Key Findings: FY 2010 Report

Below is a summary of the key findings from the fiscal year 2010 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, 2009 through September 30, 2010 (fiscal year 2010), there were 6,828 hospital admissions in Massachusetts in which at least one cardiac surgery was performed. Almost one half (46.4%) of the admissions involved isolated coronary artery bypass graft (CABG) surgery.
  • In the 14 hospitals that performed cardiac surgery during fiscal year 2010, the number of isolated CABG surgery admissions ranged from 98 to 394.
  • 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 2010 was 1.23%. This corresponded to 39 deaths out of 3,169 1 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 1.68 times that of a hospital one standard deviation below the state average.
In fiscal year 2010, no hospital was identified as a statistical outlier for isolated coronary artery bypass surgery.

The adjacent image Figure 7.1, 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 1.23%. 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.

Select the image to view full size.

FY2010-SMIR-CABG-Hosp-660x700

CABG 30-Day Mortality Report-Surgeon

  • 62 surgeons were identified with 9,792 isolated CABG surgery admissions in Massachusetts over the period October 1, 2007 through September 30, 2010.
  • Before exclusions, the isolated CABG surgery volumes ranged from 9 to 398 across the 62 surgeons.
  • Surgeon analyses were based on 61 surgeons who had 11 or more isolated 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 9,500 admissions.
  • 95.1% of the 61 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, 2007 through September 30, 2010 was:
    • 1.25% when admissions with shock, emergent, or emergent salvage status are included.
    • 1.09% when admissions with shock, emergent, or emergent salvage status are excluded.
  • After adjusting for patient risk, the risk of 30-day mortality associated with a surgeon one standard deviation above the state average was 1.65 times that for a surgeon one standard deviation below the state average. The risk is the same whether shock and emergent status admissions are included or excluded.
No surgeon was identified as a statistical outlier for the period October 1, 2007 through September 30, 2010.

The adjacent images, Figures 9.2 and 9.3, extracted from the full report, display the surgeon-specific standardized 30-day mortality incidence rates (SMIR) and corresponding 95% posterior intervals for surgeons performing CABGs in Massachusetts. The solid black vertical line in each figure is the unadjusted state 30-day mortality rate of 1.09%. Listed on the left-hand side of the figures are the total number of isolated CABG surgery admissions and the expected 30-day mortality rates for each surgeon. The expected mortality rate provides an overall assessment of case mix severity for each surgeon. Listed on the right-hand side of the figures are the estimated SMIRs.Table 9.3, in the full report identifies the surgeon name corresponding to the numbers in figures 9.2 and 9.3.

Select an image to view full size.

FY2010-SMIR-CABG-Surg1-660x810 FY2010-SMIR-CABG-Surg2-660x810

PCI In-hospital Mortality Report

  • In the period October 1, 2009 through September 30, 2010 (fiscal year 2010), there were 13,202 hospital admissions in Massachusetts in which at least one percutaneous coronary intervention (PCI) was performed.
  • 18.9% (2,493) 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, 2009 through September 30, 2010; eleven participated in the Massachusetts Primary PCI Pilot Program. Primary PCI Pilot programs are approved for shock or STEMI admissions only. Beverly Hospital performed three PCIs during this reporting period, the first one in September 2010.
  • Additional criteria for patients considered exceptionally high risk for death (Exceptional Risk) were collected and adjudicated by Mass-DAC. Eight cases were eliminated from the shock or STEMI cohort. There were no Exceptional Risk cases for the no shock and no STEMI cohort.
  • 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 four times (relative risk of 4.1) 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 two and a half times (odds of 2.5) 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 2010, no hospital was identified as a statistical outlier for this cohort.

The adjacent image Figure 7.1, 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 0.40% (43 deaths) based on analysis of 10,709 admissions. 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.

Select the image to view full size.

FY2010-PCI-SMIR-7-1-nss-660x860
Shock or STEMI Cohort

In fiscal year 2010, no hospital was identified as a statistical outlier for this cohort.

The adjacent image Figure 7.2, 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 5.07% (126 deaths) based on analysis of 2,485 (excludes Exceptional Risk) admissions. 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.

Select the image to view full size.

FY2010-PCI-SMIR-7-2-ss-660x860.