Coronary Artery Bypass Graft Surgery in New Jersey
1996 - 1997

Wave
March 1999

In November 1997, the Department of Health and Senior Services published its first coronary artery bypass graft (CABG) surgery report. This report contained information about the risk-adjusted mortality rates for both hospitals and surgeons in New Jersey using 1994-95 patient data. This document is the second release of the CABG report. This report is based on 1996-97 data and is similar to the first one. Thus, most of the basic information related to bypass surgery is the same in both reports.

Coronary heart disease (also known as coronary artery disease or ischemic heart disease) occurs when the coronary arteries, which carry blood to the heart, are clogged with fatty deposits on the artery walls. This can lead to angina (chest pain) that is caused by oxygen deficiency, particularly when the arteries are closed by 50 percent or more. Furthermore, angina is a warning sign for heart attack, when a coronary artery that carries blood to the heart is occluded or blocked. This leads to starvation of a portion of the heart muscle and an area of heart tissue that is no longer alive.

According to the American Heart Association, almost 14 million Americans have coronary artery disease, and coronary artery disease or other cardiovascular diseases claimed nearly one million deaths in the United States in 1995. This represents 41.5 percent of all deaths, or one in every 2.4 deaths.

One of the primary treatments for coronary heart disease is coronary artery bypass graft (CABG) surgery. These operations are performed by using segments of veins or arteries from other parts of the patient's body to create a detour around the blocked portion of the patient's coronary artery. In 1995, an estimated 573,000 people in the nation underwent CABG surgery. In New Jersey, a total of 16,548 people underwent isolated CABG surgery (CABG surgery with no other major heart surgery during the same admission) in 1996-1997; these people, the hospitals in which they underwent surgery, and the surgeons who performed the surgery are the subject of this report.

New Jersey's Quality Improvement Program for CABG Surgery

Under the expert guidance of the Cardiovascular Health Advisory Panel (CHAP), the New Jersey Department of Health and Senior Services has initiated a program under which the 13 hospitals in the State that have the Department's approval to perform coronary artery bypass graft (CABG) surgery, submit detailed information to the Department for analysis and feedback to hospitals, surgeons and the public. Information that is collected for each patient undergoing CABG surgery in New Jersey includes demographics, pre-operative risk factors, complications that occur during or after surgery, and discharge status (died in the hospital, discharged alive). These data have been collected since 1993, and advice has been sought throughout the process from the Cardiovascular Health Advisory Panel, the clinical community and outcome analysis experts.

Analyses consisted of identifying the pre-operative risk factors that were significantly associated with patients' chances of being discharged alive, and using statistical methods to develop a formula for predicting each patient's probability of in- hospital mortality based on those risk factors. This information was then used to assess the average pre-operative severity of illness for each hospital's (and each surgeon's) patients. The next step consisted of using the mortality rate for each hospital's (and each surgeon's) patients in conjunction with their average severity of illness to arrive at a "risk-adjusted mortality rate" that serves as a measure of quality of care. This report provides risk-adjusted mortality rates for 1996-1997 for all hospitals in which CABG surgery is performed, and for all surgeons performing 100 or more CABG operations in at least one hospital during those two years (CABG surgery without any other major heart surgery performed during the same admission).

The release of this information to hospitals, surgeons, and the public in New York and Pennsylvania has led to numerous hospital quality improvement initiatives and significant decreases in mortality rates in those states, and the Department is confident that this and subsequent releases in New Jersey will have the same effect. For instance, several New Jersey hospitals are collaborating in a "best practice" program. Another reason for the report is to enable consumers and potential patients to become more informed about their options and to be aware of patient outcomes associated with CABG surgery providers (hospitals and surgeons).

The following is a description of the patient population and the process for calculating risk-adjusted mortality rates for hospitals and surgeons. The statistical model that is used, along with all significant pre-operative risk factors, is also presented. The last section presents risk-adjusted mortality rates for hospitals and surgeons in New Jersey for 1996-1997.

Patient Population

The patients represented in this report are the 16,548 patients who have undergone isolated coronary artery bypass graft (CABG) surgery (CABG surgery with no other major heart surgery during the same admission) in New Jersey in 1996-1997. As indicated earlier, these operations are performed by using segments of veins or arteries from other parts of the patient's body to create a detour around the blocked portion of the patient's coronary artery. The total number of these patients who died during or after surgery in the same admission was 557 and the in- hospital mortality rate was 3.37 percent. This population includes Minimally Invasive Coronary Artery Bypass (MIDCAB) procedures which were first performed in New Jersey in 1996.

The Commissioner's Clinical Review Panel reviewed cases submitted by hospitals for exclusion as salvage cases and patients who appear to have died from complications of a second unrelated operation performed within the index hospitalization after full recovery from a successful cardiac operation. As a matter of public health policy, the Panel recommended removal of some of the above cases from the report so as not to unduly penalize surgeons who operate on such cases.

Rationale for using 1996-1997 Data

Data for the years 1996 and 1997 were used for this study because they represent the most recent data available. Additionally, the Data Quality Improvement Committee, a committee with physician representation from all surgery centers, also recommended that 1996 and 1997 data be used because hospitals had ample time and the opportunity to "clean up" the data before submission. Thus, the Committee felt that the 1996-97 data were much improved in comparison to the 1994-1995 data, even though it required the exclusion of several risk-factors. If the Department were to use 1994-95 data along with the 1996-1997 data, the risk-adjusted mortality rate would include "old data" as half of its weight. This is undesirable since last year's report already reflected hospital and surgeon performance for 1994 and 1995.

The recommendations of this group and the ongoing cooperation of the hospitals, physicians and surgeons in the state have lead to improvements in the process of both data collection and analysis. The results of this collaboration are likely to lead to, not only improved care for patients in the state, but to a stronger, more robust analysis of clinical results.

Assessing Hospital and Surgeon Performance For CABG Surgery By Calculating Risk-Adjusted Mortality Rates

Provider (hospital and surgeon) performance for CABG surgery is assessed by looking at patient outcomes and how they compare with outcomes throughout the state. Ideally, "patient outcomes" include such things as whether the patient died during or after surgery, what complications of surgery they suffered, their long- term survival, and their satisfaction with the care they received. This report concentrates on in-hospital mortality, which is arguably the most important outcome and also easier to collect.

In-hospital mortality is affected by the pre-operative severity of illness of CABG surgery patients, as well as by the quality of surgery and hospital care patients receive. Consequently, if some hospitals treat sicker patients, they will have higher mortality rates even if their quality of care is comparable to hospitals with patients who are not as sick. Thus, it is important to try to adjust for differences in patient severity of illness when reporting outcomes. The following is a description of how this is done when reporting hospital and surgeon outcomes.

Data Collection and Data Quality Audit

All 13 hospitals in New Jersey in which cardiac surgery is performed collect detailed patient-specific information related to the patient's demographics, pre-operative risk factors, complications of surgery and discharge status (died in the hospital, discharged alive). This process began in 1993 with a pilot data collection from a few hospitals. Full participation by all 13 cardiac centers began in 1994. This information is forwarded to the Department for data accuracy, validation and analysis. The accuracy of the data was verified by an independent auditor comparing a sample of cases against medical records. When discrepancies were found between the data and the medical records, the hospitals were asked to produce corroborating medical record documentation of their coding or to recode the cases. A verification against hospital discharge records was also conducted to assure that all cases and deaths were reported. Error trapping and frequency reports were also run several times throughout the data cleaning process and shared with the hospitals for correction.

Computing the Observed Mortality Rates for Hospitals and Surgeons

The observed mortality rate for each hospital and for each surgeon can be easily computed by dividing the number of patients who died in the hospital during or after CABG surgery by the number of patients who underwent CABG surgery (the number who died in the hospital plus the number who were discharged alive). Unfortunately, this number can be very misleading as a measure of hospital or surgeon performance because it does not account for how sick the patients were prior to surgery. If one hospital had considerably sicker patients than another hospital, it would be expected that its mortality rate would be somewhat higher. Consequently, a more fair way of comparing the performance of the two hospitals would take into account both their observed mortality rates and a measure of how sick their patients were prior to surgery.

Computing the Predicted Mortality Rates for Hospitals and Surgeons

The measure of how seriously ill each CABG patient is prior to his/her surgery is called the predicted probability of death, and represents the chance that the patient will die during or after surgery but before discharge from the hospital. The predicted probability of death is obtained using a statistical model (called logistic regression) that identifies which of a group of proposed patient risk factors are significantly related to a patient's chance of dying during or after CABG surgery, and then assigns statistical weights to those risk factors. The weights are used in a formula that generates the patient's predicted probability of death.

If a patient's predicted probability of death is 0.05, this means that it is estimated that there are five chances in 100 (or 1 chance in 20) that the patient will die in the hospital prior to discharge.

The estimate of the average risk for all of a hospital's or all of a surgeon's patients is obtained by summing the predicted probabilities of death for all of the patients and dividing by the number of patients. This number, which is called the provider's predicted or expected mortality rate, is an estimate of what the provider's mortality rate would have been if the provider's performance had been identical to the statewide performance for those patients.

The statistical methods used to predict mortality on the basis of the significant risk factors are tested to determine if they are sufficiently accurate in predicting mortality for patients who are extremely ill prior to undergoing the procedure as well as for patients who are relatively healthy. These tests have confirmed that the model is reasonably accurate in predicting how patients of all different risk levels will fare when undergoing coronary bypass surgery.

Computing the Risk-Adjusted Mortality Rate

Hospital and surgeon performance is assessed by comparing what actually happened (the observed mortality rate) with what was predicted to happen based on how severely ill the hospital's or surgeon's patients were (the expected mortality rate). First, the observed mortality rate is divided by the provider's expected mortality rate. If the resulting ratio is larger than one, the provider has a higher mortality rate than expected on the basis of its patient mix; if it is smaller than one, the provider has a lower mortality rate than expected from its patient mix. The ratio is then multiplied by the statewide mortality rate of 1996- 1997 (3.37%) to obtain the provider's risk-adjusted mortality rate.

The risk-adjusted mortality rate represents the best estimate, based on the associated statistical model, of what the provider's mortality rate would have been if the provider had a mix of patients identical to the statewide mix. Thus, the risk-adjusted mortality rate has, to the extent possible, ironed out differences among providers in patient severity of illness, since it arrives at a mortality rate for each provider on an identical group of patients.

Interpreting the Risk-Adjusted Mortality Rate

If the risk-adjusted mortality rate is lower than the statewide mortality rate, the provider has a better performance than the state as a whole; if the risk-adjusted mortality rate is higher than the statewide mortality rate, the provider has a poorer performance than the state as a whole.

The risk-adjusted mortality rate is used in this report as a measure of quality of care provided by hospitals and surgeons. However, there are reasons that a provider's risk-adjusted mortality rate may not be indicative of the quality of care being provided.

For example, extreme outcome rates may occur due to chance alone. This is particularly true for low-volume providers, for whom very high or very low mortality rates are more likely to occur than for high-volume providers. In order to minimize misinterpretation due to chance variation, coronary bypass surgeon data have been reported only for surgeons who have performed at least 100 operations over the two-year period. Another attempt to prevent misinterpretation of differences caused by chance variation is the use of expected ranges (confidence intervals) in the reported results. The interpretations of those terms are provided later when the data are presented.

Differences in hospital coding of risk factors could be an additional reason that a provider's risk-adjusted rate may not be reflective of quality of care. However, the Department of Health and Senior Services monitors the quality of coded data by reviewing patients' medical records to ascertain the presence of key risk factors. The Department also contracts with an independent audit firm to audit hospital data. When significant coding problems have been discovered, hospitals have been required to recode their data, and these recoded data have been used in the calculations that appear in this booklet.

Another reason that risk-adjusted rates may be misleading is that overall pre-procedural severity of illness may not be accurately estimated because important risk factors are missing. This is not considered to be an important factor, however, because the New Jersey system does contain a large number of risk factors that have been demonstrated to be related to patient mortality in various national and international studies. Despite the possible limitations in overall predictive power, statistical tests do indicate that the model is a reasonable predictor of in-hospital mortality for New Jersey patients.

A final reason why these data may not provide a definitive measure of provider quality care is that patient mortality is not the only way of measuring quality; for instance, complications of surgery, patient quality of life following surgery, and patient satisfaction are also important markers of quality. Although the risk-adjusted mortality rates presented here may not be a totally accurate depiction of the quality of care, the New Jersey Department of Health and Senior Services believes that this information is a valuable aid in choosing providers for coronary artery bypass graft surgery. Perhaps even more importantly, the Department feels that the information provided here can serve as a guide and an impetus for hospitals and surgeons to improve the quality of care they provide to CABG surgery patients.

RESULTS

1996-1997 Risk Factors for CABG Surgery

The significant pre-operative risk factors for CABG surgery in 1996-1997 in New Jersey are presented in Table 1, along with coefficients for the statistical model, p-values, and odds ratios. The coefficients can be used to compute a given patient's probability of death given the patient's risk factors. The p-values state the level of significance for each of the risk factors in Table 1. Note that the smaller the p-value, the more significant the risk factor is as a predictor of in-hospital mortality. Also, note that the only risk factors used in the statistical model were ones that were highly significant predictors (i.e. had p-values of .05 or smaller).

For all risk factors except age, ejection fraction and renal failure, the odds ratios represent the odds of a patient with the risk factor dying in the hospital divided by the odds of a patient without the risk factor dying in the hospital. Roughly speaking, this is the number of times more likely a patient with the risk factor is to die in the hospital than a patient without the risk factor, all other risk factors being identical. For example, the odds ratio for diabetes is 1.472. This means that a CABG surgery patient with diabetes has odds of dying in the hospital during or after surgery that are 1.472 times the odds of a patient without diabetes, assuming the two patients are identical with respect to the other risk factors presented in Table 1.

For age, the odds ratio represents the number of times more likely a patient in a certain age group is to die in the hospital than a patient whose age is below 65 years. For example, a CABG patient between 75 and 84 years of age has odds of dying in the hospital that are 2.660 times the odds of a patient who is less than 65 years old with the same other risk factors.

Table 1: Multivariable Risk Factor Equation for Isolated CABG
Hospital Deaths in New Jersey in 1996-1997.
    Logistic Regression  
Patient Risk Factor   Coefficient P-Value Odds Ratio  
Demographic          
    Ages 65 - 69 0.4793 0.0005 1.615  
    Ages 70 - 74 0.6353 <0.0001 1.888  
    Ages 75 - 84 0.9784 <0.0001 2.660  
    Ages 85 and Over 1.9160 <0.0001 6.794  
    Female 0.5540 <0.0001 1.740  
           
Comorbidity          
    Diabetes 0.3868 <0.0001 1.472  
    Renal Failure with Dialysis 1.7441 <0.0001 5.721  
    Renal Failure without Dialysis 1.3615 <0.0001 3.902  
           
Ventricular Function          
    Ejection Fraction 30% - 49% or Fair 0.5732 <0.0001 1.774  
    Ejection Fraction 1% - 29% or Poor 1.2325 <0.0001 3.430  
           
Previous Open Heart Surgery 1.4777 <0.0001 4.383  
Preoperative Intra Aortic Balloon Pump 0.6518 <0.0001 1.919  
Left Main Disease 0.3605 0.0002 1.434  
           
    Intercept -5.1543      
    C-Statistic 0.781      
           
Source: New Jersey Open Heart Surgery Database, 1996-1997.          

Similarly, for ejection fraction, the odds ratios are relative to the reference group of patients, which are the patients with an ejection fraction that is 50 percent or greater or has not been reported. Thus, for example, the odds of a patient with an ejection fraction of 29 percent or less, or "poor" dying in the hospital are 3.430 times the odds of a patient with an ejection fraction 50 percent or greater dying in the hospital. For renal failure, the odds ratio are relative to the reference group of patients without renal failure. Thus, the odds of a patient with renal on dialysis dying the hospital are 5.721 times the odds of a patient without renal failure dying in the hospital, all other risk factors being the same.

Figure 1: Number of Isolated Coronary Artery Bypass Graft (CABG) Surgeries by Hospital 1996-1997

Figure 1

1996-1997 Hospital and Surgeon Outcomes for CABG Surgery

Table 2 presents the 1996-1997 isolated CABG surgery results for the 13 hospitals in which this procedure was performed in New Jersey. For each hospital, the table contains the number of isolated CABG operations performed in 1996-1997, the number of in-hospital deaths, the observed mortality rate, the expected mortality rate based on the statistical model presented in Table 1, the risk-adjusted mortality rate, and a 95 percent confidence interval for the risk-adjusted rate.


Confidence intervals for the risk-adjusted mortality rate indicate which hospitals and surgeons had significantly more or fewer deaths than expected given the risk factors of their patients. Hospitals and surgeons with significantly higher rates than expected after adjusting for risk are those with confidence intervals entirely above the statewide rate. Hospitals and surgeons with significantly lower rates than expected, given the severity of illness of their patients before surgery, have confidence intervals entirely below the statewide rate. It should be noted that, in general, hospitals with higher volumes have smaller confidence intervals than hospitals with lower volumes.

It is important to note that the statistical techniques used have been designed to compare the patient mortality rate associated with a given provider (hospital or surgeon) with the patient mortality of the aggregate of all other providers in New Jersey. Therefore, this method does not allow for direct provider-to- provider comparisons.

Table 2: Hospital Observed, Expected and Risk-Adjusted
Mortality Rates for Isolated CABG Surgeries in New Jersey, 1996-1997
(Listed Alphabetically by Hospital)
Hospital Cases Deaths OMR EMR RAMR   95% CI for RAMR
Cooper Hospital/University M.C. 813 21 2.58 3.26 2.67 ( 1.65 , 4.08 )
Deborah Heart and Lung Center 1,690 62 3.67 3.60 3.43   ( 2.63 , 4.39 )
General Hospital Center at Passaic 918 35 3.81 3.12 4.12   ( 2.87 , 5.72 )
Hackensack University Medical Center 1,643 36 2.19 3.90 1.89 - ( 1.33 , 2.62 )
Jersey Shore Medical Center 1,162 58 4.99 3.33 5.04 + ( 3.83 , 6.52 )
Morristown Memorial Hospital 2,239 44 1.97 2.91 2.27 - ( 1.65 , 3.05 )
Newark Beth Israel Medical Center 929 61 6.57 4.26 5.19 + ( 3.97 , 6.67 )
Our Lady of Lourdes Medical Center 2,083 81 3.89 3.04 4.31 + ( 3.42 , 5.36 )
Robert Wood Johnson University Hosp. 1,697 50 2.95 3.27 3.03   ( 2.25 , 4.00 )
St. Joseph's Hospital & Medical Center 858 27 3.15 4.45 2.38   ( 1.57 , 3.46 )
St. Michael's Medical Center 888 44 4.95 3.14 5.32 + ( 3.86 , 7.14 )
The Valley Hospital 1,406 28 1.99 2.95 2.27 - ( 1.51 , 3.29 )
UMDNJ/University Hospital 222 10 4.50 3.24 4.67   ( 2.24 , 8.60 )

Statewide Total 16,548 557 3.37 3.37 3.37            

OMR: Observed mortality rate.
EMR: Expected mortality rate.
RAMR: Risk-adjusted mortality rate; RAMR = (OMR/EMR)*Statewide OMR.
+ Risk-adjusted mortality rate significantly higher than statewide rate based on 95 percent confidence interval.
- Risk-adjusted mortality rate significantly lower than statewide rate based on 95 percent confidence interval.


Source: New Jersey Open Heart Surgery Database, 1996-1997.

Observed, Expected and Risk-Adjusted Mortality Rates
for Isolated CABG Surgeries in New Jersey, 1996-1997,
High Volume Surgeons vs. All Others.

  Cases Deaths OMR EMR RAMR   95% CI for RAMR  

Surgeons with 100 CABGs and Over 15,004 488 3.25 3.36 3.26   ( 2.98 , 3.56 )  
All Others 1,544 69 4.47 3.45 4.37 + ( 3.40 , 5.52 )  

Statewide Total 16,548 557 3.37 3.37 3.37              

OMR: Observed mortality rate.
EMR: Expected mortality rate.
RAMR: Risk-adjusted mortality rate; RAMR = (OMR/EMR)*Statewide OMR.
+ Risk-adjusted mortality rate significantly higher than statewide rate based on 95 percent confidence interval.

Source: New Jersey Open Heart Surgery Database, 1996-1997.

Observed, Expected and Risk-Adjusted Mortality Rates
for Isolated CABG Surgeries in New Jersey State, 1994 and 1995

  Cases Deaths OMR EMR RAMR   95% CI for RAMR  
1994 6,957 248 3.56 3.63 3.68   ( 3.24 , 4.17 )  
1995 7,553 296 3.92 3.86 3.81   ( 3.39 , 4.27 )  

1994 - 1995 14,510 544 3.75 3.75 3.75              

OMR: Observed mortality rate.
EMR: Expected mortality rate.
RAMR: Risk-adjusted mortality rate; RAMR = (OMR/EMR)*Statewide OMR.

As indicated in Table 2, the overall mortality rate for the 16,548 CABG operations performed at the 13 hospitals was 3.37 percent. Observed mortality rates ranged from 1.97 percent to 6.57 percent. The range in expected mortality rates, which measure patient severity of illness, was from 2.91 percent to 4.45 percent.

The risk adjusted mortality rates, which are used to measure performance, ranged from 1.89 percent to 5.32 percent. Three hospitals--Hackensack University Medical Center, Morristown Memorial Hospital and Valley Hospital--had a risk-adjusted mortality rate that was significantly lower than the statewide rate. Four hospitals--Jersey Shore Medical Center, Newark Beth Israel Medical Center, Our Lady of Lourdes Medical Center and Saint Michael's Medical Center--had significantly higher risk-adjusted mortality rates than the statewide average.

1994-1997 Statewide Data

Table 3 is derived from the results of a statistical model based on New Jersey CABG surgery data from four years: 1994-1997. The table presents, for each of the four years, the observed, expected, and risk-adjusted in-hospital mortality rates for all patients undergoing isolated CABG surgery in New Jersey.

As indicated in Table 3, the volume of isolated CABG procedures rose in each of the one--year periods. The volume rose from 6,957 in 1994 to 8,286 in 1997, an increase of 19.1 percent. The observed mortality rate rose from 3.56 percent in 1994 to 3.92 percent in 1995, and then dropped to 3.66 percent in 1996 and to 3.08 percent in 1997. The expected rate rose in each of the one year periods, with a low of 3.25 percent in 1994 and a high of 3.78 percent in 1997. This rise from 1994 to 1997 represents an increase of 16.3 percent. This increase is not surprising in view of the increase in the number of patients with coronary artery disease who have been undergoing percutaneous coronary transluminal angioplasty, which is an alternative to CABG surgery among lower risk candidates for CABG surgery.

Table 3, Actual, Expected, and Risk-Adjusted Statewide Mortality
After Coronary Artery Bypass Surgery, 1994 - 1997

Year 1994 1995 1996 1997 Total
Cases 6,957 7,553 8,262 8,286 31,058
Mortality 248 296 302 255 1,101

Observed 3.56% 3.92% 3.66% 3.08% 3.54%
Expected 3.25 3.42 3.67 3.78 3.54
Risk Adjusted 3.89 4.06* 3.53 2.88** 3.54
Confidence Interval (3.42,4.40) (3.61,4.55) (3.14,3.95) (2.54,3.26)
For Risk-Adjusted
Mortality Rate

*Significantly higher than four-year average mortality rate based on 95% confidence interval.
**Significantly lower than four-year average mortality rate based on 95% confidence interval.


The risk-adjusted mortality rate rose from 3.89 percent in 1994 to 4.06 percent in 1995, then dropped to 3.53 percent in 1996, and to 2.88 percent in 1997. The drop from 3.89 percent in 1994 to 2.88 percent in 1997 represents a total decrease of 26.0 percent.

It is especially notable that the risk-adjusted mortality rate in 1997 (2.88%) was significantly lower than the four-year mortality rate for 1994-1997 (3.54%). This is indicative of an improvement in CABG surgery outcomes in New Jersey, and 1997 is the earliest time at which an improvement related to the collection and dissemination of these data could have occurred. This is due to the fact that hospitals first became aware of the new system in January 1997.

Table 4 presents the 1996-1997 CABG surgery results for 50 New Jersey surgeons performing at least 100 isolated CABG surgery operations (CABG operations with no other major heart surgery) in at least one hospital during this time period. The table contains, for each hospital and surgeon, the number of isolated CABG operations performed in 1996-1997, the number of in-hospital deaths, the observed mortality rate, the expected mortality rate based on the statistical model presented in Table 1, the risk- adjusted mortality rate, and a 95 percent confidence interval for the risk-adjusted rate. Note that the results for surgeons who performed fewer than 100 isolated CABG operations in 1996-1997 in one hospital are grouped together and reported as "All Others" in the hospital in which the operations were performed.


  Table 4: Observed, Expected and Risk-Adjusted Mortality Rates for Isolated CABG Surgeries by Hospital and Surgeon in New Jersey, 1996-1997 (Listed Alphabetically by Hospital and Surgeon)

    Hospital/Surgeon Cases Deaths OMR EMR RAMR   95% CI for RAMR  

  Cooper Hospital/University M.C.                        
    Cilley, Jonathan 266 3 1.13 3.71 1.02 - ( 0.21 , 2.99 )  
    Delrossi, Anthony 209 6 2.87 3.28 2.95   ( 1.08 , 6.42 )  
    Ng, Arthur 141 5 3.55 2.29 5.20   ( 1.68 , 12.14 )  
    All Others 197 7 3.55 3.31 3.61   ( 1.45 , 7.44 )  
    Total 813 21 2.58 3.26 2.67   ( 1.65 , 4.08 )  
  Deborah Heart and Lung Center                          
    Anderson, William 384 12 3.13 3.74 2.81   ( 1.45 , 4.91 )  
    Fernandez, Javier 159 16 10.06 4.68 7.24 + ( 4.13 , 11.75 )  
    Laub, Glenn 429 11 2.56 3.59 2.41   ( 1.20 , 4.30 )  
    McGrath, Lynn B. 718 23 3.20 3.30 3.27   ( 2.07 , 4.90 )  
    Total 1,690 62 3.67 3.60 3.43   ( 2.63 , 4.39 )  
  General Hospital Center at Passaic                          
    Baeza, Oscar 185 7 3.78 3.18 4.00   ( 1.60 , 8.24 )  
  # Goldenberg, Bruce 145 2 1.38 2.79 1.66   ( 0.19 , 6.00 )  
    Kaushik, Raj 221 7 3.17 3.20 3.33   ( 1.33 , 6.86 )  
    Saxena, Amarkanth 223 8 3.59 3.15 3.83   ( 1.65 , 7.56 )  
    All Others 144 11 7.64 3.18 8.07 + ( 4.03 , 14.45 )  
    Total 918 35 3.81 3.12 4.12   ( 2.87 , 5.72 )  
  Hackensack University Medical Center                          
    Brenner, William I. 188 7 3.72 4.12 3.04   ( 1.22 , 6.27 )  
    Hutchinson III, John E. 462 11 2.38 3.58 2.24   ( 1.12 , 4.00 )  
    Praeger, Peter I. 481 7 1.46 3.72 1.32 - ( 0.53 , 2.72 )  
    Somberg, Eric D. 421 8 1.90 3.50 1.83   ( 0.79 , 3.60 )  
    All Others 91 3 3.30 7.82 1.42   ( 0.29 , 4.15 )  
    Total 1,643 36 2.19 3.90 1.89 - ( 1.33 , 2.62 )  
  Jersey Shore Medical Center                          
    Dejene, Brook 210 11 5.24 3.64 4.84   ( 2.41 , 8.66 )  
    Rajaii-Khorasani, Ahmad 383 20 5.22 3.49 5.03   ( 3.07 , 7.77 )  
    Roberts, Arthur J. 450 21 4.67 3.37 4.66   ( 2.88 , 7.12 )  
    All Others 119 6 5.04 2.12 8.00   ( 2.92 , 17.42 )  
    Total 1,162 58 4.99 3.33 5.04 + ( 3.83 , 6.52 )  
  Morristown Memorial Hospital                          
    Brown, John M. III 417 6 1.44 2.78 1.74   ( 0.64 , 3.80 )  
    Casale, Alfred S. 418 6 1.44 2.85 1.70   ( 0.62 , 3.69 )  
    Johnson, David L. 349 5 1.43 2.92 1.65   ( 0.53 , 3.85 )  
    Neibart, Richard M. 431 9 2.09 3.16 2.23   ( 1.02 , 4.22 )  
    Parr, Grant V. S. 237 5 2.11 2.40 2.96   ( 0.95 , 6.90 )  
    Rodriguez, Alejandro 245 7 2.86 3.09 3.12   ( 1.25 , 6.42 )  
    Wenger, Robert K. 141 6 4.26 3.32 4.31   ( 1.57 , 9.38 )  
    All Others 1 0 0.00 1.58 0.00   ( 0.00 , 100.00 )  
    Total 2,239 44 1.97 2.91 2.27 - ( 1.65 , 3.05 )  
  Newark Beth Israel Medical Center                          
    Gielchinsky, Isaac 253 21 8.30 5.32 5.25   ( 3.25 , 8.02 )  
    Hussain, Syed 274 21 7.66 4.58 5.63 + ( 3.48 , 8.60 )  
  # Karanam, Ravindra 215 6 2.79 3.32 2.83   ( 1.03 , 6.16 )  
    All Others 187 13 6.95 3.43 6.83 + ( 3.63 , 11.67 )  
    Total 929 61 6.57 4.26 5.19 + ( 3.97 , 6.67 )  
  Our Lady of Lourdes Medical Center                          
    Dipaola, Douglas 256 9 3.52 3.12 3.79   ( 1.73 , 7.20 )  
    Eisen, Morris 144 6 4.17 2.84 4.94   ( 1.80 , 10.75 )  
  # Heim, John 154 7 4.55 3.32 4.61   ( 1.85 , 9.50 )  
    Kuchler, Joseph 277 7 2.53 3.07 2.77   ( 1.11 , 5.71 )  
    Luciano, Pasquale 199 11 5.53 3.16 5.90   ( 2.94 , 10.55 )  
    Manuele, Victor 144 1 0.69 2.77 0.85   ( 0.01 , 4.70 )  
    Mnayarji, Nabil 177 8 4.52 3.23 4.71   ( 2.03 , 9.29 )  
    Nayar, Amrit 202 7 3.47 2.73 4.27   ( 1.71 , 8.81 )  
    Ray, Subhash 111 10 9.01 3.60 8.41 + ( 4.03 , 15.47 )  
    Santaspirt, John 239 10 4.18 2.82 4.99   ( 2.39 , 9.18 )  
    All Others 180 5 2.78 2.98 3.14   ( 1.01 , 7.33 )  
    Total 2,083 81 3.89 3.04 4.31 + ( 3.42 , 5.36 )  
  Robert Wood Johnson University Hospital                          
    Krause, Tyrone 572 17 2.97 3.81 2.63   ( 1.53 , 4.20 )  
    Scholz, Peter 247 3 1.21 2.57 1.59   ( 0.32 , 4.64 )  
    Scott, Gregory 492 21 4.27 3.34 4.31   ( 2.66 , 6.58 )  
    Spotnitz, Alan 302 7 2.32 2.82 2.77   ( 1.11 , 5.71 )  
    All Others 84 2 2.38 2.88 2.79   ( 0.31 , 10.06 )  
    Total 1,697 50 2.95 3.27 3.03   ( 2.25 , 4.00 )  
  St. Joseph's Hospital & Medical Center                          
    DeFilippi, Vincent 279 11 3.94 5.34 2.48   ( 1.24 , 4.44 )  
    Mekhjian, Haroutune 501 11 2.20 3.70 2.00   ( 1.00 , 3.58 )  
    All Others 78 5 6.41 6.13 3.52   ( 1.13 , 8.22 )  
    Total 858 27 3.15 4.45 2.38   ( 1.57 , 3.46 )  
  St. Michael's Medical Center                          
  ## Asher, Alain 207 4 1.93 3.03 2.14   ( 0.58 , 5.49 )  
    Codoyannis, Aristotle 237 16 6.75 2.76 8.24 + ( 4.71 , 13.38 )  
  ## Herman, Steven 104 8 7.69 3.44 7.53   ( 3.24 , 14.83 )  
  # Seaver, Philip 155 11 7.10 3.49 6.84 + ( 3.41 , 12.23 )  
    All Others 185 5 2.70 3.26 2.79   ( 0.90 , 6.51 )  
    Total 888 44 4.95 3.14 5.32 + ( 3.86 , 7.14 )  
  The Valley Hospital                          
  # Goldenberg, Bruce 491 15 3.05 3.28 3.13   ( 1.75 , 5.17 )  
  # Mindich, Bruce 751 7 0.93 2.88 1.09 - ( 0.44 , 2.25 )  
    All Others 164 6 3.66 2.27 5.43   ( 1.98 , 11.83 )  
    Total 1,406 28 1.99 2.95 2.27 - ( 1.51 , 3.29 )  
  UMDNJ/University Hospital                          
  # McCormick, John R. 108 4 3.70 3.21 3.88   ( 1.04 , 9.93 )  
    All Others 114 6 5.26 3.27 5.42   ( 1.98 , 11.79 )  
    Total 222 10 4.50 3.24 4.67   ( 2.24 , 8.60 )  

    Statewide Total 16,548 557 3.37 3.37 3.37              

    # Performed operations in another New Jersey hospital.
    ## Performed operations in two or more other New Jersey hospitals.
    OMR: Observed mortality rate.
    EMR: Expected mortality rate.
    RAMR: Risk-adjusted mortality rate; RAMR = (OMR/EMR)*Statewide OMR.
    + Risk-adjusted mortality rate significantly higher than statewide rate based on 95 percent confidence interval.
    - Risk-adjusted mortality rate significantly lower than statewide rate based on 95 percent confidence interval.

Note: Only surgeons performing 100 or more operations in 1996-1997 at the hospital identified are listed by name.


Source: New Jersey Open Heart Surgery Database, 1996-1997.

As a group, "All Others" (surgeons who performed a total of less than 100 operations in 1996-1997 at one hospital) had a significantly higher risk-adjusted mortality rate than the statewide average.

Conclusion

Clearly there are differences among both hospitals and surgeons. These differences are not a matter of chance but reflect differences in performance. These data should not be used as the sole factor in making choices about providers but should be a part of the discussion between cardiac surgery patients and their referring physician. Thus, the data provided in this report should be viewed only as one of the factors to consider in selecting a surgeon and hospital. The Department believes that the patient and physician together can make the best choice after full consideration of that patient's medical needs.

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© 1999 New Jersey Department of Health and Senior Services


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