CABG Mortality Creeping Up Again
UCSF Medical Center was the only hospital in California with a below average mortality rate for patients undergoing coronary artery bypass graft surgery (CABG) in 2012, even as the overall mortality rate for the procedure has slowly been inching upward in recent years.
CABG procedures improve coronary blood flow by using blood vessels from the leg of the patient in order to bypass partially blocked arteries. It is the most common form of open heart surgery performed in the United States.
The chance of a Californian undergoing a CABG procedure and dying as a result was 2.11% in 2012, or 247 deaths related to 11,720 procedures. That's slightly higher than the 2.01% mortality rate that was reported in 2011, with 247 deaths overall, according to the Office of Statewide Health Policy and Development. The mortality rate in 2010 was 2%, and in 2009, 1.9%. However, 2012's average is still 27% lower than the 2.91% mortality rate reported in 2003, the first year reporting to state regulators was mandated.
The number of CABG procedures performed in Caliornia has been shrinking in recent years in favor of other less invasive therapies, such as drugs or the use of coronary angioplasty and stents, a procedure that can usually be performed on an outpatient basis.
There were 12,399 CABGs performed in 2011, indicating the volume of such surgeries dropped 5.6% year over year. Greater surgical volume is often directly linked to better patient outcomes, research shows.
OSHPD surveyed 126 hospitals for the ratings, and also individually evaluated the mortality rate for 272 surgeons who performed the procedure in 2012. The agency usually releases individual performance data on surgeons to the public for every other CABG report.
Although 28 hospitals that performed CABGs in 2012 reported no related deaths at all, and 35 others with patient deaths were below the statewide average, no hospital in the state was rated above average in terms of patient mortality. Only one facility had been reported above average in 2011. Sutter Memorial Hospital in Sacramento had an adjusted 2012 mortality rate of 1.19%, with four deaths out of 324 CABGs performed.
UCSF Medical Center's adjusted mortality rate was 8.18%, with five deaths connected to 60 CABG procedures. UC Irvine Medical Center in Orange was the only other University of California hospital that performed fewer CABGs in 2012, with 54 and one patient death.
Although a UCSF spokesperson did not immediately respond to an email seeking comment, its chief medical officer, Josh Adler, M.D., noted in a 2014 letter to OSHPD regarding the data that it treated a high-risk patient population. As a result, the risk-adjusted mortality rate based on the Society of Thoracic Surgeons (STS) guidelines would be 7.8%.
“The majority of these patients were transferred to out institution for high-risk vascularization and unfortunately, had multiple factors predictive of a poor outcome,” Adler wrote. He added that the CABG mortality rate for 2013 and 2014 was less than 1% for 105 cases.
UCSF cardiothoracic surgeon Georg Wieselthaler, M.D., had an adjusted mortality rate for 2012 of 10.18%, with three deaths connected to 14 CABG procedures performed. His outcomes were rated by OSHPD as worse than average. He did not immediately respond to an email or phone call seeking comment.
Among those surgeons who also had worse than average mortality rates were Dominic Tedesco, M.D., who practices at Community Memorial Hospital of San Buenaventura (7.4%, with five deaths in 69 procedures; Ashraf Osman, M.D., who practices at Fresno Heart and Surgical Center and St. Agnes Medical Center in Fresno (6.42%, with eight deaths in 115 procedures; James C. MacMillan, M.D., who practices at Doctors Medical Center in Modesto (6.81%, with eight deaths in 106 procedures); Baron Harper, M.D., who practices at Rideout Memorial Hospital in Marysville (8.84%, with seven deaths in 88 procedures; and Joe Bolton, M.D., who practices at St. Agnes and Emanuel Medical Center in Turlock (7.75%, with six deaths in 68 procedures).
There were seven surgeons with worse then average rates in 2009-10.
Among those with better than average mortality rates were Hakob G. Davtyan, M.D., who practices at Riverside Community Hospital and St. Bernardine Medical Center (zero deaths in 200 procedures); Robert C. Kinkade, M.D., who practices at Sutter Memorial (zero deaths in 219 procedures); and Henry L. Zhu, M.D., who practices at Mercy General Hospital in Sacramento and Mercy San Juan Hospital in Carmichael (zero deaths in 253 procedures), were all rated as better than average.
Along with the CABG mortality rates, OSHPD also delved into post-operative stroke rates and readmissions within 30 days of discharge from the hospital.
Unlike the mortality data, the stroke information is from 2011 and 2012 in order to increase the reliability of the statistics.
The post-operative stroke rate for those years was 1.48% (358 strokes occurring out of 24,119 CABGs performed). That is slightly higher than the 2010-11 rate of 1.32%, but in line with the national rate of 1.4% as reported by the STS.
Sutter Memorial was rated above average in its performance, with two strokes among 638 patients and an adjusted rate of 0.36%. Seton Medical Center, Rideout Memorial, Bakersfield Heart Hospital, Northridge Hospital Medical Center, and received worse than average ratings, with adjusted stroke rates of 6.36%, 4.73%,, 4.51%, and 3.98%, respectively.
The readmission rate for 2012 was 12.24% (1,292 out of 10,553 patients). That is down from the 2011 rate of 12.97%.
Methodist Hospital of Southern California in Santa Anita; John Muir Health's Concord campus; and St. Joseph’s Medical Center in Stockton all had better than average ratings for readmissions, at 2.06%, 5.63%, and 6.61% of patients, respectively.
Alvarado Hospital in San Diego; White Memorial Medical Center in East Los Angeles; Valley Presbyterian Hospital in Van Nuys; Glendale Adventist Medical Center's Wilson Terrace campus; and were all rated worse than average, with readmission rates of patients 30.24%, 28.27%, 27.13% and 21.30%, respectively.
