Key result
Undergoing CABG at Hospital D was associated with a significantly higher risk of 30-day mortality compared to reference Hospital A (OR 5.7; 95% CI 1.9-17.3).
Why the study?
Does the specific cardiac surgery unit affect 30-day mortality following isolated CABG?
Cohort (n=1,603)
Yes
Does the specific cardiac surgery unit affect 30-day mortality following isolated CABG?
Odds Ratio: 5.7 (95% CI 1.9–17.3)
There is significant variability in 30-day mortality following CABG across different hospitals, demonstrating the utility of routinely collected hospital data for screening quality of care.
Hospital variation in CABG mortality supports routine data screening for quality; leaves open causal factors and need for validation before guiding referrals.
OBJECTIVE: Monitoring health outcomes across hospitals has become a growing interest as a potential means to promote quality of care, but in Italy it is at the beginning stage. We aimed at comparing the performance of different cardiac surgery units and testing the utility of routinely collected data in this respect. METHODS: From the Lazio region hospital information system (HIS), we selected a cohort of 1603 individuals (84% males; mean age 63 years, SD 8) residing in Rome (2,685,890 inhabitants), who underwent isolated coronary artery bypass surgery (CABG, ICD-9-CM code: 36.1) in the period 1996-97 in seven major cardiac surgery units in the city. They were identified as A, B, C (teaching), D and E (non-teaching) units. Information on vital status at 30 days after the CABG surgery was obtained through an automatic record linkage with the Municipal Registry of Rome. The association between cardiac surgery units and outcome was evaluated through logistic regression taking into account the following a priori risk factors in different models: gender, age, socio-economic status, type of ischaemic heart disease and comorbidities. RESULTS: The overall mortality was 5.4% (range 2.1-11.4%). Statistically significant predictors of outcome included: age (OR=7.5 for age> or =70 vs. 35-49 years), acute myocardial infarction (OR=32.7 vs. acute-subacute forms/angina), chronic myocardial ischaemia (OR=4.2 vs. acute-subacute forms/angina), other heart diseases (OR=4.8), chronic renal disease (OR=16.0) and peripheral arterial disease (OR=2.9). Statistically significant variability in mortality was observed across hospitals; taking hospital A as reference, hospital D showed the highest risk (OR=5.7, 95% CI=1.9-17.3, in the fully adjusted model). CONCLUSIONS: We suggest that a true variation in quality of care play a role in the observed differences across hospitals, although chance and inaccurately measured risk factors cannot be excluded. Despite some limitations, the HIS is a valid tool for screening cardiac surgery units with poor performance.
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Agabiti et al. (2003) conducted a cohort in Isolated coronary artery bypass surgery (CABG) (n=1,603). Cardiac surgery unit (Hospital D) vs. Cardiac surgery unit (Hospital A) was evaluated on 30-day mortality (OR 5.7, 95% CI 1.9-17.3). Undergoing CABG at Hospital D was associated with a significantly higher risk of 30-day mortality compared to reference Hospital A (OR 5.7; 95% CI 1.9-17.3).
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