HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joshua H. Burack Joseph N. Cunningham, Jr Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Burack, J. H. Articles by Cunningham, J. N. Search for Related Content PubMed PubMed Citation Articles by Burack, J. H. Articles by Cunningham, J. N., Jr

Ann Thorac Surg 1999;68:1195-1200
© 1999 The Society of Thoracic Surgeons

---

Original Articles

Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons

^a Division of Cardiothoracic Surgery, State University of New York—Health Science Center at Brooklyn, Brooklyn, New York, USA
^b Scientific Academic Computing Center, State University of New York, Health Science Center at Brooklyn, Brooklyn, New York, USA

Address reprint requests to Dr Burack, Division of Cardiothoracic Surgery, Department of Surgery, Box 40, State University of New York, Health Science Center at Brooklyn, 450 Clarkson Ave, Brooklyn, NY 11203
e-mail: ejsd{at}erols.com

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. Public disclosure of individual surgeons mortality following coronary artery bypass (CAB) is part of the New York State Department of Health Cardiac Surgery Reporting System (CSRS). The effects on the practice of cardiac surgery, as perceived by surgeons, remain unknown.

Methods. All 150 New York State cardiac surgeons were sent an anonymous mail survey in 1997. Data was analyzed to determine the dominant opinion regarding the CSRS.

Results. One hundred and four surgeons (69.3%) responded. The majority (70%) did not experience a change in practice. Data reporting was performed by the surgeon or an employee (58%). Many picked the incorrect definition of chronic obstructive pulmonary disease (COPD) (45%) or statistical method (60%). The aspect of CSRS most in need of improvement was gaming with risk factors (40%). Most surgeons (62%) refused to operate on at least one high-risk CAB patient over the prior year, primarily because of public reporting. Refusal was more common in surgeons in practice less than 10 years, those with less than 100 cases per year, and those with a mixed cardiothoracic practice (p < 0.05, Pearson’s ² test). A significantly higher percentage of high-risk CAB patients were treated non-operatively, when compared with ascending aortic dissection patients (not disclosed) (p < 0.001, Wilcoxon signed ranks test).

Conclusions. The public disclosure of surgical results may be based on imperfect data and appears to have resulted in denial of surgical treatment to high-risk patients.

This article has been cited by other articles:

				S W Grant, A D Grayson, M Jackson, J Au, B M Fabri, G Grotte, M Jones, and B Bridgewater Does the choice of risk-adjustment model influence the outcome of surgeon-specific mortality analysis? A retrospective analysis of 14 637 patients under 31 surgeons Heart, August 1, 2008; 94(8): 1044 - 1049. [Abstract] [Full Text] [PDF]

				B Bridgewater and B Keogh Surgical "league tables": Ischaemic heart disease Heart, July 1, 2008; 94(7): 936 - 942. [Full Text] [PDF]

				H. Miyata, N. Motomura, Y. Ueda, H. Matsuda, and S. Takamoto Effect of procedural volume on outcome of coronary artery bypass graft surgery in Japan: Implication toward public reporting and minimal volume standards. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1306 - 1312. [Abstract] [Full Text] [PDF]

				J. Goldman, S. Kinnear, J. Chung, and D. J. Rothman New York City's Initiatives on Diabetes and HIV/AIDS: Implications for Patient Care, Public Health, and Medical Professionalism Am J Public Health, May 1, 2008; 98(5): 807 - 813. [Abstract] [Full Text] [PDF]

				D. L. Segev, C. E. Simpkins, R. E. Thompson, J. E. Locke, D. S. Warren, and R. A. Montgomery Obesity Impacts Access to Kidney Transplantation J. Am. Soc. Nephrol., February 1, 2008; 19(2): 349 - 355. [Abstract] [Full Text] [PDF]

				C. H. Fung, Y.-W. Lim, S. Mattke, C. Damberg, and P. G. Shekelle Systematic Review: The Evidence That Publishing Patient Care Performance Data Improves Quality of Care Ann Intern Med, January 15, 2008; 148(2): 111 - 123. [Abstract] [Full Text] [PDF]

				C. Kolling, B. R. Simmen, G. Labek, and J. Goldhahn Key factors for a successful National Arthroplasty Register J Bone Joint Surg Br, December 1, 2007; 89-B(12): 1567 - 1573. [Abstract] [Full Text] [PDF]

				S. Westaby, N. Archer, N. Manning, S. Adwani, C. Grebenik, O. Ormerod, R. Pillai, and N. Wilson Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality BMJ, October 13, 2007; 335(7623): 759 - 759. [Abstract] [Full Text] [PDF]

				B. Bridgewater, A. D Grayson, N. Brooks, G. Grotte, B. M Fabri, J. Au, T. Hooper, M. Jones, B. Keogh, and on behalf of the North West Quality Improvement Pr Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: an analysis of 25 730 patients undergoing CABG surgery under 30 surgeons over eight years Heart, June 1, 2007; 93(6): 744 - 748. [Abstract] [Full Text] [PDF]

				D. M. Shahian, F. H. Edwards, V. A. Ferraris, C. K. Haan, J. B. Rich, S.-L. T. Normand, E. R. DeLong, S. M. O'Brien, C. M. Shewan, R. S. Dokholyan, et al. Quality Measurement in Adult Cardiac Surgery: Part 1--Conceptual Framework and Measure Selection Ann. Thorac. Surg., April 1, 2007; 83(4_Supplement): S3 - S12. [Full Text] [PDF]

				L. P. Casalino, G. C. Alexander, L. Jin, and R. T. Konetzka General Internists' Views On Pay-For-Performance And Public Reporting Of Quality Scores: A National Survey Health Aff., March 1, 2007; 26(2): 492 - 499. [Abstract] [Full Text] [PDF]

				J. M. Kahn, A. A. Kramer, and G. D. Rubenfeld Transferring Critically Ill Patients Out of Hospital Improves the Standardized Mortality Ratio: A Simulation Study Chest, January 1, 2007; 131(1): 68 - 75. [Abstract] [Full Text] [PDF]

				A. J. Epstein Do cardiac surgery report cards reduce mortality? Assessing the evidence. Med Care Res Rev, August 1, 2006; 63(4): 403 - 426. [Abstract] [PDF]

				C R Canning The power of integrated data. Br. J. Ophthalmol., August 1, 2006; 90(8): 938 - 939. [Full Text] [PDF]

				Z. G. Turi Reply J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1737 - 1738. [Full Text] [PDF]

				M. B. Rosenthal and R. G. Frank What is the empirical basis for paying for quality in health care? Med Care Res Rev, April 1, 2006; 63(2): 135 - 157. [Abstract] [PDF]

				Z. G. Turi The Big Chill: The Deleterious Effects of Public Reporting on Access to Health Care for the Sickest Patients J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1766 - 1768. [Full Text] [PDF]

				C. J. Hilton, J.R. L. Hamilton, N. Vitale, and R. Haaverstad Effects of 'Bristol' on surgical practice in the United Kingdom Interactive CardioVascular and Thoracic Surgery, June 1, 2005; 4(3): 197 - 199. [Abstract] [Full Text] [PDF]

				R. M. Werner and D. A. Asch The Unintended Consequences of Publicly Reporting Quality Information JAMA, March 9, 2005; 293(10): 1239 - 1244. [Abstract] [Full Text] [PDF]

				B. Bridgewater and on behalf of the adult cardiac surgeons of north w Mortality data in adult cardiac surgery for named surgeons: retrospective examination of prospectively collected data on coronary artery surgery and aortic valve replacement BMJ, March 5, 2005; 330(7490): 506 - 510. [Abstract] [Full Text] [PDF]

				C. R. Narins, A. M. Dozier, F. S. Ling, and W. Zareba The Influence of Public Reporting of Outcome Data on Medical Decision Making by Physicians Arch Intern Med, January 10, 2005; 165(1): 83 - 87. [Abstract] [Full Text] [PDF]

				D. M. Shahian Improving Cardiac Surgery Quality--Volume, Outcome, Process? JAMA, January 14, 2004; 291(2): 246 - 248. [Full Text] [PDF]

				M. J. Swart and G. Joubert The EuroSCORE does well for a single surgeon outside Europe Eur. J. Cardiothorac. Surg., January 1, 2004; 25(1): 145 - 145. [Full Text] [PDF]

				D. Pitches, A. Burls, and A. Fry-Smith How to make a silk purse from a sow's ear--a comprehensive review of strategies to optimise data for corrupt managers and incompetent clinicians BMJ, December 20, 2003; 327(7429): 1436 - 1439. [Full Text] [PDF]

				P. P. Goodney, G. T. O'Connor, D. E. Wennberg, and J. D. Birkmeyer Do hospitals with low mortality rates in coronary artery bypass also perform well in valve replacement? Ann. Thorac. Surg., October 1, 2003; 76(4): 1131 - 1137. [Abstract] [Full Text] [PDF]

				J. H. Liu, D. A. Etzioni, J. B. O'Connell, M. A. Maggard, D. T. Hiyama, and C. Y. Ko Inpatient Surgery in California: 1990-2000 Arch Surg, October 1, 2003; 138(10): 1106 - 1112. [Abstract] [Full Text] [PDF]

				R. S. Hartz, J. A Swain, and L. Mickleborough Sixty-year perspective on coronary artery bypass grafting in women J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 620 - 622. [Full Text] [PDF]

				I. S Gilfillan Ranking heart surgeons has pitfalls BMJ, July 10, 2003; 327(7406): 107 - 107. [Full Text]

				J R Pepper Risk assessment in coronary artery surgery Heart, January 1, 2003; 89(1): 1 - 2. [Full Text] [PDF]

				D. M. Shahian, S.-L. Normand, D. F. Torchiana, S. M. Lewis, J. O. Pastore, R. E. Kuntz, and P. I. Dreyer Cardiac surgery report cards: comprehensive review and statistical critique Ann. Thorac. Surg., December 1, 2001; 72(6): 2155 - 2168. [Abstract] [Full Text] [PDF]

				B. J. Harlan Statewide reporting of coronary artery surgery results: A view from California J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 409 - 417. [Full Text] [PDF]

				J. A Swain and R. S Hartz Assessing quality in cardiac surgery: why this is necessary in the twenty-first century Perfusion, May 1, 2000; 15(3): 181 - 190. [Abstract] [PDF]