based on all isolated CABG surgery admissions, the primary analyses exclude admissions for patients with shock prior to surgery, emergent status, or emergent salvage status. The primary analyses are based on 9,667 admissions.
  • 86.7% of the 60 surgeons performed isolated CABG surgery at exactly one hospital in Massachusetts over the three-year period.
  • The unadjusted 30-day all-cause mortality rate following isolated CABG surgery in Massachusetts during the period October 1, 2006 through September 30, 2009 was:
    • 1.34% when admissions with shock, emergent, or emergent salvage status are included.
    • 1.14% when admissions with shock, emergent, or emergent salvage status are excluded.
  • After adjusting for patient risk, the odds of 30-day mortality associated with a surgeon one standard deviation above the state average was 1.63 times that for a surgeon one standard deviation below the state average. The odds are the same whether shock and emergent status admissions are included or excluded.
  • No surgeon was identified as a statistical outlier.

 

PCI In-hospital Mortality Report

Updates

  • February 6, 2012: Table 7.2, corrected the description of the between hospital parameters to indicate logits used.

Hospital Findings

  • In the period October 1, 2008 through September 30, 2009 (fiscal year 2009), there were 13,493 hospital admissions in Massachusetts in which at least one Percutaneous Coronary Intervention (PCI) was performed.
  • 19.2% (2,584) 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. (Includes Exceptional Risk cases)
  • Twenty-four hospitals performed at least one PCI during the period October 1, 2008 through September 30, 2009; ten participated in the Massachusetts Primary PCI Pilot Program. Primary PCI Pilot programs are approved for shock or STEMI admissions only.
  • Of the 13,493 PCI admissions, 189 (1.40 %) patients died during the same hospitalization in which the PCI was performed: 51 mortalities (0.47 %) occurred in 10,909 patients not arriving in shock and not having a STEMI; 138 mortalities (5.34 %) occurred in 2,584 patients arriving in shock or with a STEMI. (Includes Exceptional Risk cases)
  • Additional criteria for patients considered exceptionally high risk for death (Exceptional Risk) but whose risk factors were not collected by the ACC-NCDR were operationalized, collected, adjudicated, and if meeting these criteria, cases were eliminated (seven total for both cohorts) from all analyses.
  • 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 twice (relative risk of 1.9) 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 about one and one half (odds of 1.58) that of a hospital one standard deviation below the Massachusetts average for patients with shock or STEMI.
  • There was one hospital outlier in FY 2009 for the shock or STEMI cohort. Beth Israel Deaconess Medical Center had higher-than-predicted mortality.
  • There were no hospital outliers in FY 2009 for the no shock and no STEMI cohort