Shopping for bypass surgery
Southern Californians who need heart bypass surgery and want to know which hospitals have the best track record have some new information to help guide their decision-making.
A new state report found that three Southern California hospitals -- Hoag Memorial Hospital Presbyterian in Newport Beach, Loma Linda University Medical Center and Torrance Memorial Medical Center -- had about half the number of deaths that would normally be expected to occur during the complicated procedure to open blocked arteries. It was prepared by the Office of Statewide Health Planning & Development and the Pacific Business Group on Health, an alliance of employers who jointly purchase health insurance for their workers.
“This information will help consumers and purchasers of healthcare make judgments on where to get their bypass surgeries,” said Joseph Parker, director of healthcare outcomes for OSHPD.
The results of surgical outcomes in 2000 through 2002 were voluntarily reported by 77 of the state’s 121 hospitals. (Military hospitals were not included in the survey.) The average mortality rate at hospitals that did not report their data was almost 30% higher than at those that did, according to state officials.
Six Southern California hospitals had mortality rates that were significantly worse than expected: Alvarado Hospital Medical Center and Scripps Mercy Hospital, both in San Diego; Desert Regional Medical Center in Palm Springs, Glendale Adventist Medical Center, Providence Holy Cross Medical Center in Mission Hills and Valley Presbyterian Hospital in Van Nuys.
Officials from those hospitals said their mortality rates had improved since the data were reported.
“We need to recognize that this data is 3 to 5 years old,” said Dr. Myron Berdischewsky, the chief medical officer at Providence Holy Cross. “We’ve instituted a method by which we use the data to look at how to improve outcomes.”
The report “doesn’t give a real feel for what the situation is today,” added Eva Saltonstall, a spokeswoman for Desert Regional Medical Center.
Dr. Carl Ermshar, chief of staff at Glendale Adventist, suggested that some of the data submitted by his hospital for the report did not accurately reflect the severity of the patients’ illnesses before surgery. When that is taken into account, he said, their results look much better.
The two sponsoring groups chose coronary artery bypass graft surgery as a basis for comparison because it is one of the most common surgical procedures performed in the state. Each year, about 25,000 Californians undergo the procedure. That number is down from about 30,000 per year in the mid-1990s, when the groups began collecting data, in large part because of the growing use of balloon angioplasty as an alternative.
Angioplasty was performed 54,298 times in California in 2002, contrasted with 24,593 bypass operations the same year.
The average in-hospital death rate for the 77 hospitals participating in the report was 2.61%, compared with 3.35% for those not participating.
Generally, the hospitals with the best results were those that performed the largest number of bypass procedures, a finding that is similar to past reports. Numerous studies have found that medical outcomes for many types of surgeries often are better at hospitals that perform the highest number of procedures. “Practice makes perfect,” Parker said.
Many experts agree that a hospital should perform at least 200 bypasses per year to maintain the best skill level for the procedure. In California, however, almost 69% of hospitals offering the procedure perform fewer than 200 each year.
The report estimated that if all California patients were sent to hospitals that performed at least 450 bypasses per year, 110 lives would be saved annually.
The new report will be the last voluntary one produced by the agencies. A state law requiring all hospitals to report their data took effect Jan. 1, 2003.
Beginning in 2006, the law will require hospitals to report mortality rates for individual surgeons.
The complete data from the project is available on the websites of the two sponsoring organizations: www.pbgh.org and www.oshpd.ca.gov.
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How some hospitals ranked in Southern California
A new state report compared the death rates for patients undergoing coronary bypass surgery at 77 hospitals throughout California from 2000 to 2002. This chart is a partial list showing hospitals in Southern California that were ranked better than expected -- or worse than expected, according to the study.
Better than expected
*--* Hospital No. of operations No. of deaths Expected no.* Ratio** Loma Linda 1,006 18 39.6 0.5 Univ Med Center Hoag Mem 807 14 23.1 0.6 Hosp Presbyteria n, Newport Bch Torrance 607 12 21.3 0.6 Mem Med Center
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Worse than expected
*--* Hospital No. of operations No. of deaths Expected no.* Ratio** Alvarado 228 14 4.1 3.4 Hosp Med Center, San Diego Valley 119 9 4.4 2.0 Presby Hospital, Van Nuys Desert Reg 230 10 5.3 1.9 Med Center, Palm Springs
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*The “expected” number of deaths is based on national averages and the severity of heart problems. “Better than expected” means a hospital’s actual death rate was lower than expected considering the complexity of the cases treated.
**The “expected” death rate for all hospitals statewide is 1.0. A score lower than 1.0 indicates a lower than expected rate; scores above 1.0 indicate a higher than expected rate.
Source: Office of Statewide Health Planning & Development and Pacific Business Group on Health
