California released for the first time public reports on the mortality rates for coronary artery bypass graft procedures in the state from both hospitals and surgeons.
The reports, covering the period 2003-04, include data on 40,377 procedures performed at 121 hospitals by 302 surgeons. This is the second report by the Office of Statewide Health Planning and Development in California, but the first to include individual doctors.
For hospitals, the risk-adjusted mortality rates ranged from none to 7.83%, but 111 of 121 hospitals, or 91.7%, performed within their expected range compared to the states overall mortality rate of 3.08%, according to a summary of the reports findings posted on the agencys Web site. Four of 121 hospitals performed significantly better than the statewide average and six performed worse, according to the summary.
For physicians, the risk-adjusted mortality rates ranged from none to 32.96%. Not quite 95% of surgeons scored within an expected range, while just four surgeons were significantly better than the state average and 12 surgeons were significantly worse.
California is one of five states to collect and report outcomes from the bypass procedure using clinical data. The others are Massachusetts, New Jersey, New York and Pennsylvania. California initially had a reporting program that allowed for voluntary disclosure of results, but public reporting by hospitals became mandatory last year, and by physicians, this year. Under the law, hospitals must publicly disclose their coronary artery bypass graft outcomes annually, and physicians need to do so every other year.
Analysis of the data revealed no significant association between the number of coronary artery bypass graft surgeries that hospitals perform annually and their risk-adjusted mortality rates, the summary said. The same went for individual surgeons, further calling into question the notion there is a significant relationship between volume of surgical activity and outcomes.
Similarly for physicians, no significant association was found between the number of coronary artery bypass graft surgeries performed and a surgeons risk-adjusted mortality rate. But, the summary said, limited evidence suggests surgeons who do more than 100 of these procedures a year have modestly lower mortality rates. -- by Joseph Conn