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

doi:10.1016/S0003-4975(99)00907-8

The Annals of Thoracic Surgery

Volume 68, Issue 4, October 1999, Pages 1195-1200

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

https://doi.org/10.1016/S0003-4975(99)00907-8 Get rights and content

Abstract

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 χ² 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.

Section snippets

Material and methods

A list of all active cardiac surgeons and their addresses was obtained from the NYSDOH. In April 1997, all 150 surgeons were sent an anonymous survey, which contained 19 multiple choice questions (Appendix). A second survey was sent 6 weeks later, for non-responders. Several survey questions were designed to profile the volume, experience, and type of surgical practice, and to examine the process of the dataentry into the CSRS and familiarity with definitions and statistical results. The

Results

One hundred and four of 150 surgeons (69.3%) completed the questionnaire anonymously. On factual questions, multiple or missing answers were scored incorrect. On questions concerned with opinion, multiple responses were permitted and scored.

Approximately half of the surgeons were in practice more than 10 years (52%) and most surgeons (53%) devote at least 90% of their time to adult cardiac procedures. Typically, most surgeons (69%) perform between 100 and 300 major cardiothoracic cases yearly,

Comment

There are several important advantages and disadvantages with the New York State CSRS. The polled consensus of the involved cardiac surgeons provides new information and perspective. A potential limitation of the study lies in the human observation that a “squeaky wheel gets the grease.” Those most disenchanted with a process, are the ones most likely to respond to a survey. There is always the possibility that a silent group of surgeons are content with the process. Nonetheless, a response

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

Abstract

Section snippets

Material and methods

Results

Comment

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Am Heart J

Ann Thorac Surg

J Am Coll Cardiol

Ann Thorac Surg

State takes docs’ list to heartReleases mortality rate for NY’s cardiac surgeons

New York Newsday

Report cards on cardiac surgeonsassessing New York State’s approach

N Engl J Med

Benefits and hazards of reporting medical outcomes publicly

N Engl J Med

The decline in coronary artery bypass graft surgery mortality in New York Statethe role of surgeon volume

JAMA

Faint hearts

New York Times

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