Trenton, NJ 08625-0360
March 5, 1999
TRENTON -- The statewide death rate for patients undergoing coronary artery bypass graft surgery has declined more than 13 percent from 1994 to 1997, Health and Senior Services Commissioner Len Fishman announced today in releasing New Jersey's second cardiac surgery report card.
And when the data is risk-adjusted to account for the severity of surgical patients' health problems, the drop is even more dramatic -- 26 percent over the same four-year period.
"Patients are now facing surgery with more serious health problems. Yet the state's mortality rate is dropping. This tells us that the quality of bypass surgery is improving in New Jersey," Commissioner Fishman said.
The Department of Health and Senior Services publishes the cardiac surgery report to give consumers information they can use in discussing options with their physicians. Consumers are encouraged to choose a surgeon and hospital with their doctor's guidance. In addition to providing consumer information, the department releases the data to encourage hospitals to undertake an in-depth examination of their cardiac surgery programs.
"Cardiac Surgery in New Jersey, 1996-1997" provides data on statewide mortality following isolated bypass surgery, the most common type of heart procedure. In an isolated bypass, no other major heart procedure is performed at the same time. The report also lists risk-adjusted patient death rates for 13 hospitals and 50 surgeons who performed at least 100 bypass surgeries during the two-year period.
During 1996 and 1997, surgeons performed bypass operations on 16,548 patients and 557 patients died in the hospital during or after surgery. In 1994-1995, there were 544 deaths among the 14,510 surgeries performed.
From 1994 to 1997, the statewide mortality rate declined 13.5 percent --from 3.56 deaths per 100 patients in 1994 to 3.08 in 1997. (The rates were 3.92 in 1995 and 3.66 in 1996.)
To get a clearer picture of changes in the statewide system of cardiac care, the department also analyzed all four years data and risk-adjusted it to account for the patient population's changing health status. That showed that the death rate should have risen over the years, because patients were sicker going into surgery. But the risk-adjusted rate actually dropped from 3.89 in 1994 to 2.88 in 1997 -- a drop of 26 percent.
Several factors can influence the outcome of bypass surgery. Among these risk factors are the patient's age and sex, underlying health problems and history of prior heart surgery. These are among the factors considered when risk-adjusting data.
The cardiac surgery report released today covers a two-year period. It shows that six of the 13 hospitals doing cardiac surgery in 1996-1997 had risk-adjusted death rates that were not significantly different from the statewide average.
Three hospitals had significantly below-average death rates -- Hackensack University Medical Center, Morristown Memorial Hospital and The Valley Hospital. Four hospitals had mortality rates significantly above average -- Jersey Shore Medical Center, Newark Beth Israel Medical Center, Our Lady of Lourdes Medical Center and St. Michael's Medical Center.
The cardiac surgery report also lists individual results for 50 surgeons who performed at least 100 procedures at one hospital during the two-year period. Three had below-average risk- adjusted mortality rates, five were above average and the remainder were within the statewide average.
Data were also collected on low-volume surgeons, and their rates reported not by name, but in an "All Others" category. As a group, low-volume surgeons had a significantly higher-than- average risk-adjusted mortality rate.
Last year, the department adopted regulations phasing in a 100-procedure minimum for surgeons. The regulations require every cardiac surgery hospital to assure that each of its surgeons perform the minimum number of bypass surgeries at that hospital by the year 2001.
In developing the cardiac surgery report, the department worked with the Cardiovascular Health Advisory Panel, a group of experts that included cardiac surgeons, cardiologists and other health care professionals. The Data Quality Improvement Committee and the Commissioner's Clinical Panel also provided oversight on data quality and consistency. Dr. Edward Hannan, who helped develop a similar report in New York State, was consultant to the department on the project.