State rates heart bypass surgeons and hospitals

By Mary Engel

July 13, 2007 12 AM PT

Times Staff Writer

Californians needing a coronary bypass can now, for the first time, look up which surgeons in the state have the best -- and worst -- mortality rates for that operation.

A report released Thursday names and rates 302 surgeons who performed heart bypass operations at 121 California hospitals during 2003 and 2004. Prepared by the Office of Statewide Health Planning and Development, the 143-page study is posted on the office’s website, www.oshpd.ca.gov.

The surgeons performed 40,377 bypass surgeries in California during those two years, and the average death rate was 3.08%, or roughly one death for every 30 people undergoing the operation.

The report rated individual surgeons and hospitals using a formula that adjusted for factors that can increase the risk that a patient will die, such as age, gender, co-existing medical conditions and prior heart surgeries. Other factors such as sample size determined whether risk-adjusted rates that were higher or lower than average would be considered “significant.”

The report rated four surgeons as having mortality rates that were “significantly better” than the state average, and 12 as “significantly worse.” Three of the “better”-rated surgeons and six of the “worse”-rated practiced in Southern California.

Among the surgeons with a higher-than-average mortality rating was Dr. Ismael N. Nuno, chief of cardiac surgery at Los Angeles County-USC Medical Center. According to the state report, he did 184 bypass-only surgeries at six hospitals, and 10 patients, or 5.4%, died. Because that was more than expected when factoring in age and other risk factors, his risk-adjusted mortality rate was 6.7%.

Nuno could not be reached for comment Thursday. Joseph Parker, director of the Healthcare Outcomes Center at the state health planning agency, cautioned that the report is a snapshot of just two years, not an entire career.

“This is the most reliable and objective data we have on surgeon performance in the state,” he said. “But on the other hand, it does not tell the whole story. One of the things that influences the results is just bad luck.”

Among hospitals, Fountain Valley Regional Hospital and Medical Center in Orange County and St. John’s Regional Medical Center in Ventura County were among the four with lower-than-average death rates. Beverly Hospital in Montebello and Lakewood Regional Medical Center were among the six hospitals with higher-than-average rates.

Coronary artery disease is the leading cause of adult admissions to California hospitals, excluding childbirth. When the plaque caused by cholesterol and fat builds up enough to restrict coronary arteries, surgeons can “bypass” the blockage by taking a vein or artery from another part of the body to create a new pathway. It is a high-tech surgery, lasting four to six hours, and the recovery period involves intensive care.

The state agency has published hospital death rates for bypass surgery before, as well as for heart attacks and pneumonia, but this is the first time it has compared the performance of individual physicians. It is part of a broader movement to give consumers information to make informed decisions.

The report is also of use to insurance agencies and employers eager to get the best results for the $30,000-to-$50,000 operation, said Dr. David M. Carlisle, director of the health planning office. And publishing the results has the added benefit of prodding hospitals and surgeons to examine their practices for ways to improve their ratings, he said.

The latter is especially important because half of the roughly 20,000 bypass surgeries performed in the state each year are done on an emergency basis.

“You can’t always choose your hospital when you’re having an emergency,” said Parker, who oversaw the report. “But the report has an indirect effect on consumers by providing the hospital and surgeon with objective benchmarks and an incentive to improve their care.”

California is one of five states to collect and report outcome information, and was authorized to do so by the Legislature in 2001. New York pioneered the practice in 1989, and since then its bypass mortality rate has dropped, Carlisle said.

California’s average mortality rate of 3.08% is higher than the other four states that report outcomes. New Jersey, for example, just released figures for 2003-2004 as well, and its average mortality rate was 2.16%.

mary.engel@latimes.com

(BEGIN TEXT OF INFOBOX)

Report card

Surgeon ratings for heart bypass surgery, 2003-2004

Southern California surgeons rated better than the state average:

* Declusin, Richard J.; San Fernando Valley, Antelope Valley, Ventura and Santa Barbara

* Giritsky, Alexander; Greater San Diego

* Wang, Nan; Inland Empire, Riverside and San Bernardino

Southern California surgeons rated worse than the state average:

* Aharon, Alon S.; Inland Empire, Riverside and San Bernardino

* Housman, Leland B.; Greater San Diego

* Nuno, Ismael N.; Greater Los Angeles