CA Reports Stroke Rates in Bypass Surgery Data
For bypass graft mortality without stroke, no hospital performed significantly better than the state average. But Enloe Medical Center in Sacramento, Los Angeles Co. Harbor—UCLA Medical Center, St. Joseph's Medical Center in Stockton and Valley Presbyterian Hospital in Van Nuys, performed significantly worse.
The California agency keeps the largest public outcomes database in the country and is an important source of comparative information for performance.
Other significant findings from the report include the following:
- Of the 30,379 patients who underwent isolated CABG surgery, 405 experienced a stroke in which symptoms lasted for 72 hours or longer, a rate of 1.33%, which is close to the national rate of 1.4% reported by the Society of Thoracic Surgeons.
- The operative mortality rate for CABG surgery in the state in 2007 was 2.35%, slightly higher than 2.2% for 2006, but much lower than in the prior three years 3.1%, 3.3% and 2.9%.
- There were 347 operative deaths among the 14,756 CABG surgeries during 2007.
This latest report also scored hospitals on their use of the internal mammary artery (IMA) during CABG procedures, a practice associated with better surgical outcomes but may take longer. Five hospitals had low rates of IMA usage, including Citrus Valley Medical Center in Covina, Dameron Hospital in Stockton, Lakewood Regional Medical Center in Lakewood, Suttter Medical Center in Santa Rosa and Tri-City Medical Center in Oceanside.
Parker says that use of the IMA in bypass graft surgery is longer lasting and is associated with lower mortality, but takes about 15 minutes longer to perform than traditional use of the radial artery or saphenous vein, and that may be why some surgeons fail to use it. In 2007, the state had a 93.7% IMA usage, a 4% increase since 2003.
With its next report the state hopes to add in comparative data on how many CABG patients go into renal failure and require post-operative dialysis, another complication. Renal failure occurs in between 1% and 2% of CABG cases, on average, he says.
Debby Rogers, vice president for Quality and Emergency Services for the California Hospital Association, says her organization is "pleased that they're issuing reports with more recent data." She noted that the reports indicate a distinct "through the years that care is improving" related to CABG mortality.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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