CORONARY
ARTERY
BYPASS
SURGERY
in
New York State
1993-1995
New York State Department of Health
August 1997
New York State Department of Health
Members of the State Cardiac Advisory Committee
Chair
Vice Chair
Kenneth I. Shine, M.D.
Institute of Medicine
National Academy of Sciences
Washington, DC
Frank Cole Spencer, M.D.
Professor and Chairman
Surgery Department
New York University Medical Center
New York, NY
Members
Djavad T. Arani, M.D.
Clinical Associate Professor of Medicine
SUNY at Buffalo School of Medicine
The Buffalo General Hospital, Buffalo, NY
Alvin Mushlin, M.D., Sc.M.
Professor, Community & Preventive Medicine
University of Rochester Medical Center
Rochester, NY
Edward V. Bennett, M.D.
Chief of Cardiac Surgery
St. Peter’s Hospital, Albany, NY
Jan M. Quaegebeur, M.D., Ph.D.
Department of Surgery
Columbia-Presbyterian Hospital
New York, NY
Luther Clark, M.D.
Chief, Division of Cardiovascular Medicine
University Hospital of Brooklyn, NY
Alan Guerci, M.D.
Executive Vice President for Medical Affairs
St. Francis Hospital, Roslyn, NY
Alan Hartman, M.D.
Department of Cardiovascular Surgery
Winthrop University Hospital, Mineola, NY
O. Wayne Isom, M.D.
Director, Cardiovascular Surgery
New York Hospital - Cornell
New York, NY
Robert Jones, M.D.
Chief Medical Officer
Duke University Medical Center
Durham, NC
Rae-Ellen Kavey, M.D.
Professor of Pediatric Cardiology
SUNY Health Science Center
Syracuse, NY
Ben D. McCallister, M.D.
Chairman, Department of Cardiovascular Diseases
Mid-America Heart Institute
Kansas City, MO
Barbara J. McNeil, M.D., Ph.D.
Head, Department of Health Care Policy
Harvard Medical School, Boston, MA
Eric Rose, M.D.
Director, Division of Cardiothoracic Surgery
Presbyterian Hospital
New York, NY
Thomas J. Ryan, M.D.
Professor of Medicine
Boston University Medical Center, Boston, MA
Tomas Salerno, M.D.
Chief, Division of Cardiothoracic Surgery
Buffalo General Hospital, Buffalo, NY
Rev. Robert S. Smith
Director, Institute for Medicine in
Contemporary Society
University Hospital - Stony Brook, NY
Valavanur A. Subramanian, M.D.
Director, Department of Surgery
Lenox Hill Hospital
New York, NY
Gary Walford, M.D.
Director, Cardiac Catheterization Laboratory
St. Joseph’s Hospital, Syracuse, NY
Roberta Williams, M.D.
Chairman, Department of Pediatrics
University of North Carolina, Chapel Hill, NC
TABLE OF CONTENTS
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
CORONARY ARTERY BYPASS GRAFT SURGERY (CABG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
THE HEALTH DEPARTMENT PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
PATIENT POPULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
RISK ADJUSTMENT FOR ASSESSING PROVIDER PERFORMANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Data Collection and/Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Assessing Patient Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Predicting Patient Mortality Rates for Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Computing the Risk-Adjusted Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Interpreting the Risk-Adjusted Mortality Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
How This Contributes to Quality Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
RESULTS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
1995 Risk Factors For CABG Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Table 1
Multivariable Risk Factor Equation for CABG Hospital Deaths in
New York State in 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
1995 HOSPITAL OUTCOMES FOR CABG SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Table 2
Hospital Observed, Expected and Risk-Adjusted Mortality Rates (RAMR)
for CABG Surgery in New York State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Figure 1 Hospital Risk-Adjusted Mortality Rates for CABG in New York State . . . . . . . . . . . . . . . . . 10
1993-1995 HOSPITAL AND SURGEON DATA FOR CABG SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Table 3
Observed, Expected and Risk-Adjusted Hospital and Surgeon In-Hospital
Mortality Rates for CABG Surgery, 1993-1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Table 4
Summary Information for Surgeons Practicing at More Than One Hospital
Performing at least 200 Isolated CABG Operations in 1993-1995 in
at least Two Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC SURGERY
AND FOR ISOLATED CABG SURGERY (1993-1995) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Table 5
Total Cardiac Surgery and Isolated CABG Surgery Volumes by Hospital and Surgeon . . . . 20
MEDICAL TERMINOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
NYS CARDIAC SURGERY CENTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
INTRODUCTION
The information contained in this booklet is intended for health care providers, patients and families of
patients who are considering coronary artery bypass surgery. It provides data on risk factors associated
with bypass surgery mortality and lists hospital and physician-specific mortality rates which have been
risk-adjusted to account for differences in patient severity of illness.
New York State has taken a leadership role in setting standards for cardiac services, monitoring outcomes
and sharing performance data with patients, hospitals and physicians. Hospitals and doctors involved in
cardiac care have worked in cooperation with the Department of Health and the Cardiac Advisory
Committee to compile accurate and meaningful data which can and has been used to enhance quality of
care. We believe that this process has been instrumental in achieving the excellent outcomes that are
evidenced in this report for centers across New York State.
I encourage doctors to discuss this information with their patients and colleagues as they develop treatment
plans. While these statistics are an important tool in making informed health care choices, individual
treatment plans must be made by doctors and patients together after careful consideration of all pertinent
factors. It is important to recognize that many factors can influence the outcome of coronary artery bypass
surgery. These include the patient’s health before the procedure, the skill of the operating team and
general after care. In addition, keep in mind that the information in this booklet does not include data from
1996 or 1997. Important changes may have taken place in some hospitals during that time period.
In developing treatment plans, I would also ask that patients and physicians alike give careful
consideration to the importance of healthy lifestyles for all those affected by heart disease. While some risk
factors, such as heredity, gender and age cannot be controlled, others certainly can. Controllable risk
factors that contribute to a higher likelihood of developing coronary artery disease are high cholesterol
levels, cigarette smoking, high blood pressure, obesity and a lack of exercise. Limiting these risk factors
after bypass surgery will continue to be important in minimizing the occurrence of new blockages.
I commend the providers of this state and the Cardiac Advisory Committee for the excellent results that
have been achieved through this cooperative quality improvement system. The Department of Health will
continue to work in partnership with hospitals and physicians to ensure the continued high quality of
cardiac surgery available to New York residents.
Barbara A. DeBuono, M.D., M.P.H., Commissioner
New York State Department of Health
1
CORONARY ARTERY BYPASS GRAFT SURGERY (CABG)
Heart disease is, by far, the leading cause of
death in New York State, and the most common
form of heart disease is atherosclerotic coronary
artery disease. Different treatments are
recommended for patients with coronary artery
disease. For some people, changes in lifestyle,
such as dietary changes, not smoking and regular
exercise, can result in great improvements in
health. In other cases, medication prescribed for
high blood pressure or other conditions can
make a significant difference.
Sometimes, however, an interventional procedure
is recommended. The two common procedures
performed on patients with coronary artery
disease are coronary artery bypass graft (CABG)
surgery and percutaneous transluminal coronary
angioplasty (PTCA).
Coronary artery bypass graft surgery is a
procedure in which a vein or artery from another
part of the body is used to create an alternate
path for blood to flow to the heart, bypassing the
arterial blockage. Typically, a section of one of
the large (saphenous) veins in the leg, the radial
artery in the arm or the mammary artery in the
chest is used to construct the bypass. One or
more bypasses may be performed during a single
operation, since providing several routes for the
blood supply to travel is believed to improve
long-term success for the procedure. Triple and
quadruple bypasses are often done for this
reason, not necessarily because the patient’s
condition is more severe. CABG surgery is one of
the most common, successful major operations
currently performed in the United States.
As is true of all major surgery, risks must be
considered. The patient is totally anesthetized,
and there is generally a substantial recovery
period in the hospital followed by several weeks
recuperation at home. Even in successful cases,
there is a risk of relapse causing the need for
another operation.
Those who have CABG surgery are not cured of
coronary artery disease; the disease can still occur
in the grafted blood vessels or other coronary
arteries. In order to minimize new blockage,
patients should continue to reduce their risk
factors for heart disease.
3
THE HEALTH DEPARTMENT PROGRAM
The New York State Department of Health has
been studying the effects of patient and treatment
characteristics (called risk factors) on outcomes
for patients with heart disease. Detailed statistical
analyses of the information received from the
study have been conducted under the guidance
of the New York State Cardiac Advisory
Committee, a group of independent practicing
cardiac surgeons, cardiologists and other
professionals in related fields.
The results have been used to create a cardiac
profile system which assesses the performance of
hospitals and surgeons over time, independent of
the severity of individual patients’ preoperative
conditions.
Designed to improve health in people with heart
disease, this program is aimed at:
• understanding the health risks of patients
which adversely affect how they will fare in
coronary artery bypass surgery;
• improving the results of different treatments
of heart disease;
• improving cardiac care;
• providing information to help patients make
better decisions about their own care.
PATIENT POPULATION
All patients undergoing isolated coronary artery
bypass graft surgery (CABG surgery with no other
major heart surgery during the same admission)
in New York State hospitals, who were
discharged in 1995 are included in the one-year
results for coronary artery bypass surgery.
Similarly, all patients undergoing isolated CABG
surgery who were discharged between January 1,
1993, and December 31, 1995, are included in the
three-year results.
Isolated CABG surgery represented 74.19 percent
of all adult cardiac surgery for the three-year
period covered by this report. Total cardiac
surgery volume and isolated CABG volume are
tabulated in Table 5 by hospital and surgeon for
the period 1993 through 1995.
RISK ADJUSTMENT FOR ASSESSING PROVIDER PERFORMANCE
Provider performance is directly related to patient
outcomes. Whether patients recover quickly,
experience complications or die following a
procedure is in part a result of the kind of
medical care they receive. It is difficult, however,
to compare outcomes across hospitals when
assessing provider performance, because different
hospitals treat different types of patients.
Hospitals with sicker patients may have higher
rates of complications and death than other
hospitals in the state. The following describes
how the New York State Department of Health
adjusts for patient risk in assessing provider
outcomes.
Data Collection and Review
As part of the risk-adjustment process, New York
State hospitals where CABG surgery is performed
provide information to the Department of Health
for each patient undergoing that procedure.
Cardiac surgery departments in hospitals collect
data concerning patients’ demographic and
clinical characteristics. Approximately 40 of these
characteristics (called risk factors) are collected
4
for each patient. Along with information about
the hospital, physician and the patient’s status at
discharge, these data are entered into a computer,
and sent to the Department of Health for analysis.
Data are verified through review of unusual
reporting frequencies, cross-match of cardiac
surgery data with other Department of Health
databases and a review of medical records for a
selected sample of cases.
Assessing Patient Risk
Each person who develops coronary artery
disease has a unique health history. A cardiac
profile system has been developed to evaluate
the risk of treatment for each individual patient
based on his or her history, weighing the
important health facts for that person based on
the experiences of thousands of patients who
have undergone the same procedures in recent
years. All important risk factors for each patient
are combined to create a risk profile.
An 80-year-old patient with a history of two heart
attacks, for example, has a very different risk
profile from a 40-year-old with no previous heart
problems.
The statistical analyses conducted by the
Department of Health consist of determining
which of the risk factors collected are
significantly related to in-hospital death for CABG
surgery, and determining how to weight the
significant risk factors to predict the chance each
patient will have of dying in the hospital, given
his/her specific characteristics.
Doctors and patients should review individual
risk profiles together. Treatment decisions must
be made by doctors and patients together after
careful consideration of all the information.
Predicting Patient Mortality Rates for Providers
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 models are reasonably accurate in predicting
how patients of all different risk levels will fare
when undergoing coronary bypass surgery.
The mortality rate for each hospital and surgeon
is also predicted using the statistical model. This
is accomplished by summing the predicted
probabilities of death for each of the provider’s
patients and dividing by the number of patients.
The resulting rate is an estimate of what the
provider’s mortality rate would have been if the
provider’s performance were identical to the state
performance. The percentage is called the
predicted or expected mortality rate.
Computing the Risk-Adjusted 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 for an identical
group of patients.
To get the risk-adjusted mortality rate, the
observed mortality rate is first 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
overall statewide mortality rate (2.52% in 1995) to
obtain the provider’s risk-adjusted rate.
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 riskadjusted mortality rate is higher than the
statewide mortality rate, the provider has a worse
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 its true quality.
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, physician-specific coronary bypass data
have been reported only for surgeons who have
performed at least 200 operations over a threeyear 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. The Department of Health monitors the
quality of coded data by reviewing patients’
medical records to ascertain the presence of key
risk factors. When significant coding problems
have been discovered, hospitals have been
required to recode these data and have been
subjected to subsequent monitoring.
A final reason that risk-adjusted rates may be
misleading is that overall preprocedural 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 York State data
system contains virtually every risk factor that has
ever been demonstrated to be related to patient
mortality in national and international studies.
Although there are reasons that risk-adjusted
mortality rates presented here may not be a
perfect reflection of quality of care, the
5
Department of Health feels that this information
is a valuable aid in choosing providers for CABG
surgery.
How This Contributes to Quality Improvement
The goal of the Department of Health and the
Cardiac Advisory Committee is to improve the
quality of care in relation to CABG surgery in
New York State. Providing the hospitals and
cardiac surgeons in New York State with data
about their own outcomes for these procedures
allows them to examine the quality of their own
care, and to identify areas that need
improvement.
The data collected and analyzed in this program
are given to the Cardiac Advisory Committee.
Committee members assist with interpretation and
advise the Department of Health regarding which
hospitals and surgeons may need special
attention. Committee members have also
conducted site visits to particular hospitals, and
have recommended that some hospitals obtain
the expertise of outside consultants to design
improvements for their programs.
The overall results of this program of ongoing
review in CABG surgery show that significant
progress is being made. In response to the
program’s results for CABG surgery, facilities
have refined patient criteria, evaluated patients
more closely for preoperative risks and directed
them to the appropriate surgeon. More
importantly, many hospitals have identified
medical care process problems that have led to
less than optimal outcomes, and have altered
those processes to achieve improved results.
RESULTS
1995 Risk Factors for CABG Surgery
The significant preoperative risk factors for
coronary artery bypass surgery in 1995 are
presented in Table 1.
Roughly speaking, the odds ratio for a risk factor
represents the number of times more likely a
patient with that risk factor is of dying in the
hospital during or after CABG surgery than a
patient without the risk factor, all other risk
factors being the same. For example, the odds
ratio for the risk factor “renal failure” is 2.891.
This means that a patient who has renal failure is
approximately 2.891 times as likely to die in the
hospital as a patient who does not have renal
failure but who has the same other significant risk
factors.
For most of the risk factors in the table, there are
only two possibilities: having the risk factor or
not having it (for example, a patient either has
renal failure or does not have it). Exceptions are
age and congestive heart failure. For age, the
6
odds ratio roughly represents the number of
times more likely a patient is to die in the
hospital than a patient one year younger. Thus, a
patient undergoing CABG surgery who is 72
years old has a chance of dying in the hospital
that is approximately 1.052 times the chance that
a patient 71 years old undergoing CABG has of
dying in the hospital.
There are two risk factors involving congestive
heart failure (CHF): congestive heart failure this
admission and congestive heart failure previous
to this admission. These are mutually exclusive
risk factors in that a patient is classified as
“congestive heart failure, previous to this
admission” only if he or she has had CHF
previously but did not have CHF during the
admission for cardiac surgery. For each of these
two risk factors the odds are relative to a patient
without congestive heart failure before or during
the admission for CABG surgery.
Table 1: Multivariable Risk Factor Equation for CABG Hospital Deaths in New York State in 1995.
Logistic Regression
Patient Risk Factor
Coefficient
P-Value
Odds Ratio
Demographic
Age
Female Gender
0.0511
0.3548
<0.0001
0.0005
1.052
1.426
Hemodynamic State
Unstable
Shock
1.2128
2.0533
<0.0001
<0.0001
3.363
7.794
Severity of Atherosclerotic Process
Carotid Disease
Aortoiliac Disease
Extensively Calcified Ascending Aorta
0.4685
0.7428
0.4816
<0.0001
<0.0001
0.0008
1.598
2.102
1.619
Ventricular Function
Prev. MI < 6 Hrs.
Malignant Ventricular Arrhythmia
Congestive Heart Failure, This Admission
Congestive Heart Failure, Previously
0.6174
0.8056
0.9587
0.8088
0.0174
<0.0001
<0.0001
<0.0001
1.854
2.238
2.608
2.245
Comorbidity
Renal Failure
Previous Open Heart Operations
1.0615
1.2167
<0.0001
<0.0001
2.891
3.376
Intercept = -8.1658
C-Statistic = .807
MI = myocardial infarction
7
1995 HOSPITAL OUTCOMES FOR CABG SURGERY
Table 2 and Figure 1 present the 1995 CABG
surgery results for the 31 hospitals performing
this operation in New York. The table contains,
for each hospital, the number of isolated CABG
operations (CABG operations with no other major
heart surgery) resulting in 1995 discharges, 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, a 95 percent
confidence interval for the risk-adjusted rate and
upper and lower P-values for the risk-adjusted
mortality rate.
Definitions of key terms are as follows:
The observed mortality rate (OMR) is the
number of observed deaths divided by the
number of patients.
The expected mortality rate (EMR) is the sum
of the predicted probabilities of death for all
patients divided by the total number of patients.
The risk-adjusted mortality rate (RAMR) is the
best estimate, based on the 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.
8
Confidence intervals for the risk-adjusted
mortality rate indicate which hospitals had
significantly more or fewer deaths than expected
given the risk factors of their patients. Hospitals
with significantly higher rates than expected after
adjusting for risk are those with confidence
intervals entirely above the statewide rate.
Hospitals with significantly lower rates than
expected given the severity of illness of their
patients before surgery have confidence intervals
entirely below the statewide rate.
As indicated in Table 2, the overall mortality rate
for the 19,283 CABG operations performed at the
31 hospitals was 2.52 percent. Observed mortality
rates ranged from 1.03 percent to 4.85 percent.
The range in expected mortality rates, which
measure patient severity of illness, was from 1.68
percent to 3.00 percent.
The risk-adjusted mortality rates, which are used
to measure performance, ranged from 1.16
percent to 5.67 percent. One hospital,
St. Joseph’s, had a risk-adjusted mortality rate that
was significantly lower than the statewide rate.
Two hospitals, Upstate Medical Center and
Millard Fillmore, had significantly higher riskadjusted rates than the statewide average.
Table 2: Hospital Observed, Expected and Risk-Adjusted Mortality Rates (RAMR) for CABG Surgery in
New York State, 1995 Discharges (Listed Alphabetically by Hospital)
Hospital
Cases
Deaths
OMR
EMR
RAMR
Albany Medical Center
1163
21
1.81
2.20
2.06
(1.28,
3.15)
Arnot-Ogden
199
3
1.51
2.41
1.57
(0.32,
4.60)
Bellevue
103
5
4.85
2.16
5.67
(1.83, 13.22)
Beth Israel
355
8
2.25
2.10
2.69
(1.16,
5.31)
1231
35
2.84
2.54
2.82
(1.96,
3.92)
Ellis Hospital
487
5
1.03
2.06
1.26
(0.40,
2.93)
Erie County
196
3
1.53
1.98
1.94
(0.39,
5.67)
Lenox Hill
714
27
3.78
3.00
3.17
(2.09,
4.62)
LIJ Medical Center
388
6
1.55
2.18
1.79
(0.65,
3.89)
Maimonides
850
29
3.41
2.62
3.28
(2.20,
4.71)
Millard Fillmore
708
30
4.24
2.28
4.68 *
(3.15,
6.68)
Montefiore-Moses
387
10
2.58
1.95
3.34
(1.60,
6.14)
Montefiore-Weiler
309
10
3.24
3.00
2.72
(1.30,
5.00)
Mount Sinai
537
18
3.35
2.92
2.89
(1.71,
4.56)
New York Hospital-Cornell
930
22
2.37
2.84
2.10
(1.31,
3.18)
NYU Medical Center
645
25
3.88
3.00
3.25
(2.10,
4.80)
North Shore
651
12
1.84
2.99
1.55
(0.80,
2.71)
Presbyterian
635
12
1.89
2.46
1.93
(1.00,
3.37)
Rochester General
1053
25
2.37
2.80
2.13
(1.38,
3.15)
St. Francis
1761
32
1.82
2.41
1.90
(1.30,
2.68)
St. Joseph’s
799
9
1.13
2.44
1.16 **
(0.53,
2.21)
St. Luke’s-Roosevelt
469
15
3.20
1.86
4.33
(2.42,
7.14)
St. Peter’s
682
14
2.05
2.51
2.06
(1.12,
3.45)
St. Vincent’s
554
13
2.35
2.82
2.09
(1.11,
3.58)
Strong Memorial
453
9
1.99
2.67
1.87
(0.85,
3.55)
United Health Serv.
373
5
1.34
2.47
1.37
(0.44,
3.19)
Univ. Hospital of Brooklyn
269
9
3.35
2.34
3.59
(1.64,
6.82)
Univ. Hospital-Stony Brook
516
11
2.13
2.71
1.98
(0.99,
3.54)
Upstate Medical Center
450
15
3.33
1.68
4.98 *
(2.79,
8.22)
Westchester County
818
24
2.93
2.50
2.95
(1.89,
4.39)
Winthrop Univ. Hosp.
598
23
3.85
2.64
3.66
(2.32,
5.50)
19283
485
2.52
2.52
2.52
Buffalo General
Total
95% CI
for RAMR
* 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.
9
Figure 1: Risk-Adjusted Mortality Rates for Coronary Artery Bypass Grafts in New York State, 1995 Discharges (Listed
Alphabetically by Hospital)
Albany Medical
Medical Center
Center
Albany
Arnot-Ogden
Arnot-Ogden
Bellevue
Bellevue
Beth Israel
Israel
Beth
Buffalo General
General
Buffalo
Ellis Hospital
Hospital
Ellis
Erie County
County
Erie
Lenox Hill
Hill
Lenox
LIJ Medical
Medical Center
Center
LIJ
Maimonides
Maimonides
Millard Fillmore*
Fillmore*
Millard
Montefiore-Moses
Montefiore-Moses
Montefiore-Weiler
Montefiore-Weiler
Mount Sinai
Sinai
Mount
New
York Hospital
New York
Hospital-Cornell
NYU Medical
Medical Center
Center
NYU
North Shore
Shore
North
Presbyterian
Presbyterian
Rochester General
General
Rochester
St. Francis
Francis
St.
St. Joseph’s**
Joseph’s**
St.
St. Luke’s-Roosevelt
Luke’s-Roosevelt
St.
St. Peter’s
Peter’s
St.
St.
St. Vincent’s
Vincent’s
Strong
Strong Memorial
Memorial
United
United Health
Health Serv.
Serv.
Univ.
Univ. Hospital
Hospital of
of Brooklyn
Brooklyn
Univ.
Univ. Hospital-Stony
Hospital-Stony Brook
Brook
Upstate
Upstate Medical
Medical Center*
Center*
Westchester
Westchester County
County
Winthrop
Winthrop Univ.
Univ. Hosp.
Hosp.
0
J
J
J
JJ
JJ
J
J J
J
J
JJ
JJ
JJ
J
J
J
J
JJ
J
J J
J J
JJ
2
4
6
2.52
New York State Average
8
10
12
14
Key
Risk-adjusted mortality rate
Potential margin of statistical error
* Risk-adjusted mortality rate significantly higher
that statewide rate
** Risk-adjusted mortality rate significantly lower
than statewide rate
10
1993-1995 HOSPITAL AND SURGEON DATA FOR CABG SURGERY
Table 3 provides the number of isolated CABG
operations, number of CABG patients who died
in the hospital, observed mortality rate, expected
mortality rate, risk-adjusted mortality rate, and the
95 percent confidence interval for the riskadjusted mortality rate for 1993-95 for each of the
31 hospitals performing CABG surgery during the
time period. This hospital information is
presented for each surgeon who performed 200
or more isolated CABG operations in that hospital
during 1993-1995. The results for surgeons who
performed fewer than 200 isolated CABG
operations are grouped together and reported as
“other cases” in the hospital in which the
operations were performed. Surgeons who
performed operations in more than one hospital
are noted in the table and are listed in all
hospitals in which they performed 200 or more
operations.
Also, surgeons who have performed a total of 200
or more isolated CABG operations between 1993
and 1995 and performed CABG surgery in two or
more New York State hospitals are listed
separately in Table 4. For these surgeons, the
table presents the number of isolated CABG
operations, the number of deaths, observed
mortality rate, expected mortality rate and riskadjusted mortality rate with its 95 percent
confidence interval for each hospital in which the
surgeon performed surgery, as well as the
aggregate numbers (across all hospitals in which
the surgeon performed operations). In addition,
surgeons and hospitals with risk-adjusted
mortality rates that are significantly lower or
higher than the statewide mortality rate (as
judged by a 95% confidence interval) are noted in
Tables 3 and 4.
Table 3: Observed, Expected and Risk-Adjusted Hospital and Surgeon In-Hospital Mortality Rates for CABG
Surgery, 1993-1995
No. of
Deaths
OMR
EMR
Albany Medical Center Hospital
#Banker M
252
##Bennett E
281
#Britton L
462
#Canavan T
588
Ferraris V
279
Foster E
248
Kelley J
221
Luber J
453
##Miller S
290
All Others
202
TOTAL
3276
4
1
7
4
11
5
4
15
3
8
62
1.59
0.36
1.52
0.68
3.94
2.02
1.81
3.31
1.03
3.96
1.89
1.40
2.37
1.95
1.87
2.82
2.57
2.16
2.39
2.36
2.27
2.18
2.90
0.39 **
2.00
0.93 **
3.59
2.02
2.15
3.55
1.13
4.48
2.23
(0.78,
(0.01,
(0.80,
(0.25,
(1.79,
(0.65,
(0.58,
(1.99,
(0.23,
(1.93,
(1.71,
7.43)
2.15)
4.12)
2.39)
6.42)
4.71)
5.52)
5.86)
3.29)
8.82)
2.86)
Arnot-Ogden Memorial Hospital
Borja A
261
Quintos E
230
Vaughan J
213
All Others
54
TOTAL
758
6
5
3
0
14
2.30
2.17
1.41
0.00
1.85
2.56
2.65
2.60
1.90
2.55
2.30
2.11
1.39
0.00
1.86
(0.84,
(0.68,
(0.28,
(0.00,
(1.01,
5.01)
4.92)
4.06)
9.19)
3.12)
Cases
RAMR
95% CI
for RAMR
11
Table 3 continued
Cases
No.
of Deaths
Bellevue Hospital Center
TOTAL
270
13
4.81
2.20
5.63 *
(3.00, 9.63)
Beth Israel Medical Center
Tranbaugh R
All Others
TOTAL
684
175
859
15
2
17
2.19
1.14
1.98
2.88
1.70
2.64
1.96
1.73
1.93
(1.09, 3.23)
(0.19, 6.23)
(1.12, 3.08)
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Lajos T
Levinsky L
Lewin A
Raza S
All Others
TOTAL
530
393
681
524
226
656
486
99
3595
10
11
12
23
5
20
18
7
106
1.89
2.80
1.76
4.39
2.21
3.05
3.70
7.07
2.95
2.50
2.15
2.35
2.41
2.53
1.99
2.29
2.68
2.31
1.94
3.35
1.92
4.67 *
2.24
3.94
4.16
6.78 *
3.28 *
(0.93,
(1.67,
(0.99,
(2.96,
(0.72,
(2.41,
(2.46,
(2.71,
(2.69,
3.56)
5.99)
3.36)
7.00)
5.23)
6.09)
6.57)
13.96)
3.97)
Ellis Hospital
Depan H
#McIlduff J
##Saifi J
All Others
TOTAL
456
246
346
240
1288
11
1
6
6
24
2.41
0.41
1.73
2.50
1.86
2.27
2.05
1.58
1.88
1.97
2.73
0.51
2.82
3.42
2.43
(1.36,
(0.01,
(1.03,
(1.25,
(1.56,
4.89)
2.83)
6.14)
7.44)
3.61)
540
2
542
8
0
8
1.48
0.00
1.48
1.51
3.22
1.51
2.53
0.00
2.51
(1.09, 4.98)
(0.00,146.4)
(1.08, 4.94)
473
1302
252
2027
11
50
9
70
2.33
3.84
3.57
3.45
2.25
2.80
1.72
2.54
2.66
3.52 *
5.34
3.49 *
(1.32, 4.75)
(2.61, 4.64)
(2.43, 10.13)
(2.72, 4.41)
13
5
4
22
2.26
1.21
2.50
1.91
2.21
2.44
2.40
2.32
2.62
1.27
2.68
2.12
(1.40,
(0.41,
(0.72,
(1.33,
Erie County Medical Center
#Bell-Thomson J
All Others
TOTAL
Lenox Hill Hospital
Stelzer P
Subramanian V
All Others
TOTAL
Long Island Jewish Medical Center
Graver L
576
Palazzo R
414
All Others
160
TOTAL
1150
12
OMR
EMR
RAMR
95% CI
for RAMR
4.49)
2.96)
6.85)
3.21)
Table 3 continued
Cases
RAMR
95% CI
for RAMR
2.41
2.71
3.15
3.59
2.14
3.03
2.28
3.57
2.47
3.28
5.37
2.88
(0.74, 5.32)
(1.95, 5.99)
(1.77, 3.37)
(1.97, 5.12)
(1.96, 11.68)
(2.29, 3.56)
3.09
2.94
3.61
0.41
6.32
3.17
2.26
1.68
2.21
2.01
2.27
2.08
3.51
4.49
4.19
0.53
7.13 *
3.91 *
(2.04, 5.62)
(2.45, 7.53)
(2.48, 6.63)
(0.01, 2.93)
(3.68, 12.45)
(3.00, 5.02)
Montefiore Medical Center - Moses Division
Attai L
451
15
Brodman R
313
6
Merav A
280
5
All Others
140
6
TOTAL
1184
32
3.33
1.92
1.79
4.29
2.70
2.03
1.66
2.02
1.47
1.86
4.21
2.96
2.27
7.47 *
3.72
(2.36, 6.95)
(1.08, 6.45)
(0.73, 5.29)
(2.73, 16.26)
(2.55, 5.25)
Montefiore Medical Center - Weiler Division
#Frymus M
378
12
Sisto D
315
10
All Others
136
6
TOTAL
829
28
3.17
3.17
4.41
3.38
2.60
3.75
2.00
2.94
3.14
2.18
5.66
2.95
(1.62, 5.48)
(1.04, 4.00)
(2.07, 12.33)
(1.96, 4.27)
Mount Sinai Hospital
Ergin M
Galla J
Lansman S
All Others
TOTAL
Maimonides Medical Center
#Acinapura A
234
#Cunningham J N
371
Jacobowitz I
1318
Sabado M
415
All Others
134
TOTAL
2472
Millard Fillmore Hospital
Aldridge J
Guarino R
#Jennings L
Major W
All Others
TOTAL
New York Hospital - Cornell
Gold J
Isom O
Krieger K
Lang S
Rosengart T
All Others
TOTAL
550
477
498
243
190
1958
No.
of Deaths
OMR
EMR
5
14
40
19
6
84
2.14
3.77
3.03
4.58
4.48
3.40
17
14
18
1
12
62
553
241
407
252
1453
9
15
18
7
49
1.63
6.22
4.42
2.78
3.37
2.61
3.95
3.44
2.23
3.00
1.60
4.05
3.30
3.19
2.89
(0.73,
(2.26,
(1.96,
(1.28,
(2.14,
3.04)
6.68)
5.22)
6.58)
3.82)
223
3
1.35
2.84
1.22
(0.24, 3.55)
272
807
852
512
181
2847
5
18
23
14
6
69
1.84
2.23
2.70
2.73
3.31
2.42
2.21
2.76
3.32
3.50
2.79
3.02
2.13
2.08
2.08
2.01
3.05
2.06
(0.69,
(1.23,
(1.32,
(1.10,
(1.11,
(1.60,
4.98)
3.28)
3.13)
3.37)
6.64)
2.61)
13
Table 3 continued
14
Cases
No.
of Deaths
OMR
EMR
RAMR
95% CI
for RAMR
New York University Medical Center
#Colvin S
276
#Culliford A
380
Esposito R
287
#Galloway A
249
Spencer F
204
All Others
479
TOTAL
1875
14
6
6
8
10
22
66
5.07
1.58
2.09
3.21
4.90
4.59
3.52
3.96
3.16
3.39
3.01
2.58
4.18
3.49
3.29
1.28
1.58
2.74
4.88
2.82
2.59
(1.80,
(0.47,
(0.58,
(1.18,
(2.34,
(1.77,
(2.00,
North Shore University Hospital
Hall M
672
Nelson R
209
Pogo G
475
Tortolani A
402
All Others
33
TOTAL
1791
11
3
8
7
0
29
1.64
1.44
1.68
1.74
0.00
1.62
2.39
2.28
2.10
1.82
1.39
2.15
1.76
1.61
2.06
2.46
0.00
1.93
(0.88, 3.14)
(0.32, 4.72)
(0.89, 4.05)
(0.99, 5.07)
(0.00, 20.51)
(1.29, 2.77)
Presbyterian Hospital-City of New York
Michler R
227
10
Oz M
258
7
Rose E
475
9
Smith C
641
15
All Others
194
8
TOTAL
1795
49
4.41
2.71
1.89
2.34
4.12
2.73
2.83
2.97
1.77
3.13
1.92
2.58
3.99
2.35
2.75
1.92
5.51
2.72
(1.91, 7.34)
(0.94, 4.84)
(1.25, 5.22)
(1.07, 3.16)
(2.37, 10.86)
(2.01, 3.59)
5.51)
2.80)
3.45)
5.40)
8.97)
4.27)
3.29)
Rochester General Hospital
Cheeran D
846
Kirshner R
900
Knight P
980
All Others
265
TOTAL
2991
27
28
31
11
97
3.19
3.11
3.16
4.15
3.24
2.39
3.37
2.54
4.62
2.93
3.43
2.37
3.19
2.31
2.84
(2.26,
(1.58,
(2.17,
(1.15,
(2.30,
4.99)
3.43)
4.53)
4.13)
3.47)
St. Francis Hospital
Bercow N
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
All Others
TOTAL
11
7
4
3
14
14
18
6
77
2.06
1.12
0.84
0.93
1.51
1.44
2.84
2.18
1.61
2.38
2.02
3.38
2.59
2.13
2.56
2.54
2.20
2.45
2.22
1.42
0.64 **
0.92
1.82
1.44**
2.87
2.55
1.69 **
(1.11,
(0.57,
(0.17,
(0.19,
(0.99,
(0.79,
(1.70,
(0.93,
(1.34,
3.97)
2.93)
1.64)
2.69)
3.05)
2.41)
4.54)
5.55)
2.12)
534
627
476
323
928
975
634
275
4772
Table 3 continued
Cases
OMR
EMR
1
9
7
6
23
0.20
1.89
1.13
1.05
1.07
1.76
2.59
2.92
2.04
2.35
0.30 **
1.88
0.99 **
1.33
1.17 **
(0.00,
(0.86,
(0.40,
(0.49,
(0.74,
St. Luke’s Roosevelt Hospital-St. Luke’s Div.
Anagnostopoulos C
212
11
Aronis M
417
9
Mindich B
324
4
Swistel D
382
9
All Others
65
4
TOTAL
1400
37
5.19
2.16
1.23
2.36
6.15
2.64
2.60
1.70
1.88
3.32
2.28
2.35
5.13
3.25
1.68
1.82
6.92
2.89
(2.56, 9.18)
(1.48, 6.17)
(0.45, 4.31)
(0.83, 3.46)
(1.86, 17.72)
(2.03, 3.98)
St. Peter’s Hospital
##Bennett E
##Dal Col R
All Others
TOTAL
7
4
24
35
1.69
0.75
2.93
1.98
2.19
2.43
3.23
2.75
1.97
0.79 **
2.33
1.85
(0.79,
(0.21,
(1.49,
(1.29,
St. Vincent’s Hospital and Medical Center
Galdieri R
493
19
McGinn J
532
12
Tyras D
556
13
All Others
77
2
TOTAL
1658
46
3.85
2.26
2.34
2.60
2.77
3.33
4.24
2.24
1.23
3.16
2.97
1.37 **
2.68
5.44
2.26
(1.79, 4.64)
(0.71, 2.39)
(1.43, 4.58)
(0.61, 19.65)
(1.65, 3.01)
State University Hospital Upstate Medical Center
Parker F
326
5
Picone A
286
11
Ryan P
206
7
All Others
312
11
TOTAL
1130
34
1.53
3.85
3.40
3.53
3.01
1.74
1.71
1.44
1.67
1.66
2.26
5.79 *
6.06
5.43 *
4.66 *
(0.73, 5.27)
(2.89, 10.36)
(2.43, 12.49)
(2.71, 9.72)
(3.23, 6.51)
Strong Memorial Hospital
Hicks G
Risher W
St. Joseph’s Hospital Health Center
Marvasti M
493
Nast E
476
Nazem A
620
Rosenberg J
569
TOTAL
2158
415
536
819
1770
No.
of Deaths
RAMR
95% CI
for RAMR
1.64)
3.56)
2.05)
2.89)
1.75)
4.07)
2.02)
3.47)
2.57)
574
607
21
18
3.66
2.97
3.04
2.04
3.09
3.73
(1.91, 4.72)
(2.21, 5.89)
35
1216
2
41
5.71
3.37
2.39
2.52
6.13
3.43
(0.69, 22.14)
(2.46, 4.65)
United Health Services - Wilson Division
Cunningham J R
391
9
Wong K
346
7
Yousuf M
386
12
TOTAL
1123
28
2.30
2.02
3.11
2.49
2.34
2.09
3.06
2.51
2.53
2.49
2.60
2.55
(1.15,
(1.00,
(1.34,
(1.69,
All Others
TOTAL
4.80)
5.12)
4.55)
3.68)
15
No.
of Deaths
OMR
EMR
RAMR
University Hospital (Stony Brook)
Bilfinger T
285
Hartman A
591
Seifert F
226
All Others
183
TOTAL
1285
7
8
11
5
31
2.46
1.35
4.87
2.73
2.41
3.84
2.37
2.74
3.19
2.88
1.64
1.47
4.56
2.20
2.15
(0.66,
(0.63,
(2.28,
(0.71,
(1.46,
University Hospital of Brooklyn
Zisbrod Z
413
All Others
333
TOTAL
746
11
10
21
2.66
3.00
2.82
3.04
2.34
2.73
2.25
3.29
2.65
(1.12, 4.02)
(1.58, 6.05)
(1.64, 4.05)
Westchester County Medical Center
Axelrod H
307
Fleisher A
419
Lafaro R
377
Moggio R
348
Pooley R
280
Sarabu M
359
All Others
27
TOTAL
2117
11
7
19
6
18
2
1
64
3.58
1.67
5.04
1.72
6.43
0.56
3.70
3.02
3.35
2.21
2.11
2.44
2.15
2.78
2.17
2.48
2.75
1.94
6.14 *
1.82
7.68 *
0.52 **
4.38
3.13
(1.37, 4.92)
(0.78, 4.00)
(3.70, 9.59)
(0.66, 3.96)
(4.55, 12.14)
(0.06, 1.86)
(0.06, 24.35)
(2.41, 4.00)
Winthrop - University Hospital
Kofsky E
228
Mohtashemi M
249
Schubach S
494
Scott W
326
All Others
392
TOTAL
1689
5
7
11
4
22
49
2.19
2.81
2.23
1.23
5.61
2.90
2.16
3.10
3.19
3.17
4.10
3.25
2.61
2.33
1.79
0.99 **
3.51
2.29
(0.84,
(0.93,
(0.89,
(0.27,
(2.20,
(1.70,
1387
2.57
2.57
2.57
Table 3 continued
Statewide Totals
Cases
54024
95% CI
for RAMR
3.38)
2.89)
8.17)
5.13)
3.06)
6.09)
4.79)
3.21)
2.55)
5.32)
3.03)
* Risk-adjusted mortality rate is significantly higher than statewide rate.
** Risk-adjusted mortality rate is significantly lower than statewide rate.
# Performed operations in another New York State hospital.
## Performed operations in two or more other New York State hospitals.
OMR - The observed mortality rate is the number of observed deaths divided by the number of patients.
EMR - The expected mortality rate is the sum of the predicted probabilities of death for all patients divided by the total number of patients.
RAMR - the risk-adjusted mortality rate is the best estimate, based on the 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. It is computed as the quotient of the OMR and the EMR (OMR/EMR)multiplied by
the statewide mortality rate for the time period.
Note: Only surgeons performing 200 or more operations in 1993-1995 at the hospital identified are listed by name in Table 3.
16
TABLE 4: Summary Information for Surgeons Practicing at More Than One Hospital Performing at least 200
Isolated CABG Operations in 1993-1995 in at least Two Hospitals
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Acinapura A
Maimonides
St. Vincent’s
Total
234
77
311
5
2
7
2.14
2.60
2.25
2.41
1.23
2.11
2.28
5.44
2.73
(0.74, 5.32)
(0.61, 19.65)
(1.10, 5.64)
Banker M
Albany Med Ctr
St. Peter’s
Total
252
105
357
4
1
5
1.59
0.95
1.40
1.40
2.17
1.63
2.90
1.13
2.21
(0.78,
(0.01,
(0.71,
Bell-Thomson J
Erie County
Millard Fillmore
Total
540
36
576
8
1
9
1.48
2.78
1.56
1.51
2.12
1.54
2.53
3.37
2.60
(1.09, 4.98)
(0.04, 18.73)
(1.19, 4.93)
Bennett E
Albany Med Ctr
Ellis Hospital
St. Peter’s
Total
281
2
415
698
1
0
7
8
0.36
0.00
1.69
1.15
2.37
1.94
2.19
2.26
0.39 **
0.00
1.97
1.30 **
(0.01, 2.15)
(0.00, 100.00)
(0.79, 4.07)
(0.56, 2.56)
Britton L
Albany Med Ctr
Ellis Hospital
Total
462
5
467
7
0
7
1.52
0.00
1.50
1.95
1.57
1.94
2.00
0.00
1.98
(0.80, 4.12)
(0.00, 100.00)
(0.79, 4.08)
Canavan T
Albany Med Ctr
Ellis Hospital
Total
588
4
592
4
0
4
0.68
0.00
0.68
1.87
1.36
1.87
0.93 **
0.00
0.93 **
(0.25, 2.39)
(0.00, 100.00)
(0.25, 2.38)
Colvin S
Bellevue
NYU Med Ctr
Total
51
276
327
5
14
19
9.80
5.07
5.81
2.64
3.96
3.76
9.54 *
3.29
3.97
(3.07, 22.26)
(1.80, 5.51)
(2.39, 6.20)
Culliford A
Bellevue
NYU Med Ctr
Total
1
380
381
0
6
6
0.00
1.58
1.57
0.20
3.16
3.15
0.00
1.28
1.28
(0.00, 100.00)
(0.47, 2.80)
(0.47, 2.80)
Cunningham J N
Maimonides
Univ Hosp Brooklyn
Total
371
45
416
14
1
15
3.77
2.22
3.61
2.71
2.43
2.68
3.57
2.34
3.45
(1.95, 5.99)
(0.03, 13.04)
(1.93, 5.69)
7.43)
6.26)
5.15)
17
Cases
No. of
Deaths
OMR
EMR
Dal Col R
Albany Med Ctr
Ellis Hospital
St. Peter’s
Total
7
46
536
589
0
2
4
6
0.00
4.35
0.75
1.02
0.76
2.50
2.43
2.42
0.00
4.47
0.79 **
1.08 **
(0.00, 100.00)
(0.50, 16.14)
(0.21, 2.02)
(0.39, 2.35)
Frymus M
Montefiore-Moses
Montefiore-Weiler
Total
2
378
380
0
12
12
0.00
3.17
3.16
1.07
2.60
2.59
0.00
3.14
3.13
(0.00, 100.00)
(1.62, 5.48)
(1.62, 5.47)
Galloway A
Bellevue
NYU Med Ctr
Total
53
249
302
1
8
9
1.89
3.21
2.98
2.27
3.01
2.88
2.13
2.74
2.65
(0.03, 11.86)
(1.18, 5.40)
(1.21, 5.04)
Jennings L
Erie County
Millard Fillmore
Total
2
498
500
0
18
18
0.00
3.61
3.60
3.22
2.21
2.22
0.00
4.19
4.17
(0.00, 100.00)
(2.48, 6.63)
(2.47, 6.59)
McIlduff J
Ellis Hospital
St. Peter’s
246
172
1
4
0.41
2.33
2.05
3.89
0.51
1.53
(0.01,
(0.41,
2.83)
3.93)
418
5
1.20
2.81
1.09 **
(0.35,
2.55)
Miller S
Albany Med Ctr
Ellis Hospital
St. Peter’s
Total
290
1
198
489
3
0
3
6
1.03
0.00
1.52
1.23
2.36
1.08
3.42
2.78
1.13
0.00
1.14
1.13 **
(0.23, 3.29)
(0.00, 100.00)
(0.23, 3.32)
(0.41, 2.46)
Older T
Ellis Hospital
St. Peter’s
Total
182
187
369
4
8
12
2.20
4.28
3.25
1.75
2.85
2.30
3.23
3.86
3.63
(0.87,
(1.66,
(1.87,
Ribakove G
Bellevue
NYU Med Ctr
Total
79
141
220
3
9
12
3.80
6.38
5.45
2.24
4.98
4.00
4.36
3.29
3.50
(0.88, 12.73)
(1.50, 6.24)
(1.81, 6.12)
Table 4 continued
Total
18
RAMR
95% CI
for RAMR
8.28)
7.61)
6.33)
Table 4 continued
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Saifi J
Albany Med Ctr
Arnot-Ogden
Ellis Hospital
St. Peter’s
Total
2
54
346
1
403
0
0
6
0
6
0.00
0.00
1.73
0.00
1.49
4.25
1.90
1.58
14.57
1.67
0.00
0.00
2.82
0.00
2.29
(0.00, 100.00)
(0.00, 9.19)
(1.03, 6.14)
(0.00, 64.66)
(0.84, 4.99)
Walsh J
Albany Med Ctr
Millard Fillmore
St. Peter’s
Total
1
46
156
203
0
2
8
10
0.00
4.35
5.13
4.93
2.12
2.23
3.36
3.09
0.00
5.00
3.92
4.09
(0.00, 100.00)
(0.56, 18.06)
(1.69, 7.73)
(1.96, 7.52)
* Risk-adjusted rate is significantly higher than statewide rate.
** Risk-adjusted rate is significantly lower than statewide rate.
OMR - The observed mortality rate is the number of observed deaths divided by the number of patients.
EMR - The expected mortality rate is the sum of the predicted probabilities of death for all patients divided by the total number of patients.
RAMR - The risk-adjusted mortality rate is the best estimate, based on the 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. It is computed as the quotient of the OMR and the EMR(OMR/EMR)
multiplied by the statewide mortality rate for the time period.
Note: Only surgeons practicing at more than one hospital and performing 200 or more operations in New York State in 1993-1995 are
listed in Table 4.
19
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC SURGERY AND FOR ISOLATED
CABG SURGERY (1993-1995)
Table 5 presents, for each hospital and for each
surgeon performing at least 200 isolated CABG
operations at that hospital in 1993-1995, the total
number of adult cardiac surgeries performed,
the total number of isolated CABG operations
performed and the percentage of all adult
cardiac surgeries that were isolated CABG
operations. As in Table 3, results for surgeons
who performed fewer than 200 isolated CABG
operations are grouped together in an “All
Others” category.
arteries with no other major heart surgery during
the same admission. Total adult cardiac surgery
cases include isolated CABG, CABG combined
with another cardiac procedure such as valve
repair or replacement, single or multiple valve
replacements and any other surgery on the heart
or great vessels.
As indicated, the statewide percentage of adult
cardiac surgeries that were isolated CABG
operations in 1993-1995 was 74.19 percent
(54,024 CABG operations out of a total of 72,816
total adult cardiac surgeries).
Isolated CABG volumes include patients who
undergo bypass of one or more of the coronary
Table 5: Total Cardiac Surgery and Isolated CABG Surgery Volumes by Hospital and Surgeon, 1993 - 1995
Discharges
Total
Cardiac
Surgery
Isolated
CABGs
Albany Medical Center Hospital
Banker M
Bennett E
Britton L
Canavan T
Ferraris V
Foster E
Kelley J
Luber J
Miller S
All Others
TOTAL
274
346
628
670
385
376
261
652
339
254
4185
252
281
462
588
279
248
221
453
290
202
3276
91.97
81.21
73.57
87.76
72.47
65.96
84.67
69.48
85.55
79.53
78.28
Arnot-Ogden Memorial Hospital
Borja A
Quintos E
Vaughan J
All Others
TOTAL
323
262
244
66
895
261
230
213
54
758
80.80
87.79
87.30
81.82
84.69
Bellevue Hospital Center
TOTAL
499
270
54.11
1020
190
1210
684
175
859
67.06
92.11
70.99
Beth Israel Medical Center
Tranbaugh R
All Others
TOTAL
20
%
Isolated
CABG
Total
Cardiac
Surgery
Isolated
CABGs
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Lajos T
Levinsky L
Lewin A
Raza S
All Others
TOTAL
706
728
746
618
238
698
637
110
4481
530
393
681
524
226
656
486
99
3595
75.07
53.98
91.29
84.79
94.96
93.98
76.30
90.00
80.23
Ellis Hospital
Depan H
McIlduff J
Saifi J
All Others
TOTAL
635
295
385
314
1629
456
246
346
240
1288
71.81
83.39
89.87
76.43
79.07
661
2
663
540
2
542
81.69
100.00
81.75
Lenox Hill Hospital
Stelzer P
Subramanian V
All Others
TOTAL
795
1588
315
2698
473
1302
252
2027
59.50
81.99
80.00
75.13
Long Island Jewish Medical Center
Graver L
Palazzo R
All Others
TOTAL
821
476
197
1494
576
414
160
1150
70.16
86.97
81.22
76.97
306
517
234
371
76.47
71.76
1628
500
155
3106
1318
415
134
2472
80.96
83.00
86.45
79.59
Table 5 continued
Erie County Medical Center
Bell-Thomson J
All Others
TOTAL
Maimonides Medical Center
Acinapura A
Cunningham J N
Jacobowitz I
Sabado M
All Others
TOTAL
%
Isolated
CABG
21
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Millard Fillmore Hospital
Aldridge J
Guarino R
Jennings L
Major W
All Others
TOTAL
618
515
569
261
231
2194
550
477
498
243
190
1958
89.00
92.62
87.52
93.10
82.25
89.24
Montefiore Medical Center - Moses Division
Attai L
Brodman R
Merav A
All Others
TOTAL
610
462
382
202
1656
451
313
280
140
1184
73.93
67.75
73.30
69.31
71.50
Montefiore Medical Center - Weiler Division
Frymus M
Sisto D
All Others
TOTAL
454
421
262
1137
378
315
136
829
83.26
74.82
51.91
72.91
Mount Sinai Hospital
Ergin M
Galla J
Lansman S
All Others
TOTAL
861
398
654
642
2555
553
241
407
252
1453
64.23
60.55
62.23
39.25
56.87
New York Hospital - Cornell
Gold J
Isom O
Krieger K
Lang S
Rosengart T
All Others
TOTAL
366
562
1112
1231
719
253
4243
223
272
807
852
512
181
2847
60.93
48.40
72.57
69.21
71.21
71.54
67.10
630
692
445
481
425
679
3352
276
380
287
249
204
479
1875
43.81
54.91
64.49
51.77
48.00
70.54
55.94
Table 5 continued
New York University Medical Center
Colvin S
Culliford A
Esposito R
Galloway A
Spencer F
All Others
TOTAL
22
Table 5 continued
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
North Shore University Hospital
Hall M
Nelson R
Pogo G
Tortolani A
All Others
TOTAL
896
273
605
503
61
2338
672
209
475
402
33
1791
75.00
76.56
78.51
79.92
54.10
76.60
Presbyterian Hospital-City of New York
Michler R
Oz M
Rose E
Smith C
All Others
TOTAL
444
507
751
996
397
3095
227
258
475
641
194
1795
51.13
50.89
63.25
64.36
48.87
58.00
Rochester General Hospital
Cheeran D
Kirshner R
Knight P
All Others
TOTAL
1049
1107
1255
312
3723
846
900
980
265
2991
80.65
81.30
78.09
84.94
80.34
St. Francis Hospital
Bercow N
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
All Others
TOTAL
663
1139
600
393
1271
1237
845
397
6545
534
627
476
323
928
975
634
275
4772
80.54
55.05
79.33
82.19
73.01
78.82
75.03
69.27
72.91
St. Joseph’s Hospital Health Center
Marvasti M
Nast E
Nazem A
Rosenberg J
TOTAL
681
530
713
836
2760
493
476
620
569
2158
72.39
89.81
86.96
68.06
78.19
23
Total
Cardiac
Surgery
Isolated
CABGs
St. Luke’s Roosevelt Hospital-St. Luke’s Div.
Anagnostopoulos C
Aronis M
Mindich B
Swistel D
All Others
TOTAL
347
475
524
457
104
1907
212
417
324
382
65
1400
61.10
87.79
61.83
83.59
62.50
73.41
St. Peter’s Hospital
Bennett E
Dal Col R
All Others
TOTAL
544
630
1003
2177
415
536
819
1770
76.29
85.08
81.66
81.30
St. Vincent’s Hospital and Medical Center
Galdieri R
McGinn J
Tyras D
All Others
TOTAL
593
667
688
96
2044
493
532
556
77
1658
83.14
79.76
80.81
80.21
81.12
State University Hospital Upstate Medical Center
Parker F
492
Picone A
363
Ryan P
240
All Others
450
TOTAL
1545
326
286
206
312
1130
66.26
78.79
85.83
69.33
73.14
Strong Memorial Hospital
Hicks G
Risher W
All Others
TOTAL
857
843
77
1777
574
607
35
1216
66.98
72.00
45.45
68.43
479
407
478
391
346
386
81.63
85.01
80.75
1364
1123
82.33
332
754
350
223
1659
285
591
226
183
1285
85.84
78.38
64.57
82.06
77.46
Table 5 continued
United Health Services - Wilson Division
Cunningham J R
Wong K
Yousuf M
TOTAL
University Hospital (Stony Brook)
Bilfinger T
Hartman A
Seifert F
All Others
TOTAL
24
%
Isolated
CABG
Table 5 continued
University Hospital of Brooklyn
Zisbrod Z
All Others
TOTAL
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
498
465
963
413
333
746
82.93
71.61
77.47
Westchester County Medical Center
Axelrod H
Fleisher A
Lafaro R
Moggio R
Pooley R
Sarabu M
All Others
TOTAL
365
537
512
489
368
536
80
2887
307
419
377
348
280
359
27
2117
84.11
78.03
73.63
71.17
76.09
66.98
33.75
73.33
Winthrop - University Hospital
Kofsky E
Mohtashemi M
Schubach S
Scott W
All Others
TOTAL
263
285
657
418
472
2095
228
249
494
326
392
1689
86.69
87.37
75.19
77.99
83.05
80.62
72816
54024
74.19
STATEWIDE TOTAL
25
MEDICAL TERMINOLOGY
angina pectoris — the pain or discomfort felt
when blood and oxygen flow to the heart are
impeded by blockage in the coronary arteries.
Can also be caused by an arterial spasm.
angioplasty, also known as percutaneous
transluminal coronary angioplasty (PTCA) in this procedure, a balloon catheter is threaded
up to the site of blockage in an artery in the
heart, and is then inflated to push arterial plaque
against the wall of the artery to create a wider
channel in the artery.
arteriosclerosis — the group of diseases
characterized by thickening and loss of elasticity
of the arterial walls, popularly called “hardening
of the arteries.” Also called atherosclerotic
coronary artery disease or coronary artery
disease.
atherosclerosis — one form of arteriosclerosis
in which plaques or fatty deposits form in the
inner layer of the arteries.
coronary artery bypass graft surgery (CABG)
is a procedure in which a vein or artery from
another part of the body is used to create an
alternate path for blood to flow to the heart,
bypassing the arterial blockage. Typically, a
section of one of the large saphenous veins in the
leg, the radial artery in the arm or the mammary
artery in the chest is used to construct the bypass.
One or more bypasses may be performed during
a single operation. When no other major heart
surgery (such as valve replacement) is included,
the operation is referred to as an isolated CABG.
double, triple, quadruple bypass — the
average number of bypass grafts created during
coronary artery bypass graft surgery is three or
four. Generally, all significantly blocked arteries
are bypassed unless they enter areas of the heart
that are permanently damaged by previous heart
attacks. Five or more bypasses are occasionally
created. Multiple bypasses are often performed to
provide several alternate routes for the blood
flow and to improve the long-term success of the
procedure, not necessarily because the patient’s
condition is more severe.
cardiac catheterization — also known as
coronary angiography - a procedure for
diagnosing the condition of the heart and the
arteries connecting to it. A thin tube threaded
through an artery to the heart releases a dye,
which allows doctors to observe blockages with
an X-ray camera. This procedure is required
before coronary bypass surgery.
cardiovascular disease — disease of the heart
and blood vessels, the most common form is
coronary artery disease.
coronary arteries — the arteries that supply the
heart muscle with blood. When they are
narrowed or blocked, blood and oxygen cannot
flow freely to the heart muscle or myocardium.
ischemic heart disease (ischemia) — heart
disease that occurs as a result of inadequate
blood supply to the heart muscle or myocardium.
myocardial infarction — partial destruction of
the heart muscle due to interrupted blood supply,
also called a heart attack or coronary thrombosis.
plaque — also called atheroma, this is the fatty
deposit in the coronary artery that can block
blood flow.
risk factors for heart disease — certain risk
factors have been found to increase the
likelihood of developing heart disease. Some are
controllable or avoidable, and some cannot be
controlled. The biggest heart disease risk factors
are heredity, gender and age, all of which cannot
be controlled. Men are much more likely to
develop heart disease than women before the age
of 55, although it is the number one killer of both
men and women. The risk increases with age, so
that half of all cases are in those who are over 75
years old.
Some controllable risk factors that contribute to a
higher likelihood of developing coronary artery
disease are high cholesterol levels, cigarette
smoking, high blood pressure (hypertension),
obesity, a sedentary lifestyle or lack of exercise,
diabetes and stress or type A personality
characteristics.
stenosis — the narrowing of an artery due to
blockage. Restenosis is when the narrowing recurs
after surgery.
26
NEW YORK STATE CARDIAC SURGERY CENTERS
Albany Medical Center Hospital
New Scotland Avenue
Albany, New York 12208
Arnot Ogden Medical Center
600 Roe Avenue
Elmira, New York 14905
Bellevue Hospital
First Avenue and 27th Street
New York, New York 10016
Beth Israel Medical Center
10 Nathan D. Perlman Place
New York, New York 10003
Buffalo General Hospital
100 High Street
Buffalo, New York 14203
Ellis Hospital
1101 Nott Street
Schenectady, New York 12308
Erie County Medical Center
462 Grider Street
Buffalo, New York 14215
Lenox Hill Hospital
100 East 77th Street
New York, New York 10021
Long Island Jewish Medical Center
270-05 76th Avenue
New Hyde Park, New York 11040
Maimonides Medical Center
4802 Tenth Avenue
Brooklyn, New York 11219
Millard Fillmore Hospital
3 Gates Circle
Buffalo, New York 14209
Montefiore Medical Center
Henry & Lucy Moses Division
111 East 210th Street
Bronx, New York 11219
Montefiore Medical Center-Weiler Hospital
1825 Eastchester Road
Bronx, New York 10461
Mount Sinai Medical Center
One Gustave L. Levy Place
New York, New York 10029
New York Hospital-Cornell Medical Center
525 East 68th Street
New York, New York 10021
New York University Medical Center
550 First Avenue
New York, New York 10016
New York Hospital Medical Center-Queens
56-45 Main Street
Flushing, New York 11355
(beginning 1996)
Presbyterian Hospital - Atchley Pavillion
161 Fort Washington Avenue
New York, New York 10032
North Shore University Hospital
300 Community Drive
Manhasset, New York 11030
St. Francis Hospital
Port Washington Boulevard
Roslyn, New York 11576
Rochester General Hospital
1425 Portland Avenue
Rochester, New York 14621-3079
St. Luke’s Roosevelt Hospital Center
11-11 Amsterdam Avenue at 114th Street
New York, New York 10025
St Joseph’s Hospital Health Center
301 Prospect Avenue
Syracuse, New York 13203
St Vincent’s Hospital & Medical Center of New York
153 West 11th Street
New York, New York 10011
St. Peter’s Hospital
315 South Manning Boulevard
Albany, New York 12208
United Health Services
Wilson Hospital Division
33-57 Harrison Street
Johnson City, New York 13790
27
Strong Memorial Hospital
601 Elmwood Avenue
Rochester, New York 14642
University Hospital - Stony Brook
SUNY at Stony Brook
Stony Brook, New York 11794-8410
University Hospital of Brooklyn
450 Lenox Road
Brooklyn, New York 11203
Westchester County Medical Center
Grasslands Reservation
Valhalla, New York 10595
SUNY Upstate Medical Center
750 East Adams Street
Syracuse, New York 13210
Winthrop University Hospital
259 First Street
Mineola, New York 11501
Additional copies of this report may be obtained through the
Department of Health web site at http://www.health.state.ny.us
or by writing to:
Cardiac
Box 2000
New York State Department of Health
Albany, New York 12220
28
State of New York
George E. Pataki, Governor
Department of Health
Barbara A. DeBuono, M.D., M.P.H., Commissioner
8/97