Heart Surgery Mortality Rates

In the last two or three years, The Times has done a story (Part A, Dec. 17) on open heart surgery about this time of year. This year, as before, you reported on the variation in mortality between the “high-risk” and “low-risk” facilities. You also reported on hospitals where the high death rates have occurred for three years in a row.

As before, you report a higher risk in the “low-volume” hospitals. One-half of the open heart surgery done in Los Angeles County is done in hospitals not meeting the standards recommended by the State Health Department and the American College of Surgeons. For resons that defy common sense, nothing is done to alter this pattern. Each year more small hospitals start heart surgery programs because they are profitable.

Why do low-volume hospitals have higher mortality rates? Not, as they claim, because they do sicker patients. Many surgeons who work at several hospitals take their sicker patients to the larger hospitals because they know the care is better and they have a better chance of survival. The larger programs provide more support from specialists when patients have kidney or lung or bleeding problems, more skilled nurses and special equipment.

Open-heart surgery is a highly complex procedure and the teamwork necessary might be compared to a symphony orchestra. How often does a small town have a world-class symphony?

The facts are in. When are the medical people, the state health officials and the public going to demand an end to heart surgery in little community hospitals, when we know they are unable to provide optimum patient care and a safe passage through a very difficult procedure.

MYRVIN H. ELLESTAD, M.D.

Medical Director

Memorial Heart Institute

Long Beach Memorial

Medical Center