Death Rate Called Aid to Picking Hospital for Surgery

Mortality rates are a good guideline for consumers selecting hospitals for surgery, say administrators at several Orange County hospitals--even at those with higher than average rates.

Death rates “can be used in a constructive manner by patients to choose the hospitals where they have their surgeries done,” said Mark Aanson, executive director of Humana Hospital in Huntington Beach. “But they also should know why the rates are high, and there are usually good reasons why this is the case.” His hospital ranked second highest statewide in deaths following gallbladder removals, according to a Times analysis of data covering nearly all patients hospitalized in the state in 1985.

At Anaheim Memorial Hospital, spokeswoman Barbara Pinkowitz agreed that knowing mortality rates is helpful to consumers.

“Mortality is a key indicator of the quality of care,” she said, “and it is one of the indicators to use in deciding where to have surgery.

“But,” she cautioned, “people should also look at the patient mix at hospitals and the types of patients the hospitals service.”

Low Mortality Rates

The survey analyzed death rates associated with heart bypass operations, gallbladder removal and three other common surgeries.

Orange County hospitals with low mortality rates following gallbladder removals, according to the analysis, were Fountain Valley Regional Medical Center and St. Jude Hospital and Rehabilitation Center in Fullerton.

Higher mortality rates following that surgery occurred at Humana Hospital in Huntington Beach, Western Medical Center in Santa Ana and Santa Ana Hospital Medical Center.

At Humana, the survey found that nearly one in 10 patients died after gallbladder removal.

“Our hospital’s quality assurance (committee) had identified this as rather high,” said Humana spokesman Aanson. “But we have looked at these deaths and found that appropriate care was provided.”

Aanson said “special circumstances” and not poor patient care accounted for these deaths. He noted that all 52 of the gallbladders removed occurred during emergency, not elective, surgery. Also, some of the five people who died had other complications, such as alcohol abuse or cirrhosis.

Emergency Gallbladder Removals

In the three years since these deaths occurred, the number of emergency gallbladder removals at Humana has not decreased, Aanson said. But for reasons that are not completely clear, the death rate afterward has, Aanson said.

At St. Jude Hospital, only .55% of the 181 people who underwent gallbladder removal died. Norm Anderson, a St. Jude vice president, attributed the low rate to the “excellent training of surgeons.”

In another category, according to the survey, three of the 53 people who underwent total hip replacements at St. Jude died afterward.

Anderson said that one patient had heart disease, another had liver disease and a third had advanced cancer. The cancer patient had undergone the surgery at her request, he said, “because she was in severe pain. She had had two falls and had not been able (to walk) since the falls because she had severe pain in her left thigh.”

At Santa Ana Hospital Medical Center, where two of 44 patients (4.54%) died following gallbladder removal, associate administrator Nicole Morrow said: “We had a death rate that high because 75% of our patients are over 82 (years old) and come to us from nursing homes.

“They are high-risk patients with multiple system problems from old age,” she said. “So, it’s just not gallbladder, but also pneumonia and respiratory problems.”

At Western Medical Center, the death rate following gallbladder removals in 1985 was 5.83% of the 137 patients. The hospital’s executive director could not be reached for comment.

Fountain Valley Regional Hospital, showed a death rate of just 0.53% of the 188 patients who underwent that surgery.

3 of 54 Patients Died

In another category, three of 54 patients died at Anaheim Memorial Hospital after undergoing carotid endarterectomy, the removal of fatty plaque from arteries in the neck that supply blood to the brain.

Hospital spokeswoman Pinkowitz said those were high-risk cases. She added: “The hospital does not believe these deaths were out of line, because each case was reviewed. It was found that each of these individual patients had received appropriate care.”

The survey also found that Saddleback Community Hospital in Laguna Hills had no deaths among the 156 transurethral prostrate resections performed there.