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Ann Thorac Surg 1990;49:410-412
© 1990 The Society of Thoracic Surgeons

Articles

Hospital death on a cardiac surgical service: Negative influence of changing practice patterns

Lynn B. McGrath, MD*,a,b, Glenn W. Laub, MDa,b, Debbie Graf, RNa,b, Lorenzo Gonzalez-Lavin, MDa,b

a Department of Surgery, Deborah Heart and Lung Center and Deborah Research Institute Browns Mills, USA
b Department of Surgery University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey USA

Accepted for publication October 18, 1989.

* Address reprint requests to Dr McGrath, Department of Surgery, Deborah Heart and Lung Center, 200 Trenton Rd, Browns Mills, NJ 08015.

From January 1982 through December 1985, 3,772 patients underwent a cardiac surgical procedure for coronary or acquired heart disease. Operative mortality increased from 4% in 1982 to 7% in 1985 (p < 0.001 by {chi} 2 analysis). There was an increase over time of patients older than 70 years (p < 0.001). Female patients increased from 31% in 1982 to 35% in 1985 (p < 0.001). The percentage of patients having isolated coronary artery bypass grafting decreased from 69% in 1983 to 60% in 1985 (p < 0.001), and hospital mortality after this procedure increased (p = 0.058). Patients requiring more complex procedures including multiple-valve operations or combined valve replacement or repair plus bypass grafting increased from 1982 through 1985 (p = 0.005). Reoperations for multiple-valve procedures or combined valve repair or replacement plus coronary artery bypass grafting also increased (p = 0.02), particularly for patients more than 70 years of age (p < 0.001). Changing practice patterns have had 2 negative impact on surgical results. This evolution in cardiac surgical practice has important implications related to peer review and quality-assurance screening, diagnosis-related group reimbursement, and reporting of surgical outcomes to governmental agencies.




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