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Death rates for cardiac bypass surgery

hannah.jpgThe Boston Globe today reported that the state of Massachusetts will soon allow Internet access to statistics on patient death rates — mortality rates — for cardiac bypass operations. Called quality of care information, the statistics will be available not only for hospitals and physicians’ groups; the Web site will also give mortality rates for individual doctors.

Massachusetts plans to post a website by December 18, 2006 where anyone will be able to look up the mortality rates for 55 surgeons who perform cardiac bypass operations. The most recent figures in Massachusetts date to 2004 when approximately 4,000 patients had bypass surgery at 14 Massachusetts hospitals in 2004.

Three other states, including New York, have released mortality statistics for individual heart surgeons. There is concern among heart surgeons that rather than raising the quality of care, the end result of this publication will be a refusal of individual surgeons to perform cardiac bypass surgery, the most common type of heart surgery, on high-risk patients.

Let me put this into perspective. My mother needed cardiac bypass surgery in 1995. She also needed mitral valve repair. I researched all of the facilities in Michigan then performing heart surgery. I spoke directly with a doctor at the Grand Traverse Heart Associates. I was offered and provided mortality statistics for the entire state. These statistics showed that my mother would have been in the best of hands here in Traverse City.

I recognized of course that higher mortality statistics for some facilities (University of Michigan, for example) quite possibly reflected only that the patients who had their surgery there had higher risk factors — were sicker patients with, perhaps, more concurrent health problems. Thus, taken in perspective, higher mortality statistics should not always cast a negative reflection upon the facility or heart team. The statistics I was provided also showed that mitral valve repair can be a risky procedure, and that my mother’s age made her more at risk of dying in surgery than a patient 10 years younger.

I shared this information with my mother and with the rest of my family. An outspoken member of my family (not one of my sisters), in a knee-jerk reaction, called Traverse City “Podunk, USA” and talked Mom into having the surgery at a facility in the city where she then resided. Worse, he showed the statistics to the heart surgeon there. He said that he’d gotten them from me. The surgeon knew that I was a lawyer. Afraid that I’d sue him if Mom died, he refused to do the mitral valve repair. In the end, Mom got only the triple bypass. In Traverse City, she’d have been able to have the needed mitral valve repair as well.

Thus, I can speak from personal experience that release of mortality statistics may, in fact, discourage heart surgeons from doing riskier procedures on high-risk patients. This is not meant to discourage an individual patient, however, from requesting statistics from his or her doctor. Ask lots of questions and keep a healthy perspective.

You can read the entire Boston Globe article here. Do post your comments and concerns below.

Massachusetts heart bypass mortality statistics will be posted on hcp.med.harvard.edu/massdac/index.htm
The website of the Massachusetts Division of Health Care Finance and Policy, mass.gov/healthcareqc, also will post an abbreviated form of the mortality data.

Interestingly, Massachusetts stats will not be available for heart surgeries other than bypass operations. Based upon my experience, this is undoubtedly a good thing.

Those who are new readers of this blog can find the Introduction to Aging in Place here.

  • Lois Michelin

    These statistics will be looking worse as time goes on due to the use of the new stents and the current medications greatly reducing the need for bypass surgery except for very seriously ill people. This statistic will only cause confusion and distrust in a medical situation that may not be warranted. Your article spelled out well some of these issues. Each person must be given the opportunity to choose where they are most comfortable for his/her healing to take place.

  • http://www.record-eagle.com Jeanne Hubbard

    My mother traveled to Traverse City for her mitral valve replacement and we’re glad she did! Dr. Daniel Drake invited a gaggle of family members into his office to explain the procedure, which he did in a very kind and non-technical manner, and also made the choices very clear. He really listened to Mom’s concerns and answered all our questions to our satisfaction. The procedure went well and Mom is back home doing great.

  • bill briggs

    As you pointed out so correctly, the statistics are meaningless because the elite institutions will tend to take on the most risky cases. So why is anyone promoting publishing or even gathering the information?

    Is it politicians who want to look helpful on the surface but who do not have a clue? Is it agitators of some kind with an axe to grind? Professors who need to impress their employers by being busy?

    Many years ago there was a small simple book published named “How to Lie With Statistics”. It was cute and easy to understand even possibly for news reporters who seem to me to have great shortcomings in math and statistics.

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