CORONARY
ARTERY
BYPASS
SURGERY
in
New York State
1995-1997
New York State Department of Health
September 2000
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 and
Surgeon-in-Chief
Weill-Cornell 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
Edward V. Bennett, M.D.
Chief of Cardiac Surgery
St. Peter’s Hospital, Albany, NY
Luther Clark, M.D.
Chief, Division of Cardiovascular Medicine
University Hospital of Brooklyn
Brooklyn, NY
Jeffrey P. Gold, M.D.
Chairman, Cardiac & Thoracic Surgery
Montefiore Medical Center
Bronx, NY
Alan Hartman, M.D.
Department of Cardiovascular Surgery
Winthrop University Hospital, Mineola, NY
Robert Jones, M.D.
Mary & Deryl Hart Professor of Surgery
Duke University Medical Center, Durham, NC
Rae-Ellen Kavey, M.D.
Professor of Pediatric Cardiology
SUNY Health Science Center
Syracuse, NY
Stanley Katz, M.D.
Chief, Division of Cardiology
North Shore - LIJ Health System
Manhasset, NY
Ben D. McCallister, M.D.
Endowed Chair and Director
Cardiovascular Research
Mid America Heart Institute
Saint Luke's Hospital
Kansas City, MO
Barbara J. McNeil, M.D., Ph.D.
Head, Department of Health Care Policy
Harvard Medical School, Boston, MA
Alvin Mushlin, M.D., Sc.M.
Professor and Chair
Department of Public Health
Weill Medical College of Cornell University
New York, NY
Jan M. Quaegebeur, M.D., Ph.D.
Department of Surgery
Columbia-Presbyterian Medical Center
New York, NY
Eric Rose, M.D.
Professor, Chair and Surgeon-in-Chief,
Department of Surgery
Columbia-Presbyterian Medical Center
New York, NY
Thomas J. Ryan, M.D.
Professor of Medicine
Boston University Medical Center
Boston, MA
Rev. Robert S. Smith
Director, Sophia Center
Diocese of Rockville Centre
Huntington, 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.
Vice President of Pediatrics and
Academic Affairs
USC - Children’s Hospital
Los Angeles, CA
Cardiac Surgery Reporting System Analysis Workgroup
Members
Thomas J. Ryan, M.D. (Chair)
Senior Consultant in Cardiology
Boston University Medical Center
O. Wayne Isom, M.D.
Professor & Chairman
Department of Cardiothoracic Surgery
Weill – Cornell Medical Center
Jeffrey P. Gold, M.D.
Chairman, Cardiac & Thoracic Surgery
Montefiore Medical Center
Alvin Mushlin, M.D.,Sc.M.
Professor & Chair
Weill Medical College of Cornell University
Eric Rose, M.D.
Professor & Chair, Department of Surgery
Columbia Presbyterian Medical Center
Edward V. Bennett, M.D.
Chief of Cardiac Surgery
St. Peter’s Hospital
Alan Hartman, M.D.
Department of Cardiovascular Services
Winthrop University Hospital
Robert Jones, M.D.
Mary & Deryl Hart Professor of Surgery
Duke University Medical Center
Barbara McNeil, M.D., Ph.D.
Head, Department of Health Care Policy
Harvard Medical School
Valavanur A. Subramanian, M.D.
Director, Department of Surgery
Lenox Hill Hospital
Staff & Consultants to CSRS Analysis Workgroup
Donna R. Doran
Administrator, Cardiac Services Program
New York State Department of Health
Rhonda J. O’Brien
Cardiac Database Manager
Cardiac Services Program
New York State Department of Health
Edward Hannan, Ph.D.
Professor & Chair
Department of Health Policy,
Management & Behavior
SUNY School of Public Health
Michael Racz
Research Scientist
Department of Health Policy,
Management & Behavior
SUNY School of Public Health
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
1997 Risk Factors for CABG Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Table 1
Multivariable Risk Factor Equation for CABG Hospital
Deaths in New York State in 1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
1997 HOSPITAL OUTCOMES FOR CABG SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Table 2
Hospital Observed, Expected and Risk-Adjusted Mortality
Rates (RAMR) for CABG Surgery in New York State, 1997 Discharges . . . . . . . . . . . . . . . . 9
Figure 1 Risk-Adjusted Mortality Rates for CABG in
New York State, 1997 Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1995-1997 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,
1995-1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Table 4
Summary Information for Surgeons Practicing at More
Than One Hospital, 1995-1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC
SURGERY AND FOR ISOLATED CABG SURGERY (1995-1997) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Table 5
Total Cardiac Surgery and Isolated CABG Surgery
Volumes by Hospital and Surgeon, 1995-1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
CRITERIA USED IN REPORTING SIGNIFICANT RISK FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
MEDICAL TERMINOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
NYS CARDIAC SURGERY CENTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
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 after 1997. 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 (CAC), 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 1997 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, 1995, and
December 31, 1997, are included in the threeyear results.
Isolated CABG surgery represented 73.15 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 1995 through 1997.
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
4
characteristics. Approximately 40 of these
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.
Patients particiating in the international multiinstitutional SHOCK trial who undergo bypass
surgery are excluded from hospital assessments
based on a 1995 recommendation by the CAC. In
1997, one SHOCK trial case (a live discharge) was
reported but excluded from the 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.
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 decisions must
be made by doctors and patients together after
consideration of all the information.
PredictingPatientMortalityRatesforProviders
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 (2.22% in 1997) 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. To prevent
5
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
1997 Risk Factors for CABG Surgery
The significant preoperative risk factors for
coronary artery bypass surgery in 1997 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 stroke is 1.892. This means
that a patient who had a stroke prior to surgery is
approximately 1.892 times as likely to die in the
hospital as a patient who did not have a stroke
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
had a stroke or has not had a stroke). Exceptions
are age, ejection fraction (which is a measure of
the heart’s ability to pump blood), previous
myocardial infarction (MI, or heart attack), and
renal failure.
In this model, age is treated as a continuous
variable with two components, one for patients
older than 75 and another for all patients,
including those older than 75. Thus, the risk of
mortality increases with age in general, and
increases at a faster rate for patients over 75.
The odds ratios for the categories for ejection
fraction are relative to the omitted range (30%
and higher). Thus, patients with an ejection
fraction of less than 20% have odds of dying in
the hospital that are 3.750 times the odds of a
person with an ejection fraction of 30% or higher,
all other risk factors being the same. Similarly,
the odds ratios for the categories of previous MI
are relative to the odds for patients with no MI or
an MI more than six hours prior to surgery. The
odds ratios for renal failure with and without
dialysis are relative to the omitted category which
is “no renal failure.”
1997 was the first year that cardiopulmonary
resuscitation (CPR) was collected as a risk factor.
CPR is based on status just prior to surgery.
Table 1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1997.
Logistic Regression
Patient Risk Factor
Prevalence (%)
Coefficient
P-Value
Odds Ratio
Demographic
Age
# of Years in Age >75
Female Gender
....
....
28.73
0.0407
0.0625
0.4125
<0.0001
.0023
<.0001
....
....
1.515
Hemodynamic State
Unstable
Shock
Cardiopulmonary Resuscitation
1.53
0.61
0.28
0.9519
1.4432
2.0636
<0.0001
<0.0001
<0.0001
2.591
4.234
7.874
15.64
1.11
1.67
0.6084
1.3984
1.3048
<0.0001
<0.0001
<0.0001
1.837
4.049
3.687
4.76
6.39
1.0926
0.6375
<0.0001
<0.0001
2.591
1.892
Ventricular Function
Previous MI, less than 6 hours
Ejection Fraction Less Than 20%
Ejection Fraction 20%-29%
0.96
1.77
7.10
1.2905
1.3217
0.8422
<0.0001
<0.0001
<0.0001
3.634
3.750
2.321
Previous Open Heart Operations
6.55
1.0421
<0.0001
2.835
Comorbidities
Chronic Obstructive
Pulmonary Disease
Renal Failure with Dialysis
Renal Failure, Creatinine > 2.5
(no dialysis)
Severity of Atherosclerotic Process
Aortoiliac Disease
Stroke
Intercept = -7.5736
C Statistic = 0.797
7
1997 HOSPITAL OUTCOMES FOR CABG SURGERY
Table 2 and Figure 1 present the 1997 CABG
surgery results for the 33 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 1997 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 20,220 CABG operations performed at the
33 hospitals was 2.22%. Observed mortality rates
ranged from 0% (at a facility that began
performing cardiac surgery in 1997) to 4.19%. The
range in expected mortality rates, which measure
patient severity of illness, was 1.08% to 2.81%.
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 0% to
4.55%. One hospital, Buffalo General, had a riskadjusted mortality rate that was significantly
higher than the statewide rate. Three hospitals,
Rochester General, St. Joseph’s Hospital and
Winthrop University Hospital, had significantly
lower 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,
1997 Discharges (Listed Alphabetically by Hospital)
Hospital
Cases
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Albany Medical Center
975
18
1.85
1.66
2.47
(1.46,
3.91)
Arnot-Ogden
128
4
3.13
2.40
2.89
(0.78,
7.40)
92
1
1.09
1.51
1.60
(0.02,
8.92)
444
9
2.03
2.31
1.95
(0.89,
3.69)
1217
47
3.86
2.45
3.50*
(2.57,
4.66)
Columbia Presbyterian-NYP
702
15
2.14
2.14
2.22
(1.24,
3.66)
Ellis Hospital
538
5
0.93
1.43
1.45
(0.47,
3.37)
Erie County
225
3
1.33
1.47
2.01
(0.40,
5.88)
LIJ Medical Center
398
11
2.76
1.90
3.24
(1.61,
5.79)
Lenox Hill
805
27
3.35
2.30
3.24
(2.13,
4.71)
Maimonides
874
22
2.52
2.28
2.45
(1.54,
3.71)
Millard Fillmore
830
23
2.77
1.86
3.30
(2.09,
4.95)
Montefiore - Einstein
310
4
1.29
1.80
1.59
(0.43,
4.08)
Montefiore - Moses
415
9
2.17
2.52
1.91
(0.87,
3.63)
Mount Sinai
453
19
4.19
2.81
3.31
(1.99,
5.17)
NYU Hospitals Center
535
17
3.18
2.56
2.76
(1.61,
4.42)
New York Hospital - Queens
298
7
2.35
1.48
3.52
(1.41,
7.25)
North Shore
819
15
1.83
2.66
1.53
(0.85,
2.52)
1073
14
1.30
2.44
1.19**
(0.65,
1.99)
29
0
0.00
1.08
0.00
(0.00,
26.05)
St. Francis
1793
29
1.62
2.17
1.65
(1.11,
2.37)
St. Josephs
895
4
0.45
2.24
0.44**
(0.12,
1.13)
St. Lukes-Roosevelt
373
9
2.41
2.59
2.07
(0.94,
3.92)
St. Peters
672
11
1.64
1.76
2.07
(1.03,
3.70)
St. Vincents
527
17
3.23
1.96
3.66
(2.13,
5.87)
Strong Memorial
404
9
2.23
2.37
2.08
(0.95,
3.96)
United Health Services
396
12
3.03
2.36
2.86
(1.47,
4.99)
Univ. Hosp. - Stony Brook
658
15
2.28
2.05
2.47
(1.38,
4.07)
Univ. Hosp. - Upstate
511
8
1.57
2.32
1.50
(0.64,
2.95)
Univ. Hosp. of Brooklyn
181
7
3.87
1.89
4.55
(1.82,
9.37)
Weill Cornell-NYP
832
21
2.52
2.75
2.04
(1.26,
3.12)
Westchester Medical Center
957
26
2.72
2.34
2.58
(1.68,
3.78)
Winthrop Univ. Hosp.
861
11
1.28
2.54
1.12**
(0.56,
2.00)
20220
449
2.22
Bellevue
Beth Israel
Buffalo General
Rochester General
St. Elizabeth
Total
* 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, 1997 Discharges (Listed Alphabetically by Hospital)
J
Albany Medical Center
Arnot-Ogden
J
Bellevue
Beth Israel
J
Buffalo General*
Columbia Presbyterian-NYP
J
J
J
Ellis Hospital
J
J
Erie County
J
J
LIJ Medical Center
Lenox Hill
J
Maimonides
Millard Fillmore
J
Montefiore - Einstein
Montefiore - Moses
J
Mount Sinai
J
NYU Hospitals Center
New York Hospital - Queens
North Shore
Rochester General**
St. Elizabeth
J
J
J
St. Francis
26.05
J
J
St. Lukes-Roosevelt
St. Peters
St. Vincents
J
J
Strong Memorial
United Health Services
Univ. Hosp. - Stony Brook
J
J
Univ. Hosp. - Upstate
Univ. Hosp. of Brooklyn
J
Weill Cornell-NYP
Westchester Medical Center
J
Winthrop Univ. Hosp.**
0
J
J
J
St. Josephs**
J
J
1
J
J
J
2
3
4
5
6
7
8
9
10
2.22
New York State Average
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
1995-1997 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 1995-97 for each of the 33
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 1995-1997, and/or (b)
who performed at least one isolated CABG
operation in each of the years 1995-1997.
The results for surgeons not meeting the above
criteria are grouped together and reported as “All
Others” 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 1995-1997.
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: Surgeon Observed, Expected, and Risk-Adjusted Mortality Rates (RAMR) for Coronary Artery Bypass Grafts
in New York State, 1995-1997 Discharges
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Albany Medical Center Hospital
##Banker M
#Britton L
Canavan T
#Dal Col R
Foster E
Kelley J
Luber J
#Miller S
#Sardella G
All Others
TOTAL
91
464
572
1
263
552
448
490
156
237
3274
2
5
5
0
4
15
12
4
0
6
53
2.20
1.08
0.87
0.00
1.52
2.72
2.68
0.82
0.00
2.53
1.62
1.49
1.50
1.59
0.63
2.27
1.86
2.40
2.10
1.24
1.86
1.87
3.52
1.71
1.31
0.00
1.60
3.49
2.66
0.93**
0.00
3.26
2.07
(0.40, 12.72)
(0.55,
4.00)
(0.42,
3.06)
(0.00, 100.00)
(0.43,
4.09)
(1.95,
5.76)
(1.37,
4.65)
(0.25,
2.38)
(0.00,
4.54)
(1.19,
7.10)
(1.55,
2.71)
Arnot Ogden Memorial Hospital
Quintos E
Vaughan J
All Others
TOTAL
264
122
76
462
10
2
1
13
3.79
1.64
1.32
2.81
2.25
2.68
1.97
2.32
4.02
1.46
1.60
2.90
(1.92,
(0.16,
(0.02,
(1.54,
7.39)
5.28)
8.90)
4.96)
11
Table 3 continued
Cases
No.
of Deaths
OMR
34
47
122
2
84
289
4
2
3
1
2
12
11.76
4.26
2.46
50.00
2.38
4.15
3.24
2.03
2.31
4.10
1.91
2.27
8.69
5.00
2.54
29.12
2.97
4.37
Beth Israel Medical Center
Hoffman D
#Stelzer P
Tranbaugh R
All Others
TOTAL
199
210
774
44
1227
1
4
19
0
24
0.50
1.90
2.45
0.00
1.96
1.63
2.81
2.67
1.84
2.49
0.74
1.62
2.20
0.00
1.87
(0.01,
(0.44,
(1.32,
(0.00,
(1.20,
4.09)
4.14)
3.44)
10.80)
2.79)
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Lajos T
Levinsky L
Lewin A
Raza S
Salerno T
All Others
TOTAL
526
237
748
445
332
624
444
315
4
3675
17
8
17
20
4
14
23
12
0
115
3.23
3.38
2.27
4.49
1.20
2.24
5.18
3.81
0.00
3.13
2.94
3.05
2.26
2.33
2.15
1.77
2.16
2.90
2.99
2.37
2.63
2.65
2.40
4.60*
1.34
3.03
5.73*
3.14
0.00
3.16*
(1.53,
(1.14,
(1.40,
(2.81,
(0.36,
(1.66,
(3.63,
(1.62,
(0.00,
(2.61,
4.21)
5.22)
3.85)
7.11)
3.43)
5.09)
8.60)
5.49)
73.25)
3.79)
Columbia Presbyterian - NY Presbyterian Hospital
#Edwards N
49
2
Michler R
302
8
Oz M
575
16
Rose E
367
3
Smith C
658
7
Spotnitz H
8
1
All Others
67
2
TOTAL
2026
39
4.08
2.65
2.78
0.82
1.06
12.50
2.99
1.92
2.21
2.89
2.39
1.75
2.28
2.22
2.15
2.30
4.42
2.19
2.78
1.12
1.12**
13.44
3.31
2.00
(0.50,
(0.94,
(1.59,
(0.22,
(0.45,
(0.18,
(0.37,
(1.42,
15.95)
4.32)
4.51)
3.26)
2.30)
74.76)
11.95)
2.73)
0.00
0.00
1.15
1.10
0.00
1.52
0.64
1.21
0.81
0.86
1.96
1.67
0.92
1.79
1.15
1.74
0.00
0.00
1.40
1.58
0.00
2.03
1.32
1.66
Bellevue Hospital Center
#Colvin S
#Galloway A
#Glassman L
#Grossi E
#Ribakove G
TOTAL
Ellis Hospital
##Banker M
#Britton L
Depan H
McIlduff J
#Older T
#Saifi J
All Others
TOTAL
12
1
1
434
454
1
525
157
1573
0
0
5
5
0
8
1
19
EMR
RAMR
95% CI
for RAMR
(2.34, 22.24)
(0.56, 18.06)
(0.51,
7.43)
(0.38, 100.00)
(0.33, 10.73)
(2.25,
7.63)
(0.00, 100.00)
(0.00, 100.00)
(0.45,
3.28)
(0.51,
3.69)
(0.00, 100.00)
(0.88,
4.01)
(0.02,
7.36)
(1.00,
2.60)
Table 3 continued
Cases
No.
of Deaths
623
2
55
680
8
0
1
9
1.28
0.00
1.82
1.32
137
590
189
69
189
1205
2379
8
14
5
4
5
50
86
Long Island Jewish Medical Center
Graver L
560
#Kerr P
1
Kline G
162
Palazzo R
442
All Others
28
TOTAL
1193
Maimonides Medical Center
#Acinapura A
#Burack J
Cane J
Connolly M
#Cunningham J N
#Jacobowitz I
#Ketosugbo A
#Sabado M
#Zisbrod Z
All Others
TOTAL
Millard Fillmore Hospital
Aldridge J
Ashraf M
#Bell-Thomson J
Guarino R
#Jennings L
#Kerr P
Major W
All Others
TOTAL
Erie County Medical Center
#Bell-Thomson J
#Jennings L
All Others
TOTAL
Lenox Hill Hospital
##Geller C
#Jacobowitz I
McCabe J
#Sabado M
#Stelzer P
Subramanian V
TOTAL
RAMR
95% CI
for RAMR
1.64
3.66
1.09
1.60
1.87
0.00
4.00
1.97
(0.81, 3.68)
(0.00,100.00)
(0.05, 22.27)
(0.90, 3.75)
5.84
2.37
2.65
5.80
2.65
4.15
3.61
1.47
2.84
1.99
2.16
2.37
2.61
2.52
9.47*
1.99
3.18
6.41
2.66
3.79*
3.42*
(4.08, 18.66)
(1.09, 3.35)
(1.03, 7.43)
(1.72, 16.40)
(0.86, 6.22)
(2.82, 5.00)
(2.74, 4.23)
14
0
4
7
1
26
2.50
0.00
2.47
1.58
3.57
2.18
2.21
8.93
1.85
1.91
2.13
2.05
2.71
0.00
3.18
1.98
4.01
2.54
(1.48, 4.55)
(0.00, 98.13)
(0.86, 8.15)
(0.79, 4.09)
(0.05, 22.30)
(1.66, 3.72)
364
2
22
449
365
700
91
201
317
34
2545
13
0
2
7
17
16
4
11
8
1
79
3.57
0.00
9.09
1.56
4.66
2.29
4.40
5.47
2.52
2.94
3.10
2.25
4.81
3.83
2.87
2.55
2.91
2.45
3.14
2.33
2.06
2.68
3.79
0.00
5.67
1.30
4.37*
1.88
4.29
4.17
2.59
3.41
2.76
(2.02,
(0.00,
(0.64,
(0.52,
(2.54,
(1.07,
(1.15,
(2.08,
(1.11,
(0.04,
(2.19,
477
276
49
478
550
355
171
55
2411
12
9
1
13
17
21
2
3
78
2.52
3.26
2.04
2.72
3.09
5.92
1.17
5.45
3.24
2.10
2.08
2.75
1.68
1.86
2.28
1.92
1.13
1.97
2.87
3.74
1.77
3.86
3.98
6.19*
1.46
11.52
3.93*
OMR
EMR
6.48)
91.15)
20.48)
2.68)
6.99)
3.05)
10.99)
7.46)
5.10)
18.99)
3.44)
(1.48, 5.01)
(1.71, 7.10)
(0.02, 9.86)
(2.05, 6.60)
(2.31, 6.37)
(3.83, 9.47)
(0.16, 5.26)
(2.32, 33.66)
(3.11, 4.91)
13
Table 3 continued
Cases
No.
of Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Montefiore Medical Center - Einstein Division
#Camacho M
2
Frater R
88
#Frymus M
438
##Geller C
22
##Gold J
11
Sisto D
379
TOTAL
940
0
2
6
0
0
14
22
0.00
2.27
1.37
0.00
0.00
3.69
2.34
0.80
2.03
2.22
2.03
0.76
2.83
2.43
0.00
2.68
1.47
0.00
0.00
3.12
2.31
(0.00, 100.00)
(0.30, 9.67)
(0.54, 3.21)
(0.00, 19.65)
(0.00, 100.00)
(1.70, 5.23)
(1.44, 3.49)
Montefiore Medical Center - Moses Division
Attai L
328
Brodman R
311
#Camacho M
190
#Frymus M
3
##Geller C
5
##Gold J
78
Merav A
258
All Others
7
TOTAL
1180
9
6
9
1
0
0
8
0
33
2.74
1.93
4.74
33.33
0.00
0.00
3.10
0.00
2.80
2.07
1.97
2.33
0.85
1.23
1.15
2.62
0.83
2.13
3.17
2.34
4.86
93.85
0.00
0.00
2.83
0.00
3.14
(1.45, 6.03)
(0.85, 5.09)
(2.22, 9.23)
(1.23, 100.00)
(0.00, 100.00)
(0.00, 9.81)
(1.22, 5.58)
(0.00, 100.00)
(2.16, 4.41)
Mount Sinai Hospital
Ergin M
Galla J
Griepp R
Lansman S
All Others
TOTAL
484
329
66
408
197
1484
7
13
1
24
6
51
1.45
3.95
1.52
5.88
3.05
3.44
2.72
3.45
2.00
2.97
3.33
3.00
1.27
2.74
1.81
4.74*
2.19
2.74
(0.51, 2.62)
(1.46, 4.69)
(0.02, 10.09)
(3.03, 7.05)
(0.80, 4.76)
(2.04, 3.60)
6
1
98
278
9
392
0
0
5
3
0
8
0.00
0.00
5.10
1.08
0.00
2.04
1.72
2.43
1.56
1.72
1.05
1.66
0.00
0.00
7.82*
1.50
0.00
2.93
(0.00,
(0.00,
(2.52,
(0.30,
(0.00,
(1.26,
New York Hospital - Queens
#Altorki N
#Isom O
#Ko W
#Lang S
#Rosengart T
TOTAL
14
85.04)
100.00)
18.26)
4.39)
93.17)
5.77)
Cases
No.
of Deaths
NYU Hospitals Center
#Colvin S
Culliford A
Esposito R
#Galloway A
#Glassman L
#Grossi E
#Ribakove G
Spencer F
All Others
TOTAL
197
400
321
221
47
176
223
130
50
1765
11
7
7
9
1
6
8
6
2
57
5.58
1.75
2.18
4.07
2.13
3.41
3.59
4.62
4.00
3.23
2.85
2.92
2.98
3.26
2.42
2.93
3.50
3.61
3.31
3.09
4.69
1.43
1.75
2.98
2.10
2.78
2.45
3.06
2.89
2.50
(2.34,
(0.57,
(0.70,
(1.36,
(0.03,
(1.01,
(1.06,
(1.12,
(0.32,
(1.89,
8.39)
2.95)
3.60)
5.66)
11.70)
6.05)
4.83)
6.65)
10.42)
3.24)
North Shore University Hospital
Hall M
#Levy M
Pogo G
#Tortolani A
All Others
TOTAL
841
81
591
616
172
2301
9
4
16
10
3
42
1.07
4.94
2.71
1.62
1.74
1.83
2.84
2.46
2.56
2.80
2.80
2.74
0.90**
4.81
2.53
1.39
1.49
1.59**
(0.41,
(1.29,
(1.45,
(0.66,
(0.30,
(1.15,
1.71)
12.30)
4.11)
2.55)
4.35)
2.15)
Rochester General Hospital
Cheeran D
Kirshner R
Knight P
Kwan S
All Others
TOTAL
860
787
910
431
145
3133
18
22
17
14
3
74
2.09
2.80
1.87
3.25
2.07
2.36
2.09
2.96
2.88
3.21
2.46
2.71
2.40
2.26
1.55
2.42
2.01
2.08
(1.42,
(1.41,
(0.90,
(1.32,
(0.40,
(1.64,
3.79)
3.42)
2.48)
4.06)
5.87)
2.62)
29
29
0
0
0.00
0.00
0.89
0.89
0.00
0.00
(0.00,
(0.00,
34.13)
34.13)
949
637
295
791
835
1121
691
49
5368
19
9
6
12
16
17
12
1
92
2.00
1.41
2.03
1.52
1.92
1.52
1.74
2.04
1.71
2.17
1.63
3.15
2.55
2.06
2.51
2.48
1.92
2.31
2.21
2.07
1.54
1.42
2.22
1.44**
1.67
2.55
1.77**
(1.33,
(0.94,
(0.56,
(0.73,
(1.27,
(0.84,
(0.86,
(0.03,
(1.43,
3.45)
3.93)
3.36)
2.49)
3.61)
2.31)
2.92)
14.16)
2.18)
Table 3 continued
St. Elizabeth Medical Center
All Others
TOTAL
St. Francis Hospital
Bercow N
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
All Others
TOTAL
OMR
EMR
RAMR
95% CI
for RAMR
15
Table 3 continued
Cases
No.
of Deaths
OMR
EMR
RAMR
95% CI
for RAMR
St. Josephs Hospital Health Center
Marvasti M
557
Nast E
662
Nazem A
665
Rosenberg J
622
TOTAL
2506
1
9
6
4
20
0.18
1.36
0.90
0.64
0.80
1.88
2.28
2.43
2.13
2.19
0.23**
1.43
0.89**
0.72**
0.87**
(0.00,
(0.65,
(0.32,
(0.19,
(0.53,
1.27)
2.71)
1.93)
1.85)
1.34)
St. Lukes Roosevelt Hospital
Anagnostopoulos C
Aronis M
Connery C
Mindich B
Swistel D
All Others
TOTAL
229
412
87
85
449
10
1272
12
10
1
4
14
0
41
5.24
2.43
1.15
4.71
3.12
0.00
3.22
2.29
1.84
2.12
1.82
2.71
5.21
2.27
5.46*
3.16
1.29
6.18
2.75
0.00
3.39*
(2.82,
(1.51,
(0.02,
(1.66,
(1.50,
(0.00,
(2.43,
9.54)
5.80)
7.20)
15.82)
4.62)
16.84)
4.60)
St. Peters Hospital
##Banker M
Bennett E
#Dal Col R
#Edwards N
#Miller S
#Older T
#Saifi J
#Sardella G
TOTAL
456
518
592
286
5
174
1
63
2095
9
9
9
3
0
8
0
0
38
1.97
1.74
1.52
1.05
0.00
4.60
0.00
0.00
1.81
2.43
1.93
1.82
1.68
1.95
2.96
14.39
1.35
2.05
1.94
2.15
2.00
1.50
0.00
3.71
0.00
0.00
2.12
(0.89,
(0.98,
(0.91,
(0.30,
(0.00,
(1.60,
(0.00,
(0.00,
(1.50,
3.68)
4.09)
3.79)
4.37)
90.15)
7.31)
60.92)
10.34)
2.91)
1
21
11
19
1
53
2.78
4.33
2.02
3.54
100.00
3.31
1.14
2.20
2.72
2.08
0.62
2.31
5.82
4.71*
1.77
4.07*
100.00*
3.42*
State University Hospital Upstate Medical Center
Alfieris G
213
5
Brandt B
239
8
Parker F
271
5
Picone A
347
9
Ryan P
385
8
TOTAL
1455
35
2.35
3.35
1.85
2.59
2.08
2.41
2.08
2.18
2.33
2.25
1.79
2.11
2.70
3.67
1.89
2.75
2.78
2.73
St. Vincents Hospital and Medical Center
#Acinapura A
36
Galdieri R
485
McGinn J
545
Tyras D
536
All Others
1
TOTAL
1603
16
(0.08, 32.40)
(2.92,
7.20)
(0.88,
3.17)
(2.45,
6.36)
(5.01, 100.00)
(2.56,
4.47)
(0.87,
(1.58,
(0.61,
(1.25,
(1.20,
(1.90,
6.30)
7.22)
4.42)
5.22)
5.47)
3.79)
Cases
No.
of Deaths
659
614
32
1305
15
19
2
36
2.28
3.09
6.25
2.76
2.93
2.17
3.50
2.59
1.86
3.41
4.27
2.55
(1.04,
(2.05,
(0.48,
(1.79,
3.06)
5.32)
15.42)
3.53)
United Health Services - Wilson Division
Cunningham J R
361
Wong K
386
Yousuf M
392
All Others
39
TOTAL
1178
4
9
14
1
28
1.11
2.33
3.57
2.56
2.38
2.31
2.38
3.18
2.39
2.62
1.15
2.34
2.68
2.57
2.16
(0.31,
(1.07,
(1.46,
(0.03,
(1.44,
2.94)
4.45)
4.50)
14.27)
3.13)
University Hospital at Stony Brook
Bilfinger T
442
#Hartman A
222
#Levy M
412
Seifert F
408
All Others
188
TOTAL
1672
14
2
8
9
4
37
3.17
0.90
1.94
2.21
2.13
2.21
3.13
2.32
2.24
2.03
1.72
2.38
2.42
0.93
2.07
2.59
2.96
2.23
(1.32,
(0.10,
(0.89,
(1.18,
(0.80,
(1.57,
4.06)
3.35)
4.09)
4.92)
7.58)
3.07)
University Hospital of Brooklyn
Anderson J
#Burack J
#Cunningham J N
#Ketosugbo A
Piccone V
#Zisbrod Z
All Others
TOTAL
185
191
3
26
39
209
14
667
9
6
0
0
1
6
2
24
4.86
3.14
0.00
0.00
2.56
2.87
14.29
3.60
2.52
2.61
1.28
2.50
2.56
2.34
3.23
2.50
4.61
2.87
0.00
0.00
2.39
2.93
10.58
3.43
Weill Cornell - NY Presbyterian Hospital
#Altorki N
124
##Gold J
102
#Isom O
279
#Ko W
77
Krieger K
760
#Lang S
492
#Rosengart T
668
#Tortolani A
21
All Others
37
TOTAL
2560
4
1
6
4
13
15
13
2
0
58
3.23
0.98
2.15
5.19
1.71
3.05
1.95
9.52
0.00
2.27
2.41
2.27
2.07
6.18
2.50
3.03
3.08
6.89
5.22
2.88
3.20
1.03
2.48
2.01
1.63
2.41
1.51
3.30
0.00
1.88
Table 3 continued
Strong Memorial Hospital
Hicks G
Risher W
All Others
TOTAL
OMR
EMR
RAMR
95% CI
for RAMR
(2.10,
8.75)
(1.05,
6.25)
(0.00, 100.00)
(0.00, 13.49)
(0.03, 13.30)
(1.07,
6.37)
(1.19, 38.19)
(2.20,
5.11)
(0.86,
(0.01,
(0.91,
(0.54,
(0.87,
(1.35,
(0.80,
(0.37,
(0.00,
(1.43,
8.20)
5.74)
5.41)
5.14)
2.79)
3.97)
2.58)
11.93)
4.54)
2.43)
17
Cases
No.
of Deaths
Westchester Medical Center
Axelrod H
Fleisher A
Lafaro R
Moggio R
Pooley R
Sarabu M
All Others
TOTAL
384
539
403
437
418
478
40
2699
14
9
15
6
23
5
0
72
3.65
1.67
3.72
1.37
5.50
1.05
0.00
2.67
3.02
1.98
2.28
2.53
2.58
2.77
2.75
2.50
2.89
2.02
3.90
1.30
5.10*
0.90**
0.00
2.55
(1.58,
(0.92,
(2.18,
(0.47,
(3.23,
(0.29,
(0.00,
(1.99,
Winthrop - University Hospital
#Hartman A
Kofsky E
Mohtashemi M
Schubach S
Scott W
Sutaria M
Williams L
All Others
TOTAL
316
602
230
557
292
116
128
2
2243
3
10
7
12
4
8
6
0
50
0.95
1.66
3.04
2.15
1.37
6.90
4.69
0.00
2.23
3.17
2.41
2.85
2.42
2.18
5.13
3.03
1.72
2.71
0.72**
1.65
2.55
2.13
1.50
3.22
3.70
0.00
1.97
(0.14,
2.09)
(0.79,
3.03)
(1.02,
5.25)
(1.10,
3.72)
(0.40,
3.85)
(1.38,
6.34)
(1.35,
8.05)
(0.00, 100.00)
(1.46,
2.59)
59581
1424
2.39
Table 3 continued
Statewide Total
OMR
EMR
RAMR
95% CI
for RAMR
4.85)
3.84)
6.43)
2.82)
7.65)
2.11)
7.96)
3.21)
* 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, 1995-1997
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Acinapura A
Maimonides
St. Vincent’s
400
364
36
14
13
1
3.50
3.57
2.78
2.15
2.25
1.14
3.89
3.79
5.82
(2.12, 6.52)
(2.02,
6.48)
(0.08, 32.40)
Altorki N
New York Hosp-Queens
Weill Cornell
130
6
124
4
0
4
3.08
0.00
3.23
2.38
1.72
2.41
3.10
0.00
3.20
(0.83, 7.93)
(0.00, 85.04)
(0.86,
8.20)
Banker M
Albany Medl Ctr
Ellis Hospital
St. Peters Hospital
548
91
1
456
11
2
0
9
2.01
2.20
0.00
1.97
2.27
1.49
0.81
2.43
2.11
3.52
0.00
1.94
(1.05, 3.78)
(0.40, 12.72)
(0.00, 100.00)
(0.89,
3.68)
Bell-Thomson J
Erie County
Millard Fillmore
672
623
49
9
8
1
1.34
1.28
2.04
1.72
1.64
2.75
1.86
1.87
1.77
(0.85,
(0.81,
(0.02,
Britton L
Albany Med Ctr
Ellis Hospital
465
464
1
5
5
0
1.08
1.08
0.00
1.50
1.50
0.86
1.71
1.71
0.00
(0.55, 3.99)
(0.55,
4.00)
(0.00, 100.00)
Burack J
Maimonides
Univ Hosp - Brooklyn
193
2
191
6
0
6
3.11
0.00
3.14
2.64
4.81
2.61
2.82
0.00
2.87
(1.03, 6.13)
(0.00, 91.15)
(1.05,
6.25)
Camacho M
Montefiore Einstein
Montefiore Moses
192
2
190
9
0
9
4.69
0.00
4.74
2.31
0.80
2.33
4.84
0.00
4.86
(2.21, 9.19)
(0.00, 100.00)
(2.22,
9.23)
Colvin S
Bellevue
NYU Hosp Ctr
231
34
197
15
4
11
6.49
11.76
5.58
2.90
3.24
2.85
5.34*
8.69
4.69
(2.99, 8.82)
(2.34, 22.24)
(2.34,
8.39)
Cunningham J N
Maimonides
Univ Hosp Brooklyn
368
365
3
17
17
0
4.62
4.66
0.00
2.54
2.55
1.28
4.35*
4.37*
0.00
(2.53, 6.97)
(2.54,
6.99)
(0.00, 100.00)
Dal Col R
Albany Med Ctr
St. Peters
593
1
592
9
0
9
1.52
0.00
1.52
1.82
0.63
1.82
1.99
0.00
2.00
(0.91, 3.79)
(0.00, 100.00)
(0.91,
3.79)
Edwards N
Columbia Presbyterian
St. Peters
335
49
286
5
2
3
1.49
4.08
1.05
1.75
2.21
1.68
2.03
4.42
1.50
(0.66, 4.75)
(0.50, 15.95)
(0.30,
4.37)
3.53)
3.68)
9.86)
19
Table 4 continued
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Frymus M
Montefiore Einstein
Montefiore Moses
441
438
3
7
6
1
1.59
1.37
33.33
2.21
2.22
0.85
1.71
1.47
93.85
(0.69, 3.53)
(0.54,
3.21)
(1.23, 100.00)
Galloway A
Bellevue
NYU Hosp Ctr
268
47
221
11
2
9
4.10
4.26
4.07
3.05
2.03
3.26
3.22
5.00
2.98
(1.60, 5.76)
(0.56, 18.06)
(1.36,
5.66)
Geller C
Lenox Hill
Montefiore Einstein
Montefiore Moses
164
137
22
5
8
8
0
0
4.88
5.84
0.00
0.00
1.54
1.47
2.03
1.23
7.57*
9.47*
0.00
0.00
(3.26,
(4.08,
(0.00,
(0.00,
Glassman L
Bellevue
NYU Hosp Ctr
169
122
47
4
3
1
2.37
2.46
2.13
2.34
2.31
2.42
2.42
2.54
2.10
(0.65, 6.19)
(0.51,
7.43)
(0.03, 11.70)
Gold J
Montefiore Einstein
Montefiore Moses
Weill Cornell
191
11
78
102
1
0
0
1
0.52
0.00
0.00
0.98
1.72
0.76
1.15
2.27
0.73
0.00
0.00
1.03
(0.01, 4.04)
(0.00, 100.00)
(0.00,
9.81)
(0.01,
5.74)
Grossi E
Bellevue
NYU Hosp Ctr
178
2
176
7
1
6
3.93
50.00
3.41
2.94
4.10
2.93
3.19
29.12
2.78
(1.28, 6.58)
(0.38, 100.00)
(1.01,
6.05)
Hartman A
Univ Hosp Stony Brook
Winthrop Univ Hosp
538
222
316
5
2
3
0.93
0.90
0.95
2.82
2.32
3.17
0.79**
0.93
0.72**
(0.25,
(0.10,
(0.14,
Isom O
New York Hosp-Queens
Weill Cornell
280
1
279
6
0
6
2.14
0.00
2.15
2.07
2.43
2.07
2.47
0.00
2.48
(0.90, 5.38)
(0.00, 100.00)
(0.91,
5.41)
1290
590
700
30
14
16
2.33
2.37
2.29
2.88
2.84
2.91
1.93
1.99
1.88
(1.30,
(1.09,
(1.07,
Jennings L
Erie County
Millard Fillmore
552
2
550
17
0
17
3.08
0.00
3.09
1.86
3.66
1.86
3.95
0.00
3.98
(2.30, 6.32)
(0.00, 100.00)
(2.31,
6.37)
Kerr P
Long Island Jewish
Millard Fillmore
356
1
355
21
0
21
5.90
0.00
5.92
2.30
8.93
2.28
6.12*
0.00
6.19*
(3.79, 9.36)
(0.00, 98.13)
(3.83,
9.47)
Jacobowitz I
Lenox Hill
Maimonides
20
14.91)
18.66)
19.65)
100.00)
1.84)
3.35)
2.09)
2.75)
3.35)
3.05)
Table 4 continued
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Ketosugbo A
Maimonides
Univ Hosp Brooklyn
117
91
26
4
4
0
3.42
4.40
0.00
2.46
2.45
2.50
3.32
4.29
0.00
(0.89, 8.51)
(1.15, 10.99)
(0.00, 13.49)
Ko W
New York Hosp-Queens
Weill Cornell
175
98
77
9
5
4
5.14
5.10
5.19
3.59
1.56
6.18
3.42
7.82*
2.01
(1.56, 6.49)
(2.52, 18.26)
(0.54,
5.14)
Lang S
New York Hosp-Queens
Weill Cornell
770
278
492
18
3
15
2.34
1.08
3.05
2.55
1.72
3.03
2.19
1.50
2.41
(1.30,
(0.30,
(1.35,
Levy M
North Shore
Univ Hosp Stony Brook
493
81
412
12
4
8
2.43
4.94
1.94
2.27
2.46
2.24
2.56
4.81
2.07
(1.32, 4.47)
(1.29, 12.30)
(0.89,
4.09)
Miller S
Albany Med Ctr
St. Peters
495
490
5
4
4
0
0.81
0.82
0.00
2.10
2.10
1.95
0.92**
0.93**
0.00
(0.25, 2.36)
(0.25,
2.38)
(0.00, 90.15)
Older T
Ellis Hospital
St. Peters
175
1
174
8
0
8
4.57
0.00
4.60
2.95
0.92
2.96
3.70
0.00
3.71
(1.59, 7.30)
(0.00, 100.00)
(1.60,
7.31)
Ribakove G
Bellevue
NYU Hosp Ctr
307
84
223
10
2
8
3.26
2.38
3.59
3.06
1.91
3.50
2.54
2.97
2.45
(1.22, 4.67)
(0.33, 10.73)
(1.06,
4.83)
Rosengart T
New York Hosp-Queens
Weill Cornell
677
9
668
13
0
13
1.92
0.00
1.95
3.06
1.05
3.08
1.50
0.00
1.51
(0.80, 2.57)
(0.00, 93.17)
(0.80,
2.58)
Sabado M
Lenox Hill
Maimonides
270
69
201
15
4
11
5.56
5.80
5.47
2.89
2.16
3.14
4.60*
6.41
4.17
(2.57, 7.58)
(1.72, 16.40)
(2.08,
7.46)
Saifi J
Ellis Hospital
St. Peters
526
525
1
8
8
0
1.52
1.52
0.00
1.82
1.79
14.39
2.00
2.03
0.00
(0.86, 3.95)
(0.88,
4.01)
(0.00, 60.92)
Sardella G
Albany Med Ctr
St. Peters
219
156
63
0
0
0
0.00
0.00
0.00
1.27
1.24
1.35
0.00
0.00
0.00
(0.00, 3.15)
(0.00,
4.54)
(0.00, 10.34)
Stelzer P
Beth Israel
Lenox Hill
399
210
189
9
4
5
2.26
1.90
2.65
2.60
2.81
2.37
2.07
1.62
2.66
(0.94,
(0.44,
(0.86,
3.46)
4.39)
3.97)
3.93)
4.14)
6.22)
21
Table 4 continued
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Tortolani A
North Shore
Weill Cornell
637
616
21
12
10
2
1.88
1.62
9.52
2.93
2.80
6.89
1.54
1.39
3.30
(0.79, 2.68)
(0.66,
2.55)
(0.37, 11.93)
Zisbrod Z
Maimonides
Univ Hosp Brooklyn
526
317
209
14
8
6
2.66
2.52
2.87
2.34
2.33
2.34
2.72
2.59
2.93
(1.49,
(1.11,
(1.07,
4.57)
5.10)
6.37)
* 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 (1995-1997)
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.
Table 5 presents, for each hospital and for each
surgeon performing at least 200 isolated CABG
operations at that hospital in 1995-1997 and/or
performing one or more isolated CABG
operations in each of the years 1995- 1997, 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.
As indicated, the statewide percentage of adult
cardiac surgeries that were isolated CABG
operations in 1995-1997 was 73.15 percent
(59,581 CABG operations out of a total of 81,456
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, 1995-1997
Total
%
Cardiac
Isolated
Isolated
Surgery
CABGs
CABG
Albany Medical Center Hospital
Banker M
Britton L
Canavan T
Dal Col R
Foster E
Kelley J
Luber J
Miller S
Sardella G
All Others
TOTAL
99
659
663
1
418
722
637
594
164
317
4274
91
464
572
1
263
552
448
490
156
237
3274
91.92
70.41
86.27
100.00
62.92
76.45
70.33
82.49
95.12
74.76
76.60
Arnot-Ogden Memorial Hospital
Quintos E
Vaughan J
All Others
TOTAL
307
142
93
542
264
122
76
462
85.99
85.92
81.72
85.24
Bellevue Hospital Center
Colvin S
Galloway A
Glassman L
Grossi E
Ribakove G
TOTAL
113
95
149
2
158
517
34
47
122
2
84
289
30.09
49.47
81.88
100.00
53.16
55.90
23
Total
Cardiac
Surgery
Isolated
CABGs
Beth Israel Medical Center
Hoffman D
Stelzer P
Tranbaugh R
All Others
TOTAL
226
421
1084
52
1783
199
210
774
44
1227
88.05
49.88
71.40
84.62
68.82
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Lajos T
Levinsky L
Lewin A
Raza S
Salerno T
All Others
TOTAL
667
554
827
515
346
668
592
378
37
4584
526
237
748
445
332
624
444
315
4
3675
78.86
42.78
90.45
86.41
95.95
93.41
75.00
83.33
10.81
80.17
Columbia Presbyterian - NY Presbyterian Hospital
Edwards N
Michler R
Oz M
Rose E
Smith C
Spotnitz H
All Others
TOTAL
68
545
983
616
1063
12
329
3616
49
302
575
367
658
8
67
2026
72.06
55.41
58.49
59.58
61.90
66.67
20.36
56.03
Ellis Hospital
Banker M
Britton L
Depan H
McIlduff J
Older T
Saifi J
All Others
TOTAL
1
1
628
562
2
644
174
2012
1
1
434
454
1
525
157
1573
100.00
100.00
69.11
80.78
50.00
81.52
90.23
78.18
747
2
57
806
623
2
55
680
83.40
100.00
96.49
84.37
Table 5 continued
Erie County Medical Center
Bell-Thomson J
Jennings L
All Others
TOTAL
24
%
Isolated
CABG
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Lenox Hill Hospital
Geller C
Jacobowitz I
McCabe J
Sabado M
Stelzer P
Subramanian V
TOTAL
158
740
248
106
351
1427
3030
137
590
189
69
189
1205
2379
86.71
79.73
76.21
65.09
53.85
84.44
78.51
Long Island Jewish Medical Center
Graver L
Kerr P
Kline G
Palazzo R
All Others
TOTAL
798
1
186
543
42
1570
560
1
162
442
28
1193
70.18
100.00
87.10
81.40
66.67
75.99
Maimonides Medical Center
Acinapura A
Burack J
Cane J
Connolly M
Cunningham J N
Jacobowitz I
Ketosugbo A
Sabado M
Zisbrod Z
All Others
TOTAL
462
3
27
541
514
860
107
246
360
36
3156
364
2
22
449
365
700
91
201
317
34
2545
78.79
66.67
81.48
82.99
71.01
81.40
85.05
81.71
88.06
94.44
80.64
Millard Fillmore Hospital
Aldridge J
Ashraf M
Bell-Thomson J
Guarino R
Jennings L
Kerr P
Major W
All Others
TOTAL
565
308
69
530
603
420
187
73
2755
477
276
49
478
550
355
171
55
2411
84.42
89.61
71.01
90.19
91.21
84.52
91.44
75.34
87.51
Table 5 continued
25
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Montefiore Medical Center - Einstein Division
Camacho M
Frater R
Frymus M
Geller C
Gold J
Sisto D
TOTAL
2
204
514
24
19
543
1306
2
88
438
22
11
379
940
100.00
43.14
85.21
91.67
57.89
69.80
71.98
Montefiore Medical Center - Moses Division
Attai L
Brodman R
Camacho M
Frymus M
Geller C
Gold J
Merav A
All Others
TOTAL
464
449
258
4
7
108
349
13
1652
328
311
190
3
5
78
258
7
1180
70.69
69.27
73.64
75.00
71.43
72.22
73.93
53.85
71.43
Mount Sinai Hospital
Ergin M
Galla J
Griepp R
Lansman S
All Others
TOTAL
791
559
391
658
328
2727
484
329
66
408
197
1484
61.19
58.86
16.88
62.01
60.06
54.42
7
1
124
331
11
474
6
1
98
278
9
392
85.71
100.00
79.03
83.99
81.82
82.70
Table 5 continued
New York Hospital - Queens
Altorki N
Isom O
Ko W
Lang S
Rosengart T
TOTAL
26
Total
Cardiac
Surgery
Isolated
CABGs
NYU Hospitals Center
Colvin S
Culliford A
Esposito R
Galloway A
Glassman L
Grossi E
Ribakove G
Spencer F
All Others
TOTAL
602
726
462
433
60
302
326
272
60
3243
197
400
321
221
47
176
223
130
50
1765
32.72
55.10
69.48
51.04
78.33
58.28
68.40
47.79
83.33
54.42
North Shore University Hospital
Hall M
Levy M
Pogo G
Tortolani A
All Others
TOTAL
1149
103
754
734
269
3009
841
81
591
616
172
2301
73.19
78.64
78.38
83.92
63.94
76.47
Rochester General Hospital
Cheeran D
Kirshner R
Knight P
Kwan S
All Others
TOTAL
1116
1003
1255
502
151
4027
860
787
910
431
145
3133
77.06
78.46
72.51
85.86
96.03
77.80
37
37
29
29
78.38
78.38
1229
1225
404
1017
1173
1469
894
60
7471
949
637
295
791
835
1121
691
49
5368
77.22
52.00
73.02
77.78
71.18
76.31
77.29
81.67
71.85
Table 5 continued
St. Elizabeth Medical Center
All Others
TOTAL
St. Francis Hospital
Bercow N
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
All Others
TOTAL
%
Isolated
CABG
27
Total
Cardiac
Surgery
Isolated
CABGs
St. Josephs Hospital Health Center
Marvasti M
Nast E
Nazem A
Rosenberg J
TOTAL
778
783
770
919
3250
557
662
665
622
2506
71.59
84.55
86.36
67.68
77.11
St. Lukes Roosevelt Hospital-St. Lukes Div.
Anagnostopoulos C
Aronis M
Connery C
Mindich B
Swistel D
All Others
TOTAL
395
553
134
160
539
17
1798
229
412
87
85
449
10
1272
57.97
74.50
64.93
53.13
83.30
58.82
70.75
St. Peters Hospital
Banker M
Bennett E
Dal Col R
Edwards N
Miller S
Older T
Saifi J
Sardella G
All Others
TOTAL
514
776
745
337
7
229
1
73
1
2683
456
518
592
286
5
174
1
63
0
2095
88.72
66.75
79.46
84.87
71.43
75.98
100.00
86.30
0.00
78.08
St. Vincents Hospital and Medical Center
Acinapura A
Galdieri R
McGinn J
Tyras D
All Others
TOTAL
43
625
706
640
1
2015
36
485
545
536
1
1603
83.72
77.60
77.20
83.75
100.00
79.55
State University Hospital Upstate Medical Center
Alfieris G
Brandt B
Parker F
Picone A
Ryan P
All Others
TOTAL
340
326
423
449
494
2
2034
213
239
271
347
385
0
1455
62.65
73.31
64.07
77.28
77.94
0.00
71.53
Table 5 continued
28
%
Isolated
CABG
Table 5 continued
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Strong Memorial Hospital
Hicks G
Risher W
All Others
TOTAL
953
952
57
1962
659
614
32
1305
69.15
64.50
56.14
66.51
United Health Services - Wilson Division
Cunningham J R
Wong K
Yousuf M
All Others
TOTAL
463
473
486
47
1469
361
386
392
39
1178
77.97
81.61
80.66
82.98
80.19
University Hospital at Stony Brook
Bilfinger T
Hartman A
Levy M
Seifert F
All Others
TOTAL
530
307
492
592
225
2146
442
222
412
408
188
1672
83.40
72.31
83.74
68.92
83.56
77.91
300
230
10
30
48
255
27
900
185
191
3
26
39
209
14
667
61.67
83.04
30.00
86.67
81.25
81.96
51.85
74.11
155
186
622
155
1113
728
970
30
88
4047
124
102
279
77
760
492
668
21
37
2560
80.00
54.84
44.86
49.68
68.28
67.58
68.87
70.00
42.05
63.26
University Hospital of Brooklyn
Anderson J
Burack J
Cunningham J N
Ketosugbo A
Piccone V
Zisbrod Z
All Others
TOTAL
Weill Cornell - NY Presbyterian Hospital
Altorki N
Gold J
Isom O
Ko W
Krieger K
Lang S
Rosengart T
Tortolani A
All Others
TOTAL
29
Table 5 continued
Isolated
CABGs
%
Isolated
CABG
Westchester Medical Center
Axelrod H
Fleisher A
Lafaro R
Moggio R
Pooley R
Sarabu M
All Others
TOTAL
467
686
580
587
516
691
52
3579
384
539
403
437
418
478
40
2699
82.23
78.57
69.48
74.45
81.01
69.18
76.92
75.41
Winthrop - University Hospital
Hartman A
Kofsky E
Mohtashemi M
Schubach S
Scott W
Sutaria M
Williams L
All Others
TOTAL
512
709
276
778
393
148
162
4
2982
316
602
230
557
292
116
128
2
2243
61.72
84.91
83.33
71.59
74.30
78.38
79.01
50.00
75.22
81456
59581
73.15
Statewide Total
30
Total
Cardiac
Surgery
CriteriaUsedinReportingSignificantRiskFactors(1997)
Based on Documentation in Medical Record
Patient Risk Factor
Definitions
Hemodynamic State
Determined just prior to surgery
• Unstable
Patient requires pharmacologic or mechanical support to
maintain blood pressure or output
• Shock
Acute hypotension (systolic blood pressure <80 mmHg) or
low cardiac index (<2.0 liters/min/m), despite
pharmacologic or mechanical support
• Cardiopulmonary Resuscitation
Patient requires cardiopulmonary resuscitation
Comorbidities
• Chronic Obstructive
Pulmonary Disease
Patient requires chronic (longer than three months),
bronchodilator therapy to avoid disability from obstructive
airway disease; or has a forced expiratory volume in one
second of less than 75% of the predicted value or less than
1.25 liters; or has a room air pO2 < 60 or a pCO2 >50
• Renal Failure, Dialysis
The patient is on chronic peritoneal or hemodialysis
• Renal Failure,Creatinine>2.5
Pre-operative creatinine greater than 2.5 mg/dl
Severity of Atherosclerotic Process
• Aortoiliac Disease
Angiographic demonstration of at least 50% narrowing in a
major aortoiliac vessel, previous surgery for such disease,
absent femoral pulses, or inability to insert a catheter or
intra-aortic balloon due to iliac aneurysm or obstruction of
the aortoiliac arteries
• Stroke
A history of stroke, with or without residual deficit
Ventricular Function
• Previous MI, less than 6 hours
One or more myocardial infarctions less than 6 hours
before surgery
• Ejection Fraction
Value of the ejection fraction taken closest to the
procedure. When a calculated measure is unavailable, the
EF should be estimated visually from the ventriculogram or
by echocardiography. Intraoperative direct observation of
the heart is not an adequate basis for a visual estimate of
the ejection fraction
Previous Open Heart Operations
Open heart surgery previous to the hospitalization. For the
purpose of this reporting system, minimally invasive
procedures are considered open heart surgery
31
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) or
percutaneous coronary intervetion (PCI). 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.
32
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; 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.
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 poor stress management.
stenosis - the narrowing of an artery due to
blockage. Restenosis is when the narrowing
recurs after surgery.
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
Columbia Presbyterian Medical
Center – NY Presbyterian
161 Fort Washington Avenue
New York, New York 10032
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 CenterWeiler Hospital of
A Einstein College
1825 Eastchester Road
Bronx, New York 10461
Mount Sinai Medical Center
One Gustave L. Levy Place
New York, New York 10019
NYU Hospitals Center
550 First Avenue
New York, New York 10016
New York Hospital Medical
Center-Queens
56-45 Main Street
Flushing, New York 11355
North Shore University Hospital
300 Community Drive
Manhasset, New York 11030
Rochester General Hospital
1425 Portland Avenue
Rochester, New York 14621-3079
St. Elizabeth Medical Center
2209 Genesee Street
Utica, New York 13413
St. Francis Hospital
Port Washington Boulevard
Roslyn New York 11576
St. Joseph’s Hospital
Health Center
301 Prospect Avenue
Syracuse, New York 13203
St. Peter’s Hospital
315 South Manning Boulevard
Albany, New York 12208
St. Vincent’s Hospital & Medical
Center of NY
153 West 11th Street
New York, New York 10011
Strong Memorial Hospital
601 Elmwood Avenue
Rochester, New York 14642
United Health Services
Wilson Hospital Division
33-57 Harrison Street
Johnson City, New York 13790
University Hospital at 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
University Hospital Upstate
Medical Center
750 East Adams Street
Syracuse, New York 13210
Weill-Cornell Medical Center –
NY Presbyterian
525 East 68th Street
New York, New York 10021
Westchester Medical Center
Grasslands Reservation
Valhalla, New York 10595
Winthrop – University Hospital
259 First Street
Mineola, New York 11501
St. Luke’s Roosevelt
Hospital Center
11-11 Amsterdam Avenue at
114th Street
New York, New York 10025
33
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
34
State of New York
George E. Pataki, Governor
Department of Health
Antonia C. Novello, M.D., M.P.H., Dr.P.H., Commissioner
9/00