CORONARY
ARTERY
BYPASS
SURGERY
in
New York State
1994-1996
New York State Department of Health
October 1998
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
O. Wayne Isom, M.D.
Professor and Chairman
Department of Cardiothoracic Surgery
New York Hospital - Cornell
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
Barbara J. McNeil, M.D., Ph.D.
Head, Department of Health Care Policy
Harvard Medical School, Boston, MA
Edward V. Bennett, M.D.
Chief of Cardiac Surgery
St. Peter’s Hospital, Albany, NY
Alvin Mushlin, M.D., Sc.M.
Professor, Community Medicine & Medicine
University of Rochester Medical Center
Rochester, NY
Luther Clark, M.D.
Chief, Division of Cardiovascular Medicine
University Hospital of Brooklyn, NY
Jan M. Quaegebeur, M.D., Ph.D.
Department of Surgery
Columbia-Presbyterian Hospital, New York, NY
Jeffrey P. Gold, M.D.
Chairman, Cardiac & Thoracic Surgery
Montefiore Medical Center
Bronx, NY
Eric Rose, M.D.
Chairman, Department of Surgery
Columbia University, New York, NY
Alan Guerci, M.D.
Executive Vice President for Medical Affairs
St. Francis Hospital, Roslyn, NY
Thomas J. Ryan, M.D.
Professor of Medicine
Boston University Medical Center
Boston, MA
Alan Hartman, M.D.
Department of Cardiovascular Surgery
Winthrop University Hospital, Mineola, NY
Tomas Salerno, M.D.
Chief, Division of Cardiothoracic Surgery
The Buffalo General Hospital, Buffalo, NY
Robert Jones, M.D.
Mary & Deryl Hart Professor of Surgery
Duke University Medical Center
Durham, NC
Rev. Robert S. Smith
Stony Brook, NY
Rae-Ellen Kavey, M.D.
Professor of Pediatric Cardiology
SUNY Health Science Center
Syracuse, NY
Ben D. McCallister, M.D.
Endowed Chair and Director
Cardiovascular Research
Mid America Heart Institute
Kansas City, MO
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, Data Validation and Identifying In-Hospital Deaths . . . . . . . . . . . . . . . . . . . . . . . . .4
Assessing Patient Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
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
1996 Risk Factors for CABG Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Table 1
Multivariable Risk Factor Equation for CABG Hospital
Deaths in New York State in 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1996 HOSPITAL OUTCOMES FOR CABG SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Table 2
Hospital Observed, Expected and Risk-Adjusted Mortality
Rates (RAMR) for CABG Surgery in New York State, 1996 Discharges . . . . . . . . . . . . . . . .9
Figure 1 Risk-Adjusted Mortality Rates for CABG in
New York State, 1996 Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1994-1996 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,
1994-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Table 4
Summary Information for Surgeons Practicing at More
Than One Hospital, 1994-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC
SURGERY AND FOR ISOLATED CABG SURGERY (1994-1996) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Table 5
Total Cardiac Surgery and Isolated CABG Surgery
Volumes by Hospital and Surgeon, 1994-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
MEDICAL TERMINOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
NYS CARDIAC SURGERY CENTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
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 riskadjusted 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.
We 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 1997 or 1998. Important changes may have taken place in some hospitals during that time
period.
In developing treatment plans, it is important 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.
Providers of this state and the Cardiac Advisory Committee are to be commended 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.
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’ pre-operative
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 1996 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, 1994, and
December 31, 1996, are included in the threeyear results.
Isolated CABG surgery represented 73.92 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 1994 through 1996.
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, Data Validation and Identifying
In-Hospital Deaths
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 collect data
concerning patients’ demographic and clinical
characteristics. Approximately 40 of these
4
characteristics (called risk factors) are collected
for each patient. Along with information about
the procedure, 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-matching of cardiac
surgery data with other Department of Health
databases and a review of medical records for a
selected sample of cases. These activities are
extremely helpful in ensuring consistent
interpretation of data elements across hospitals.
The analysis bases mortality on deaths occurring
during the same hospital stay in which a patient
underwent cardiac surgery. In the past, the data
validation activities have focused on the acute
care stay at the surgery center. However, changes
in the health care system have resulted in an
increasing number of administrative discharges
within the hospital. For example, a patient may
be discharged from an acute care bed to a
hospice or rehabilitation bed within the same
hospital stay in order to differentiate
reimbursement for differing levels of care. Data
validation activities for 1996 identified one facility
where such administrative discharges lead to a
substantial misrepresentation of cardiac surgery
mortalities for that program. In order to assure
consistency across all programs, a review of
statewide discharge patterns was instituted to
confirm all deaths occuring within the premises
of the cardiac surgery center. It should be noted
that the bulk of the additional deaths identified
were at one facility and that reporting practices at
that facility have been scrutinized by the
Department of Health and the Cardiac Advisory
Committee. The program will be carefully
monitored in the future.
In this report, an in-hospital death is defined as a
patient who died subsequent to CABG surgery
during the same acute care admission; was
discharged to another unit of the same hospital
(e.g., hospice care, rehabilitation) and died; or
was transferred to a formally affiliated cardiac
surgery program and died.
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 than 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 or her specific characteristics.
Doctors and patients should review individual
risk profiles together. Treatment must be made by
doctors and patients together after 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 (2.44% in 1996) 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.
5
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. To prevent
misinterpretation of differences caused by chance
variation, confidence intervals are reported in the
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 riskadjusted 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 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 coronary artery
bypass graft 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.
Committe 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
1996 Risk Factors for CABG Surgery
The significant preoperative risk factors for
coronary artery bypass surgery in 1996 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 “diabetes” is 1.688. This
means that a patient who has diabetes is
approximately 1.688 times as likely to die in the
hospital as a patient who does not have diabetes
but who has the same other significant risk
factors.
6
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
diabetes or does not have it). Exceptions are age,
body surface area (which is calculated using the
patient’s height and weight), ejection fraction
(which is a measure of the heart’s ability to pump
blood), and previous myocardial infarction (MI,
or heart attack).
For body surface area, the odds ratio roughly
represents the number of times more likely a
patient is to die in the hospital than a patient
with a body surface area that is one unit smaller.
For age and age2, the relationship is more
complicated because there is a quadratic
(squared) term in addition to a linear term. No
odds ratios are given for these two terms because
they should be considered in conjunction with
one another.
of less than 20% have odds of dying in the
hospital that are 3.604 times the odds of a person
with an ejection fraction of 40% or higher, all
other risk factors being the same. Similarly, the
odds ratios for the categories of previous MI are
relative to the omitted categories, which are “no
MI or an MI more than seven days prior to
surgery.”
The odds ratios for the categories for ejection
fraction are relative to the omitted range (40%
and higher). Thus, patients with ejection fractions
Table 1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1996.
Logistic Regression
Patient Risk Factor
Coefficient
P-Value
Odds Ratio
Demographic
Age
(Age)2/100
Female Gender
Body Surface Area
-0.1327
0.1345
0.5448
-0.8177
0.0040
<.0001
<.0001
0.0011
....
....
1.724
0.441
Hemodynamic State
Unstable
Shock
0.8470
2.6546
<0.0001
<0.0001
2.333
14.219
Comorbidities
Chronic Obstructive
Pulmonary Disease
Diabetes
Renal Failure with Dialysis
Renal Failure, Creatinine > 2.5
Hepatic Failure
0.3927
0.5237
1.8253
0.9783
2.1878
0.0010
<0.0001
<0.0001
<0.0001
<0.0001
1.481
1.688
6.205
2.660
8.916
0.9201
0.6247
<0.0001
<0.0001
2.509
1.868
Ventricular Function
Prev. MI < 24 Hrs.
Previous MI, 1-7 days
Ejection Fraction Less Than 20%
Ejection Fraction 20%-29%
Ejection Fraction 30%-39%
0.9226
0.4184
1.2821
0.6505
0.4806
<0.0001
0.0014
<0.0001
<0.0001
<0.0001
2.516
1.520
3.604
1.916
1.617
Previous Open Heart Operations
1.2858
<0.0001
3.617
Severity of Atherosclerotic Process
Aortoiliac Disease
Stroke
Intercept = -0.7081
C Statistic = .813
7
1996 HOSPITAL OUTCOMES FOR CABG SURGERY
Table 2 and Figure 1 present the 1996 CABG
surgery results for the 32 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 1996 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 and a 95% confidence
interval for the risk-adjusted rate.
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.
Definitions of key terms follow:
As indicated in Table 2, the overall mortality rate
for the 20,078 CABG operations performed at the
32 hospitals was 2.44%. Observed mortality rates
ranged from 0.86% to 6.38%. The range in
expected mortality rates, which measure patient
severity of illness, was from 1.38% to 3.45%.
The observed mortality rate (OMR) is the
number of observed deaths divided by the total
number of patients who underwent isolated
CABG surgery.
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
The risk-adjusted mortality rates, which are used
to measure performance, ranged from 1.10% to
5.93%. One hospital, St. Joseph’s, had a riskadjusted mortality rate that was significantly lower
than the statewide rate. Three hospitals, St.
Vincent’s, St. Luke’s-Roosevelt and Lenox Hill,
had significantly higher risk-adjusted rates than
the statewide average.
Table 2: Hospital Observed, Expected and Risk-Adjusted Mortality Rates (RAMR) for CABG Surgery in New York State,
1996 Discharges (Listed Alphabetically by Hospital)
Hospital
Cases
Deaths
OMR
EMR
RAMR
1136
14
1.23
1.88
1.60
(0.87,
135
6
4.44
1.83
5.93
(2.16, 12.90)
94
6
6.38
3.45
4.52
(1.65,
9.83)
428
7
1.64
2.35
1.70
(0.68,
3.50)
1227
33
2.69
2.38
2.76
(1.90,
3.88)
Ellis Hospital
548
9
1.64
1.78
2.25
(1.03,
4.27)
Erie County
259
3
1.16
1.84
1.53
(0.31,
4.48)
Lenox Hill
860
32
3.72
2.49
3.64*
(2.49,
5.14)
LIJ Medical Center
407
9
2.21
2.27
2.38
(1.08,
4.51)
Maimonides
821
28
3.41
2.91
2.86
(1.90,
4.14)
Millard Fillmore
873
25
2.86
2.19
3.20
(2.07,
4.72)
Montefiore-Moses
378
14
3.70
2.27
3.97
(2.17,
6.67)
Montefiore-Weiler
321
8
2.49
2.61
2.33
(1.00,
4.59)
Mount Sinai
494
14
2.83
2.83
2.45
(1.34,
4.10)
New York Hospital-Cornell
798
15
1.88
2.91
1.58
(0.88,
2.60)
New York Hospital-Queens
94
1
1.06
1.38
1.88
(0.02, 10.46)
NYU Hospitals Center
585
15
2.56
3.20
1.96
(1.09,
3.23)
North Shore
831
15
1.81
2.62
1.68
(0.94,
2.77)
Presbyterian
689
12
1.74
2.45
1.73
(0.89,
3.03)
Rochester General
1007
35
3.48
3.10
2.74
(1.91,
3.81)
St. Francis
1814
31
1.71
2.30
1.81
(1.23,
2.57)
St. Joseph’s
812
7
0.86
1.91
1.10**
(0.44,
2.27)
St. Luke’s-Roosevelt
430
17
3.95
2.27
4.25*
(2.48,
6.81)
St. Peter’s
741
13
1.75
1.93
2.22
(1.18,
3.80)
St. Vincent’s
522
23
4.41
2.49
4.32*
(2.74,
6.48)
Strong Memorial
448
18
4.02
2.69
3.64
(2.16,
5.75)
United Health Serv.
409
11
2.69
2.88
2.28
(1.14,
4.08)
Univ.Hosp. of Brooklyn
217
8
3.69
3.00
3.00
(1.29,
5.91)
Univ.Hosp.-Stony Brook
498
11
2.21
2.59
2.08
(1.04,
3.72)
Univ.Hosp.-Upstate
494
12
2.43
2.38
2.50
(1.29,
4.36)
Westchester County
924
22
2.38
2.55
2.28
(1.43,
3.44)
Winthrop Univ. Hosp.
784
16
2.04
2.38
2.09
(1.20,
3.40)
20078
490
2.44
Albany Medical Center
Arnot-Ogden
Bellevue
Beth Israel
Buffalo General
Total
95% CI
for RAMR
2.69)
* 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 CABG in New York State, 1996 Discharges (Listed Alphabetically by Hospital)
J
Albany
AlbanyMedical
Medical Center
Center
Arnot-Ogden
Arnot-Ogden
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
J
Bellevue
Bellevue
Beth
Israel
Beth Israel
Buffalo
Buffalo General
General
Ellis
Hospital
Ellis Hospital
Erie
Erie County
County
LenoxHill*
Hill
Lenox
LIJ
LIJMedical
MedicalCenter*
Center
Maimonides
Maimonides
Millard
Millard Fillmore
Fillmore
Montefiore-Moses
Montefiore-Moses
Montefiore-Weiler
Montefiore-Weiler
Mount
Sinai
Mount Sinai
NewNew
York
Hospital-Queens
YorkHospital-Cornell
New
NewYork
YorkHospital-Cornell
Hospital-Queens
NYU
NYUMedical
Medical Center
Center
North
North Shore
Shore
Presbyterian
Presbyterian
Rochester
Rochester General
General
St.
St. Francis
Francis
St. Joseph’s**
Joseph’s**
St.
St.Luke’s-Roosevelt*
Luke’s-Roosevelt*
St.
St. Peter’s
Peter’s
St.
St. Vincent’s*
Vincent’s*
Strong Memorial
Memorial
Strong
United Health
Health Serv.
Serv.
United
Univ.Hospital
Hospital of Brooklyn
Brooklyn
Univ.
Univ.Hospital-Stony
Hospital-Stony Brook
Univ.
Brook
UpstateMedical
Medical Center
Center
Upstate
Westchester County
County
Westchester
Winthrop Univ.
Univ. Hosp.
Hosp.
Winthrop
0
2
4
2.44
New York State Average
J
6
8
10
12
14
Key
Risk-adjusted mortality rate
Potential margin of statistical error
* 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.
10
1994-1996 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% confidence interval for the risk-adjusted
mortality rate for 1994-96 for each of the 32
hospitals performing CABG surgery during the
time period.
This hospital information is presented for each
surgeon (a) who performed 200 or more isolated
CABG operations during 1994-1996, and/or (b)
who performed at least one isolated CABG
operation in each of the years 1994-1996. Please
note that in previous years information was not
supplied for the second group. The Cardiac
Advisory Committee has recommended that this
group be included in this year’s report in order to
provide more complete information to hospitals,
surgeons and the public.
The results for surgeons not meeting the above
criteria 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 and/or performed at least one
operation in each of the years 1994-1996.
Also, surgeons who met criterion (a) and/or
criterion (b) above and have 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 risk-adjusted 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 riskadjusted 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, 1994-1996
No. of
Deaths
OMR
EMR
232
56
473
600
3
229
276
438
528
458
2
171
3466
5
0
5
5
0
9
4
7
14
3
0
1
53
2.16
0.00
1.06
0.83
0.00
3.93
1.45
1.60
2.65
0.66
0.00
0.58
1.53
1.44
2.71
1.70
1.75
0.84
2.76
2.37
2.04
2.42
2.25
3.24
1.30
2.04
3.70
0.00
1.54
1.18
0.00
3.54
1.51
1.95
2.71
0.72**
0.00
1.12
1.86 **
(1.19, 8.64)
(0.00, 5.99)
(0.50, 3.60)
(0.38, 2.76)
(0.00,100.0)
(1.61, 6.72)
(0.41, 3.88)
(0.78, 4.01)
(1.48, 4.55)
(0.15, 2.11)
(0.00,100.0)
(0.01, 6.22)
(1.40, 2.44)
157
260
153
570
3
8
2
13
1.91
3.08
1.31
2.28
2.55
2.36
2.65
2.49
1.86
3.23
1.22
2.27
(0.37,
(1.39,
(0.14,
(1.21,
Cases
Albany Medical Center Hospital
##Banker M
#Bennett E
#Britton L
#Canavan T
##Dal Col R
Ferraris V
Foster E
Kelley J
Luber J
##Miller S
##Saifi J
All Others
TOTAL
Arnot-Ogden Medical Center
Borja A
Quintos E
Vaughan J
TOTAL
RAMR
95% CI
for RAMR
5.43)
6.37)
4.41)
3.88)
11
Table 3 continued
Cases
No.
of Deaths
OMR
46
1
48
114
3
78
290
8
0
2
4
1
2
17
17.39
0.00
4.17
3.51
33.33
2.56
5.86
Beth Israel Medical Center
Hoffman D
#Stelzer P
Tranbaugh R
All Others
TOTAL
147
101
772
33
1053
1
1
17
0
19
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Lajos T
Levinsky L
Lewin A
Raza S
Salerno T
All Others
TOTAL
498
318
723
494
247
643
493
214
1
3631
Ellis Hospital
##Banker M
#Britton L
#Canavan T
##Dal Col R
Depan H
#McIlduff J
##Miller S
#Older T
##Saifi J
All Others
TOTAL
Bellevue Hospital Center
#Colvin S
#Crawford B
#Galloway A
#Glassman L
#Grossi E
#Ribakove G
TOTAL
Erie County Medical Center
#Bell-Thomson J
#Jennings L
TOTAL
12
RAMR
95% CI
for RAMR
2.86
5.21
2.54
2.04
5.11
2.24
2.35
15.08 *
0.00
4.07
4.27
16.17
2.84
6.19 *
(6.50,29.72)
(0.00,100.0)
(0.46,14.70)
(1.15,10.93)
(0.21,89.95)
(0.32,10.26)
(3.61, 9.92)
0.68
0.99
2.20
0.00
1.80
1.72
2.80
2.66
2.00
2.52
0.98
0.88
2.05
0.00
1.78
(0.01, 5.45)
(0.01, 4.87)
(1.20, 3.29)
(0.00,13.78)
(1.07, 2.77)
13
7
10
19
0
14
21
9
0
93
2.61
2.20
1.38
3.85
0.00
2.18
4.26
4.21
0.00
2.56
2.71
2.38
2.31
2.22
2.19
1.94
2.27
2.94
3.30
2.32
2.39
2.29
1.49
4.29 *
0.00 **
2.79
4.66 *
3.54
0.00
2.74
(1.27, 4.09)
(0.92, 4.73)
(0.71, 2.73)
(2.58, 6.71)
(0.00, 1.68)
(1.52, 4.68)
(2.88, 7.12)
(1.62, 6.73)
(0.00,100.0)
(2.21, 3.36)
1
2
2
3
444
411
1
31
526
36
1457
0
0
0
0
7
4
0
1
10
0
22
0.00
0.00
0.00
0.00
1.58
0.97
0.00
3.23
1.90
0.00
1.51
0.92
0.95
1.36
1.66
2.11
1.90
0.88
2.33
1.64
1.24
1.86
0.00
0.00
0.00
0.00
1.85
1.27
0.00
3.44
2.87
0.00
2.01
(0.00,100.0)
(0.00,100.0)
(0.00,100.0)
(0.00,100.0)
(0.74, 3.82)
(0.34, 3.26)
(0.00,100.0)
(0.04,19.13)
(1.37, 5.28)
(0.00,20.42)
(1.26, 3.05)
636
2
638
8
0
8
1.26
0.00
1.25
1.74
5.26
1.75
1.79
0.00
1.78
(0.77, 3.53)
(0.00,86.40)
(0.76, 3.50)
EMR
Table 3 continued
Cases
No.
of Deaths
OMR
EMR
RAMR
95% CI
for RAMR
88
255
189
31
353
1285
7
2208
6
5
4
1
11
52
2
81
6.82
1.96
2.12
3.23
3.12
4.05
28.57
3.67
1.54
2.97
2.11
2.60
2.38
2.68
1.35
2.56
10.96 *
1.64
2.49
3.08
3.24
3.75 *
52.44 *
3.55 *
(4.00,23.86)
(0.53, 3.82)
(0.67, 6.38)
(0.04,17.13)
(1.62, 5.80)
(2.80, 4.92)
(5.89,100.0)
(2.82, 4.41)
Long Island Jewish Medical Center
Graver L
562
#Kerr P
15
Palazzo R
454
All Others
179
TOTAL
1210
12
2
8
2
24
2.14
13.33
1.76
1.12
1.98
2.07
4.93
2.18
1.91
2.12
2.56
6.71
2.01
1.45
2.32
(1.32, 4.47)
(0.75,24.23)
(0.86, 3.95)
(0.16, 5.23)
(1.48, 3.45)
Maimonides Medical Center
#Acinapura A
#Burack J
Cane J
#Cunningham J N
#Jacobowitz I
#Ketosugbo A
#Sabado M
#Zisbrod Z
All Others
TOTAL
272
3
19
370
1133
110
355
91
151
2504
10
0
1
16
33
5
18
2
1
86
3.68
0.00
5.26
4.32
2.91
4.55
5.07
2.20
0.66
3.43
2.44
3.16
3.40
2.42
3.18
2.67
3.50
2.75
3.36
3.01
3.74
0.00
3.84
4.43 *
2.27
4.23
3.59
1.99
0.49
2.83
(1.79, 6.88)
(0.00,96.09)
(0.05,21.38)
(2.53, 7.19)
(1.56, 3.19)
(1.36, 9.87)
(2.13, 5.67)
(0.22, 7.17)
(0.01, 2.72)
(2.26, 3.50)
Millard Fillmore Hospital
Aldridge J
#Bell-Thomson J
Guarino R
#Jennings L
#Kerr P
Major W
All Others
TOTAL
542
49
506
591
272
202
78
2240
15
1
19
19
18
2
1
75
2.77
2.04
3.75
3.21
6.62
0.99
1.28
3.35
2.21
2.64
1.80
2.18
2.38
2.18
2.00
2.13
3.10
1.92
5.18 *
3.65
6.90 *
1.13
1.59
3.90 *
(1.73, 5.12)
(0.03,10.67)
(3.12, 8.09)
(2.20, 5.70)
(4.08,10.90)
(0.13, 4.08)
(0.02, 8.85)
(3.07, 4.89)
Lenox Hill Hospital
##Geller C
#Jacobowitz I
McCabe J
#Sabado M
#Stelzer P
Subramanian V
All Others
TOTAL
13
Table 3 continued
Cases
No.
of Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Montefiore Medical Center - Moses Division
Attai L
394
Brodman R
308
#Camacho M
148
#Frymus M
2
##Geller C
21
##Gold J
23
Merav A
274
All Others
11
TOTAL
1181
12
6
10
0
0
0
7
1
36
3.05
1.95
6.76
0.00
0.00
0.00
2.55
9.09
3.05
1.87
1.42
1.81
0.84
0.85
1.77
2.04
1.88
1.76
4.05
3.41
9.26 *
0.00
0.00
0.00
3.10
11.99
4.29 *
(2.09, 7.07)
(1.25, 7.43)
(4.43,17.03)
(0.00,100.0)
(0.00,51.02)
(0.00,22.38)
(1.24, 6.40)
(0.16,66.70)
(3.01, 5.95)
Montefiore Medical Center - Weiler Division
#Camacho M
2
Frater R
91
#Frymus M
410
##Geller C
43
##Gold J
4
Sisto D
373
TOTAL
923
0
2
7
1
0
15
25
0.00
2.20
1.71
2.33
0.00
4.02
2.71
0.77
1.47
2.16
2.27
1.01
3.02
2.44
0.00
3.71
1.96
2.54
0.00
3.31
2.76
(0.00,100.0)
(0.42,13.40)
(0.78, 4.03)
(0.03,14.12)
(0.00,100.0)
(1.85, 5.46)
(1.78, 4.07)
Mount Sinai Hospital
Ergin M
Galla J
Griepp R
Lansman S
All Others
TOTAL
528
333
87
441
129
1518
8
16
3
21
3
51
1.52
4.80
3.45
4.76
2.33
3.36
2.89
4.06
2.03
3.59
3.55
3.36
1.30
2.94
4.21
3.29
1.62
2.48
(0.56, 2.57)
(1.68, 4.77)
(0.85,12.31)
(2.03, 5.03)
(0.33, 4.74)
(1.85, 3.27)
New York Hospital - Cornell
#Altorki N
##Gold J
Isom O
Krieger K
#Lang S
#Rosengart T
All Others
TOTAL
149
178
276
774
706
550
37
2670
6
3
6
15
19
12
2
63
4.03
1.69
2.17
1.94
2.69
2.18
5.41
2.36
2.33
2.48
1.99
2.54
2.94
3.35
5.32
2.78
4.28
1.69
2.71
1.89
2.27
1.61
2.52
2.11
(1.56,
(0.34,
(0.99,
(1.06,
(1.37,
(0.83,
(0.28,
(1.62,
1
70
3
20
94
0
0
0
1
1
0.00
0.00
0.00
5.00
1.06
1.60
1.48
1.32
1.46
1.47
0.00
0.00
0.00
8.51
1.79
(0.00,100.0)
(0.00, 8.75)
(0.00,100.0)
(0.11,47.35)
(0.02, 9.95)
New York Hospital - Queens
#Altorki N
#Lang S
#Rosengart T
All Others
TOTAL
14
9.32)
4.92)
5.90)
3.12)
3.55)
2.82)
9.10)
2.69)
Table 3 continued
Cases
No.
of Deaths
NYU Hospitals Center
#Colvin S
#Crawford B
Culliford A
Esposito R
#Galloway A
#Glassman L
#Grossi E
#Ribakove G
Spencer F
TOTAL
253
95
401
294
231
63
180
179
163
1859
12
2
3
6
6
2
8
11
11
61
4.74
2.11
0.75
2.04
2.60
3.17
4.44
6.15
6.75
3.28
3.84
2.83
2.64
3.52
2.80
3.78
3.49
4.41
3.59
3.35
3.06
1.84
0.70 **
1.44
2.30
2.09
3.16
3.45
4.66
2.43
(1.58,
(0.21,
(0.14,
(0.52,
(0.84,
(0.23,
(1.36,
(1.72,
(2.33,
(1.86,
North Shore University Hospital
Hall M
Nelson R
Pogo G
Tortolani A
All Others
TOTAL
796
125
547
579
35
2082
9
1
12
12
0
34
1.13
0.80
2.19
2.07
0.00
1.63
2.53
2.19
2.11
2.29
2.11
2.33
1.11 **
0.91
2.57
2.24
0.00
1.74 **
(0.51, 2.11)
(0.01, 5.05)
(1.33, 4.50)
(1.16, 3.91)
(0.00,12.35)
(1.21, 2.43)
Presbyterian Hospital - City of New York
Bregman D
67
Michler R
282
Oz M
424
Rose E
406
Smith C
654
Spotnitz H
19
All Others
21
TOTAL
1873
1
8
13
5
10
3
1
41
1.49
2.84
3.07
1.23
1.53
15.79
4.76
2.19
2.14
2.91
2.88
1.67
2.57
1.72
1.50
2.46
1.73
2.42
2.64
1.83
1.48
22.83 *
7.88
2.21
Rochester General Hospital
Cheeran D
Kirshner R
Knight P
Kwan S
All Others
TOTAL
26
29
25
14
3
97
3.07
3.36
2.58
4.58
3.70
3.16
2.22
3.55
2.80
3.48
3.15
2.93
3.42
2.35
2.28
3.26
2.92
2.68
847
863
969
306
81
3066
OMR
EMR
RAMR
95% CI
for RAMR
5.35)
6.65)
2.05)
3.13)
5.01)
7.53)
6.22)
6.18)
8.35)
3.12)
(0.02, 9.63)
(1.04, 4.76)
(1.40, 4.51)
(0.59, 4.26)
(0.71, 2.71)
(4.59,66.71)
(0.10,43.82)
(1.58, 2.99)
(2.24,
(1.57,
(1.48,
(1.78,
(0.59,
(2.17,
5.02)
3.37)
3.37)
5.47)
8.53)
3.27)
15
Table 3 continued
Cases
No.
of Deaths
824
644
409
591
919
1079
696
31
5193
15
6
7
8
16
17
20
0
89
1.82
0.93
1.71
1.35
1.74
1.58
2.87
0.00
1.71
2.21
1.91
3.53
2.63
2.15
2.51
2.68
2.01
2.44
2.04
1.21
1.20 **
1.27
2.01
1.56
2.66
0.00
1.74 **
(1.14, 3.36)
(0.44, 2.64)
(0.48, 2.48)
(0.55, 2.51)
(1.15, 3.26)
(0.91, 2.49)
(1.63, 4.11)
(0.00,14.61)
(1.40, 2.15)
St. Joseph’s Hospital Health Center
Marvasti M
490
Nast E
621
Nazem A
639
Rosenberg J
584
TOTAL
2334
1
10
7
3
21
0.20
1.61
1.10
0.51
0.90
1.79
2.30
2.75
1.85
2.20
0.28 **
1.73
0.99 **
0.69 **
1.01 **
(0.00,
(0.83,
(0.40,
(0.14,
(0.63,
St. Luke’s Roosevelt Hospital - St. Lukes Div.
Anagnostopoulos C
234
Aronis M
545
Connery C
71
Mindich B
127
Swistel D
422
TOTAL
1399
13
11
3
4
13
44
5.56
2.02
4.23
3.15
3.08
3.15
2.37
1.75
2.12
1.80
3.09
2.28
5.81 *
2.86
4.94
4.33
2.47
3.42 *
(3.09, 9.93)
(1.43, 5.12)
(0.99,14.43)
(1.17,11.09)
(1.31, 4.22)
(2.48, 4.59)
St. Peter’s Hospital
##Banker M
#Bennett E
##Dal Col R
#McIlduff J
##Miller S
#Older T
##Saifi J
All Others
TOTAL
3
10
6
1
1
9
0
4
34
1.08
1.75
0.98
7.14
2.27
3.85
0.00
1.75
1.72
2.50
2.05
1.94
2.06
2.79
2.51
16.35
2.13
2.17
1.07
2.12
1.26
8.58
2.02
3.79
0.00
2.03
1.97
(0.21, 3.12)
(1.01, 3.90)
(0.46, 2.74)
(0.11,47.75)
(0.03,11.25)
(1.73, 7.20)
(0.00,55.64)
(0.55, 5.20)
(1.36, 2.75)
3
26
9
18
56
5.08
5.22
1.61
3.33
3.38
1.28
2.59
3.66
2.14
2.76
9.88
5.00 *
1.09 **
3.85
3.04
(1.99,28.86)
(3.26, 7.32)
(0.50, 2.08)
(2.28, 6.08)
(2.30, 3.95)
St. Francis Hospital
Bercow N
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
All Others
TOTAL
279
570
610
14
44
234
1
229
1981
St. Vincent’s Hospital and Medical Center
#Acinapura A
59
Galdieri R
498
McGinn J
558
Tyras D
541
TOTAL
1656
16
OMR
EMR
RAMR
95% CI
for RAMR
1.57)
3.19)
2.04)
2.02)
1.55)
Table 3 continued
Cases
No.
of Deaths
OMR
RAMR
95% CI
for RAMR
631
641
6
1278
17
21
1
39
2.69
3.28
16.67
3.05
2.79
2.19
4.30
2.49
2.39
3.72
9.61
3.03
(1.39, 3.83)
(2.30, 5.68)
(0.13,53.48)
(2.16, 4.15)
United Health Services - Wilson Division
Cunningham J R
393
Wong K
383
Yousuf M
397
TOTAL
1173
7
10
11
28
1.78
2.61
2.77
2.39
2.50
2.51
3.07
2.69
1.77
2.59
2.24
2.20
(0.71,
(1.24,
(1.12,
(1.46,
University Hospital of Brooklyn
Anderson J
#Burack J
#Cunningham J N
#Ketosugbo A
Piccone V
#Zisbrod Z
All Others
TOTAL
153
153
11
3
37
340
12
709
5
6
0
0
1
10
1
23
3.27
3.92
0.00
0.00
2.70
2.94
8.33
3.24
2.64
2.88
2.90
6.15
2.70
2.67
3.64
2.75
3.07
3.37
0.00
0.00
2.48
2.73
5.68
2.93
(0.99, 7.15)
(1.23, 7.34)
(0.00,28.53)
(0.00,49.28)
(0.03,13.81)
(1.31, 5.02)
(0.07,31.59)
(1.86, 4.39)
University Hospital (Stony Brook)
Bilfinger T
370
#Hartman A
431
Levy M
373
Seifert F
283
TOTAL
1457
11
4
8
9
32
2.97
0.93
2.14
3.18
2.20
3.55
2.21
2.56
2.31
2.66
2.08
1.04
2.08
3.42
2.05
(1.04,
(0.28,
(0.90,
(1.56,
(1.40,
University Hospital Upstate Medical Center
Brandt B
187
Parker F
308
Picone A
311
Ryan P
342
All Others
156
TOTAL
1304
8
5
8
8
4
33
4.28
1.62
2.57
2.34
2.56
2.53
1.91
1.67
1.86
1.73
2.05
1.81
5.57
2.41
3.43
3.36
3.11
3.47
(2.40,10.97)
(0.78, 5.63)
(1.48, 6.76)
(1.45, 6.62)
(0.84, 7.95)
(2.39, 4.87)
Westchester County Medical Center
Axelrod H
345
Fleisher A
493
Lafaro R
412
Moggio R
413
Pooley R
353
Sarabu M
427
All Others
13
TOTAL
2456
13
10
18
5
19
4
1
70
3.77
2.03
4.37
1.21
5.38
0.94
7.69
2.85
3.24
2.09
2.11
2.53
2.50
2.83
2.11
2.52
2.88
2.40
5.14 *
1.19
5.33 *
0.82 **
9.06
2.81
(1.53, 4.93)
(1.15, 4.42)
(3.05, 8.13)
(0.38, 2.77)
(3.21, 8.32)
(0.22, 2.10)
(0.12,50.38)
(2.19, 3.55)
Strong Memorial Hospital
Hicks G
Risher W
All Others
TOTAL
EMR
3.64)
4.75)
4.01)
3.18)
3.72)
2.66)
4.10)
6.49)
2.89)
17
Table 3 continued
Winthrop - University Hospital
#Hartman A
Kofsky E
Mohtashemi M
Schubach S
Scott W
Sutaria M
Williams L
All Others
TOTAL
Statewide Total
Cases
No.
of Deaths
153
421
250
505
297
107
118
88
1939
2
8
7
13
5
8
7
5
55
1.31
1.90
2.80
2.57
1.68
7.48
5.93
5.68
2.84
57412
1424
2.48
OMR
EMR
2.99
2.18
2.75
2.77
2.56
6.22
3.40
3.43
2.88
RAMR
1.08
2.17
2.53
2.30
1.63
2.98
4.33
4.11
2.44
95% CI
for RAMR
(0.12,
(0.93,
(1.01,
(1.22,
(0.53,
(1.28,
(1.73,
(1.32,
(1.84,
3.91)
4.27)
5.21)
3.94)
3.80)
5.88)
8.91)
9.58)
3.18)
* 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 each patient 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.
18
Table 4: Summary Information for Surgeons Practicing at More than One Hospital, 1994-1996
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Acinapura A
Maimonides
St. Vincent’s
Total
272
59
331
10
3
13
3.68
5.08
3.93
2.44
1.28
2.23
3.74
9.88
4.37
(1.79, 6.88)
(1.99, 28.86)
(2.32, 7.47)
Altorki N
New York Hospital-Cornell
New York Hospital-Queens
Total
149
1
150
6
0
6
4.03
0.00
4.00
2.33
1.60
2.33
4.28
0.00
4.26
(1.56, 9.32)
(0.00, 100.00)
(1.56, 9.28)
Banker M
Albany Med Ctr
Ellis Hospital
St. Peter’s
Total
232
1
279
512
5
0
3
8
2.16
0.00
1.08
1.56
1.44
0.92
2.50
2.02
3.70
0.00
1.07
1.92
(1.19, 8.64)
(0.00, 100.00)
(0.21, 3.12)
(0.83, 3.79)
Bell-Thomson J
Erie County
Millard Fillmore
Total
636
49
685
8
1
9
1.26
2.04
1.31
1.74
2.64
1.80
1.79
1.92
1.81
(0.77, 3.53)
(0.03, 10.67)
(0.82, 3.43)
Bennett E
Albany Med Ctr
St. Peter’s
Total
56
570
626
0
10
10
0.00
1.75
1.60
2.71
2.05
2.11
0.00
2.12
1.88
(0.00,
(1.01,
(0.90,
Britton L
Albany Med Ctr
Ellis Hospital
Total
473
2
475
5
0
5
1.06
0.00
1.05
1.70
0.95
1.70
1.54
0.00
1.54
(0.50, 3.60)
(0.00, 100.00)
(0.50, 3.59)
Burack J
Maimonides
Univ Hosp - Brooklyn
Total
3
153
156
0
6
6
0.00
3.92
3.85
3.16
2.88
2.89
0.00
3.37
3.30
(0.00, 96.09)
(1.23, 7.34)
(1.21, 7.19)
Camacho M
Montefiore-Moses
Montefiore-Weiler
Total
148
2
150
10
0
10
6.76
0.00
6.67
1.81
0.77
1.80
9.26*
0.00
9.21*
(4.43, 17.03)
(0.00, 100.00)
(4.41, 16.94)
Canavan T
Albany Med Ctr
Ellis Hospital
Total
600
2
602
5
0
5
0.83
0.00
0.83
1.75
1.36
1.74
1.18
0.00
1.18
(0.38, 2.76)
(0.00, 100.00)
(0.38, 2.76)
5.99)
3.90)
3.45)
19
Table 4 continued
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Colvin S
Bellevue
NYU Hosp Ctr
Total
46
253
299
8
12
20
17.39
4.74
6.69
2.86
3.84
3.69
15.08*
3.06
4.49*
(6.50, 29.72)
(1.58, 5.35)
(2.74, 6.94)
Crawford B
Bellevue
NYU Hosp Ctr
Total
1
95
96
0
2
2
0.00
2.11
2.08
5.21
2.83
2.86
0.00
1.84
1.81
(0.00, 100.00)
(0.21, 6.65)
(0.20, 6.53)
Cunningham J N
Maimonides
Univ Hosp - Brooklyn
Total
370
11
381
16
0
16
4.32
0.00
4.20
2.42
2.90
2.44
4.43*
0.00
4.27
(2.53, 7.19)
(0.00, 28.53)
(2.44, 6.94)
Dal Col R
Albany Med Ctr
Ellis Hospital
St. Peter’s
Total
3
3
610
616
0
0
6
6
0.00
0.00
0.98
0.97
0.84
1.66
1.94
1.93
0.00
0.00
1.26
1.25
(0.00, 100.00)
(0.00, 100.00)
(0.46, 2.74)
(0.46, 2.73)
Frymus M
Montefiore-Moses
Montefiore-Weiler
2
410
0
7
0.00
1.71
0.84
2.16
0.00
1.96
(0.00, 100.00)
(0.78, 4.03)
412
7
1.70
2.16
1.95
(0.78,
Galloway A
Bellevue
NYU Hosp Ctr
Total
48
231
279
2
6
8
4.17
2.60
2.87
2.54
2.80
2.76
4.07
2.30
2.58
(0.46, 14.70)
(0.84, 5.01)
(1.11, 5.09)
Geller C
Lenox Hill
Montefiore-Moses
Montefiore-Weiler
Total
88
21
43
152
6
0
1
7
6.82
0.00
2.33
4.61
1.54
0.85
2.27
1.65
10.96*
0.00
2.54
6.91*
Glassman L
Bellevue
NYU Hosp Ctr
Total
114
63
177
4
2
6
3.51
3.17
3.39
2.04
3.78
2.66
4.27
2.09
3.16
(1.15, 10.93)
(0.23, 7.53)
(1.16, 6.89)
Gold J
Montefiore-Moses
Montefiore-Weiler
New York Hospital-Cornell
Total
23
4
178
205
0
0
3
3
0.00
0.00
1.69
1.46
1.77
1.01
2.48
2.37
0.00
0.00
1.69
1.53
(0.00, 22.38)
(0.00, 100.00)
(0.34, 4.92)
(0.31, 4.47)
Total
20
(4.00,
(0.00,
(0.03,
(2.77,
4.02)
23.86)
51.02)
14.12)
14.23)
Table 4 continued
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Grossi E
Bellevue
NYU Hosp Ctr
Total
3
180
183
1
8
9
33.33
4.44
4.92
5.11
3.49
3.52
Hartman A
Univ Hosp - Stony Brook
Winthrop Univ Hosp
Total
431
153
584
4
2
6
0.93
1.31
1.03
2.21
2.99
2.42
1.04
1.08
1.05 **
(0.28,
(0.12,
(0.39,
2.66)
3.91)
2.30)
255
1133
1388
5
33
38
1.96
2.91
2.74
2.97
3.18
3.14
1.64
2.27
2.16
(0.53,
(1.56,
(1.53,
3.82)
3.19)
2.96)
Jennings L
Erie County
Millard Fillmore
Total
2
591
593
0
19
19
0.00
3.21
3.20
5.26
2.18
2.19
0.00
3.65
3.62
(0.00, 86.40)
(2.20, 5.70)
(2.18, 5.66)
Kerr P
LIJ Medical Center
Millard Fillmore
Total
15
272
287
2
18
20
13.33
6.62
6.97
4.93
2.38
2.51
6.71
6.90 *
6.88 *
(0.75, 24.23)
(4.08, 10.90)
(4.20, 10.62)
Ketosugbo A
Maimonides
Univ Hosp - Brooklyn
Total
110
3
113
5
0
5
4.55
0.00
4.42
2.67
6.15
2.76
4.23
0.00
3.98
(1.36, 9.87)
(0.00, 49.28)
(1.28, 9.28)
Lang S
New York Hospital-Cornell
New York Hospital-Queens
Total
706
70
776
19
0
19
2.69
0.00
2.45
2.94
1.48
2.81
2.27
0.00
2.16
(1.37,
(0.00,
(1.30,
McIlduff J
Ellis Hospital
St.Peter’s
Total
411
14
425
4
1
5
0.97
7.14
1.18
1.90
2.06
1.90
1.27
8.58
1.53
(0.34, 3.26)
(0.11, 47.75)
(0.49, 3.58)
Miller S
Albany Med Ctr
Ellis Hospital
St. Peter’s
Total
458
1
44
503
3
0
1
4
0.66
0.00
2.27
0.80
2.25
0.88
2.79
2.30
0.72 **
0.00
2.02
0.86 **
(0.15, 2.11)
(0.00, 100.00)
(0.03, 11.25)
(0.23, 2.20)
Jacobowitz I
Lenox Hill
Maimonides
Total
16.17
3.16
3.47
(0.21, 89.95)
(1.36, 6.22)
(1.58, 6.58)
3.55)
8.75)
3.38)
21
Table 4 continued
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Older T
Ellis Hospital
St. Peter’s
Total
31
234
265
1
9
10
3.23
3.85
3.77
2.33
2.51
2.49
3.44
3.79
3.76
(0.04, 19.13)
(1.73, 7.20)
(1.80, 6.91)
Ribakove G
Bellevue
NYU Hosp Ctr
Total
78
179
257
2
11
13
2.56
6.15
5.06
2.24
4.41
3.75
2.84
3.45
3.34
(0.32, 10.26)
(1.72, 6.18)
(1.78, 5.72)
Rosengart T
New York Hospital-Cornell
New York Hospital-Queens
Total
550
3
553
12
0
12
2.18
0.00
2.17
3.35
1.32
3.34
1.61
0.00
1.61
(0.83, 2.82)
(0.00, 100.00)
(0.83, 2.81)
Sabado M
Lenox Hill
Maimonides
Total
31
355
386
1
18
19
3.23
5.07
4.92
2.60
3.50
3.43
3.08
3.59
3.56
(0.04, 17.13)
(2.13, 5.67)
(2.14, 5.56)
Saifi J
Albany Med Ctr
Ellis Hospital
St. Peter’s
2
526
1
0
10
0
0.00
1.90
0.00
3.24
1.64
16.35
0.00
2.87
0.00
(0.00, 100.00)
(1.37, 5.28)
(0.00, 55.64)
529
10
1.89
1.68
2.80
(1.34,
5.14)
Stelzer P
Beth Israel
Lenox Hill
Total
101
353
454
1
11
12
0.99
3.12
2.64
2.80
2.38
2.48
0.88
3.24
2.65
(0.01,
(1.62,
(1.37,
4.87)
5.80)
4.62)
Zisbrod Z
Maimonides
Univ Hosp-Brooklyn
Total
91
340
431
2
10
12
2.20
2.94
2.78
2.75
2.67
2.69
1.99
2.73
2.57
(0.22,
(1.31,
(1.33,
7.17)
5.02)
4.49)
Total
* 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 probability of death for each patient 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.
22
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC SURGERY AND FOR ISOLATED
CABG SURGERY (1994-1996)
Table 5 presents, for each hospital and for each
surgeon performing at least 200 isolated CABG
operations at that hospital in 1994-1996 and/or
performing one or more isolated CABG
operations in each of the years 1994- 1996,
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
not meeting the above criteria 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 1994-1996 was 73.92 percent
(57,412 CABG operations out of a total of 77,668
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, 1994-1996
Total
%
Cardiac
Isolated
Isolated
Surgery
CABGs
CABG
Albany Medical Center Hospital
Banker M
Bennett E
Britton L
Canavan T
Dal Col R
Ferraris V
Foster E
Kelley J
Luber J
Miller S
Saifi J
All Others
TOTAL
Arnot-Ogden Medical Center
Borja A
Quintos E
Vaughan J
TOTAL
249
67
653
681
3
321
430
545
763
539
2
200
4453
232
56
473
600
3
229
276
438
528
458
2
171
3466
93.17
83.58
72.43
88.11
100.00
71.34
64.19
80.37
69.20
84.97
100.00
85.50
77.84
194
302
173
669
157
260
153
570
80.93
86.09
88.44
85.20
23
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
131
1
89
151
3
144
519
46
1
48
114
3
78
290
35.11
100.00
53.93
75.50
100.00
54.17
55.88
Beth Israel Medical Center
Hoffman D
Stelzer P
Tranbaugh R
All Others
TOTAL
169
178
1099
35
1481
147
101
772
33
1053
86.98
56.74
70.25
94.29
71.10
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Lajos T
Levinsky L
Lewin A
Raza S
Salerno T
All Others
TOTAL
665
631
802
578
262
688
657
244
14
4541
498
318
723
494
247
643
493
214
1
3631
74.89
50.40
90.15
85.47
94.27
93.46
75.04
87.70
7.14
79.96
Ellis Hospital
Banker M
Britton L
Canavan T
Dal Col R
Depan H
McIlduff J
Miller S
Older T
Saifi J
All Others
TOTAL
1
3
2
4
614
501
1
46
616
44
1832
1
2
2
3
444
411
1
31
526
36
1457
100.00
66.67
100.00
75.00
72.31
82.04
100.00
67.39
85.39
81.82
79.53
768
2
770
636
2
638
82.81
100.00
82.86
Table 5 continued
Bellevue Hospital Center
Colvin S
Crawford B
Galloway A
Glassman L
Grossi E
Ribakove G
TOTAL
Erie County Medical Center
Bell-Thomson J
Jennings L
TOTAL
24
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Lenox Hill Hospital
Geller C
Jacobowitz I
McCabe J
Sabado M
Stelzer P
Subramanian V
All Others
TOTAL
103
306
247
42
607
1541
11
2857
88
255
189
31
353
1285
7
2208
85.44
83.33
76.52
73.81
58.15
83.39
63.64
77.28
Long Island Jewish Medical Center
Graver L
Kerr P
Palazzo R
All Others
TOTAL
801
18
544
210
1573
562
15
454
179
1210
70.16
83.33
83.46
85.24
76.92
Maimonides Medical Center
Acinapura A
Burack J
Cane J
Cunningham J N
Jacobowitz I
Ketosugbo A
Sabado M
Zisbrod Z
All Others
TOTAL
342
4
23
511
1401
130
427
107
178
3123
272
3
19
370
1133
110
355
91
151
2504
79.53
75.00
82.61
72.41
80.87
84.62
83.14
85.05
84.83
80.18
Millard Fillmore Hospital
Aldridge J
Bell-Thomson J
Guarino R
Jennings L
Kerr P
Major W
All Others
TOTAL
627
69
559
670
313
222
89
2549
542
49
506
591
272
202
78
2240
86.44
71.01
90.52
88.21
86.90
90.99
87.64
87.88
Table 5 continued
25
Table 5 continued
26
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Montefiore Medical Center - Moses Division
Attai L
Brodman R
Camacho M
Frymus M
Geller C
Gold J
Merav A
All Others
TOTAL
539
452
200
3
24
31
378
25
1652
394
308
148
2
21
23
274
11
1181
73.10
68.14
74.00
66.67
87.50
74.19
72.49
44.00
71.49
Montefiore Medical Center - Weiler Division
Camacho M
Frater R
Frymus M
Geller C
Gold J
Sisto D
TOTAL
2
213
496
45
9
512
1277
2
91
410
43
4
373
923
100.00
42.72
82.66
95.56
44.44
72.85
72.28
Mount Sinai Hospital
Ergin M
Galla J
Griepp R
Lansman S
All Others
TOTAL
836
543
406
708
225
2718
528
333
87
441
129
1518
63.16
61.33
21.43
62.29
57.33
55.85
New York Hospital - Cornell
Altorki N
Gold J
Isom O
Krieger K
Lang S
Rosengart T
All Others
TOTAL
202
314
607
1091
1027
778
65
4084
149
178
276
774
706
550
37
2670
73.76
56.69
45.47
70.94
68.74
70.69
56.92
65.38
New York Hospital - Queens
Altorki N
Lang S
Rosengart T
All Others
TOTAL
1
81
3
23
108
1
70
3
20
94
100.00
86.42
100.00
86.96
87.04
Total
Cardiac
Surgery
Isolated
CABGs
NYU Hospitals Center
Colvin S
Crawford B
Culliford A
Esposito R
Galloway A
Glassman L
Grossi E
Ribakove G
Spencer F
All Others
TOTAL
621
116
720
451
447
77
294
252
341
1
3320
253
95
401
294
231
63
180
179
163
0
1859
40.74
81.90
55.69
65.19
51.68
81.82
61.22
71.03
47.80
0.00
55.99
North Shore University Hospital
Hall M
Nelson R
Pogo G
Tortolani A
All Others
TOTAL
1042
161
692
683
66
2644
796
125
547
579
35
2082
76.39
77.64
79.05
84.77
53.03
78.74
Presbyterian Hospital - City of New York
Bregman D
Michler R
Oz M
Rose E
Smith C
Spotnitz H
All Others
TOTAL
96
536
773
666
1025
33
206
3335
67
282
424
406
654
19
21
1873
69.79
52.61
54.85
60.96
63.80
57.58
10.19
56.16
Rochester General Hospital
Cheeran D
Kirshner R
Knight P
Kwan S
All Others
TOTAL
1075
1086
1257
350
88
3856
847
863
969
306
81
3066
78.79
79.47
77.09
87.43
92.05
79.51
Table 5 continued
%
Isolated
CABG
27
Total
Cardiac
Surgery
Isolated
CABGs
St. Francis Hospital
Bercow N
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
All Others
TOTAL
1042
1203
540
750
1271
1410
914
41
7171
824
644
409
591
919
1079
696
31
5193
79.08
53.53
75.74
78.80
72.31
76.52
76.15
75.61
72.42
St. Joseph’s Hospital Health Center
Marvasti M
Nast E
Nazem A
Rosenberg J
TOTAL
696
709
733
856
2994
490
621
639
584
2334
70.40
87.59
87.18
68.22
77.96
St. Luke’s Roosevelt Hospital - St. Lukes Div.
Anagnostopoulos C
Aronis M
Connery C
Mindich B
Swistel D
TOTAL
391
649
113
255
514
1922
234
545
71
127
422
1399
59.85
83.98
62.83
49.80
82.10
72.79
St. Peter’s Hospital
Banker M
Bennett E
Dal Col R
McIlduff J
Miller S
Older T
Saifi J
All Others
TOTAL
303
790
717
22
54
312
1
262
2461
279
570
610
14
44
234
1
229
1981
92.08
72.15
85.08
63.64
81.48
75.00
100.00
87.40
80.50
St. Vincent’s Hospital and Medical Center
Acinapura A
Galdieri R
McGinn J
Tyras D
TOTAL
69
626
700
659
2054
59
498
558
541
1656
85.51
79.55
79.71
82.09
80.62
Table 5 continued
28
%
Isolated
CABG
Total
Cardiac
Surgery
Isolated
CABGs
Strong Memorial Hospital
Hicks G
Risher W
All Others
TOTAL
916
933
30
1879
631
641
6
1278
68.89
68.70
20.00
68.01
United Health Services - Wilson Division
Cunningham J R
Wong K
Yousuf M
TOTAL
490
452
479
1421
393
383
397
1173
80.20
84.73
82.88
82.55
230
192
19
5
43
412
24
925
153
153
11
3
37
340
12
709
66.52
79.69
57.89
60.00
86.05
82.52
50.00
76.65
University Hospital (Stony Brook)
Bilfinger T
Hartman A
Levy M
Seifert F
All Others
TOTAL
437
565
452
447
1
1902
370
431
373
283
0
1457
84.67
76.28
82.52
63.31
0.00
76.60
University Hospital Upstate Medical Center
Brandt B
Parker F
Picone A
Ryan P
All Others
TOTAL
283
459
409
425
230
1806
187
308
311
342
156
1304
66.08
67.10
76.04
80.47
67.83
72.20
Westchester County Medical Center
Axelrod H
Fleisher A
Lafaro R
Moggio R
Pooley R
Sarabu M
All Others
TOTAL
415
637
570
557
453
608
40
3280
345
493
412
413
353
427
13
2456
83.13
77.39
72.28
74.15
77.92
70.23
32.50
74.88
Table 5 continued
University Hospital of Brooklyn
Anderson J
Burack J
Cunningham J N
Ketosugbo A
Piccone V
Zisbrod Z
All Others
TOTAL
%
Isolated
CABG
29
Table 5 continued
Winthrop - University Hospital
Hartman A
Kofsky E
Mohtashemi M
Schubach S
Scott W
Sutaria M
Williams L
All Others
TOTAL
Statewide Total
30
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
228
493
287
701
387
142
152
102
2492
153
421
250
505
297
107
118
88
1939
67.11
85.40
87.11
72.04
76.74
75.35
77.63
86.27
77.81
77668
57412
73.92
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 surery (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.
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; none of these
which can 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 more than 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.
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.
31
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 Center
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
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 Division
1825 Eastchester Road
Bronx, New York 10461
Mount Sinai Medical Center
One Gustave L. Levy Place
New York, New York 10019
New York Hospital-Cornell Medical Center
525 East 68th Street
New York, New York 10021
NYU Hospitals Center
550 First Avenue
New York, New York 10016
32
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 NY
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
Strong Memorial Hospital
601 Elmwood Avenue
Rochester, New York 14642
University Hospital - Stony Brook
SUNY Health Science Center 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
University Hospital 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
33
State of New York
George E. Pataki, Governor
Department of Health
Barbara A. DeBuono, M.D., M.P.H., Commissioner
10/98