Hospital CABG Death Rate Up Slightly

The number of Californians dying as a result of undergoing coronary artery bypass grafts or CABG in 2013 is stable, although slightly elevated from the prior year, according to data released last week by the Office for Statewide Health Planning and Development.

The mortality rate for isolated CABG procedures in California was 2.29% in 2013 – 273 patients died out of 11,940 procedures that were performed at the 125 hospitals surveyed. That is up from the 2012 morality rate of 2.11%, but remains significantly lower than the 2.91% mortality rate that was reported in 2003, the first year OSHPD began gathering and reporting on such data.

There were no outliers among the hospitals surveyed. All were rated as average in performance, with mortality rates ranging from zero to 10.42%. 

There were 25 hospitals that performed a total of 1,288 CABGs without a single death reported, according to OSHPD data.

The highest mortality rate, accorded to Centinela Hospital Medical Center in Los Angeles, was for three deaths out of 25 CABGs performed. However, OSHPD officials say the data is adjusted for patient acuity and that was likely why the hospital's performance was within the mean.

There were few outliers among the three other areas measured by OSHPD: CABG plus valve replacement mortality rate; post-operative stroke; 30-day readmission rates and usage of internal mammary arteries.

The risk-adjusted mortality rate for CABG plus valve replacement was 6%, the first time data was reported by OSHPD. 

The hospitals surveyed had mortality rates ranging from zero to 39.15%. That last number, accorded to Saint Mary's Medical Center in San Francisco, was for three deaths among eight procedures. It was the only hospital surveyed that OSHPD that performed worse than average. Scripps Memorial Hospital in La Jolla was the only hospital to receive a better than average mark, with one death among 150 procedures, an adjusted mortality rate of 0.85%.

For post-operative strokes, the risk adjusted rate was 1.49%, with 352 cases reported. That is flat from prior years, and up slightly from 2008, when the rate was 1.43%.

Nineteen hospitals reported no strokes at all. None received an above average score. Two hospitals received below-average scores: Rideout Memorial Hospital in Marysville had an adjusted rate of 6.31%, with 10 strokes among 170 cases, while Kaiser Foundation Hospital in San Francisco had an adjusted rate of 2.84%, with 16 strokes among 654 patients.

For 30-day readmissions, the risk adjusted rate was 11.66%. That's part of a slight downward trend from 2007, when the rate was just below 13%. Averages ranged from zero to 39.29%, which was accorded to Henry Mayo Newhall Memorial Hospital in Santa Clarita, with five readmissions among 12 patients. It was one of six hospitals that had below average scores. A spokesperson for Henry Mayo did not respond to a request seeking comment.

In a letter to OSHPD, officials, Shasta Regional Medical Center said it had implemented an initiative to improve patient readmissions. It had a readmission rate of 22.45%, with 14 readmits among 73 patients,

“We have implemented immediate post-discharge phone calls to patients, collaborated with the home health agencies and skilled nursing facilities regarding followup care,” said the letter, authored by Shasta Chief Executive Officer Cyndy Gordon. “We have seen a steady in our readmission rates since putting these efforts into effect.

Two facilities had better than average scores: Stanford Hospitals & Clinics and Marian Regional Medical Center in Santa Maria.

Six hospitals were accorded low scores for the use of internal mammary arteries. Such a procedure occurs in 96.6% of all CABG procedures.