CORONARY
ARTERY
BYPASS
SURGERY
in
New York State
1996-1998
New York State Department of Health
January 2001
Members of the New York 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
Alfred T. Culliford, M.D.
Professor of Clinical Surgery
NYU Medical Center
New York, 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)
Professor of Medicine
Boston University Medical Center
Jeffrey P. Gold, M.D.
Chairman, Cardiac & Thoracic Surgery
Montefiore Medical Center
Eric Rose, M.D.
Professor, Chair & Surgeon-in-Chief
Department of Surgery
Columbia Presbyterian Medical Center
Alan Hartman, M.D.
Department of Cardiovascular Surgery
Winthrop University Hospital
Barbara McNeil, M.D., Ph.D.
Head, Department of Health Care Policy
Harvard Medical School
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
Casey S. Roark
Sr. Research Support Specialist &
Cardiac Databases Coordinator
Research Foundation of SUNY
O. Wayne Isom, M.D.
Professor & Chairman
Department of Cardiothoracic Surgery
Weill – Cornell Medical Center
Alvin Mushlin, M.D.,Sc.M.
Professor & Chair
Department of Public Health
Weill Medical College of Cornell University
Edward V. Bennett, M.D.
Chief of Cardiac Surgery
St. Peter’s Hospital
Robert Jones, M.D.
Mary & Deryl Hart Professor of Surgery
Duke University Medical Center
Valavanur A. Subramanian, M.D.
Director, Department of Surgery
Lenox Hill Hospital
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
Rosemary Lombardo
Research Support Specialist &
Cardiac Data Coordinator
Research Foundation of SUNY
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
RESULTS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
1998 Risk Factors for CABG Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Table 1
Multivariable Risk Factor Equation for CABG Hospital
Deaths in New York State in 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
1998 HOSPITAL OUTCOMES FOR CABG SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Table 2
Hospital Observed, Expected and Risk-Adjusted Mortality
Rates (RAMR) for CABG Surgery in New York State, 1998 Discharges . . . . . . . . . . . . . . . . .9
Figure 1 Risk-Adjusted Mortality Rates for CABG in
New York State, 1998 Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1996-1998 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,
1996-1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Table 4
Summary Information for Surgeons Practicing at More
Than One Hospital, 1996-1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC
SURGERY AND FOR ISOLATED CABG SURGERY (1996-1998) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Table 5
Total Cardiac Surgery and Isolated CABG Surgery
Volumes by Hospital and Surgeon, 1996-1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
CRITERIA USED IN REPORTING SIGNIFICANT RISK FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
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
risk-adjusted to account for differences in patient severity of illness.
New York State has taken a leadership role in setting standards for cardiac services, monitoring outcomes
and sharing performance data with patients, hospitals and physicians. Hospitals and doctors involved
in cardiac care have worked in cooperation with the Department of Health and the Cardiac Advisory
Committee to compile accurate and meaningful data which can and has been used to enhance quality
of care. We believe that this process has been instrumental in achieving the excellent outcomes that are
evidenced in this report for centers across New York State.
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
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
2
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 1998 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, 1996 and
December 31, 1998 are included in the three-year
results.
Isolated CABG surgery represented 71.85 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 1996 through 1998.
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.
Patients particiating in the international multiinstitutional SHOCK trial who undergo bypass
surgery are excluded from hospital assessments
based on a 1996 recommendation by the CAC. In
1998, two SHOCK trial cases (one live discharge
and one death) were 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 admission, or was discharged to
hospice care.
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 a previous
stroke, for example, has a very different risk
profile than a 40-year-old with no previous stroke.
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.
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 riskadjusted 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 (2.15% in 1998) 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
risk-adjusted 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
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.
5
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
1998 Risk Factors for CABG Surgery
The significant preoperative risk factors for
coronary artery bypass surgery in 1998 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 1.612. This means that
a patient who had a stroke prior to surgery is
approximately 1.612 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), and renal failure.
For age, the odds ratio roughly represents the
number of times more likely a patient is to die
in the hospital than a patient one year younger.
Thus, a patient undergoing CABG Surgery who
is 72 years old has a chance of dying that
is approximately 1.069 times the chance that a
patient 71 years old undergoing CABG has of
dying in the hospital.
The odds ratios for the categories for ejection
fraction are relative to the omitted range (40% and
higher). Thus, patients with an ejection fraction of
less than 20% have odds of dying in the hospital
that are 4.151 times the odds of a person with an
ejection fraction of 40% or higher, all other risk
factors being the same. The odds ratios for renal
failure with and without dialysis are relative to the
omitted category which is “no renal failure.”
Table 1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1998.
Logistic Regression
Patient Risk Factor
Prevalence (%)
Coefficient
P-Value
Odds Ratio
Demographic
Age
Female Gender
….
28.92
0.0671
0.5105
<0.0001
<0.0001
1.069
1.666
Hemodynamic State
Unstable
Shock
1.32
0.45
1.0423
1.8458
<0.0001
<0.0001
2.836
6.333
30.91
2.28
15.97
0.3607
0.9759
0.5012
0.0010
<0.0001
<0.0001
1.434
2.654
1.651
1.89
1.27
0.10
0.9213
1.7384
3.0535
<0.0001
<0.0001
<0.0001
2.513
5.688
21.190
Aortoiliac Disease
Stroke
5.42
7.01
0.5481
0.4775
0.0006
0.0016
1.730
1.612
Ventricular Function
Ejection Fraction < 20
Ejection Fraction 20-29
Ejection Fraction 30-39
1.77
7.40
14.49
1.4235
0.8183
0.6186
<0.0001
<0.0001
<0.0001
4.151
2.267
1.856
Previous Open Heart Operations
5.98
0.6800
<0.0001
1.974
Comorbidities
Diabetes
Malignant Ventricular Arrhythmia
COPD
Renal Failure (no dialysis),
Creatinine > 2.5
Renal Failure requiring Dialysis
Hepatic Failure
Severity of Atherosclerotic Process
Intercept = -9.4988
C Statistic = 0.793
7
1998 HOSPITAL OUTCOMES FOR CABG SURGERY
Table 2 and Figure 1 present the 1998 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 1998 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 18,814 CABG operations performed at
the 33 hospitals was 2.15%. Observed mortality
rates ranged from 0.68% to 7.27%. The range in
expected mortality rates, which measure patient
severity of illness, was 1.23% to 3.12%.
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 0.82%
to 12.76%. Two hospitals, St, Vincent's Medical
Center and Bellevue Hospital, had risk-adjusted
mortality rates that were significantly higher than
the statewide rate. Two hospitals, 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,
1998 Discharges (Listed Alphabetically by Hospital)
Hospital
Cases
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Albany Medical Center
834
11
1.32
1.57
1.81
(0.90,
3.23)
Arnot-Ogden
106
5
4.72
1.62
6.27
(2.02,
14.63)
55
4
7.27
1.23
12.76 *
(3.43,
32.67)
446
5
1.12
2.28
1.06
(0.34,
2.47)
1082
20
1.85
1.92
2.07
(1.27,
3.20)
Columbia Presbyterian-NYP
599
10
1.67
2.04
1.76
(0.84,
3.23)
Ellis Hospital
447
6
1.34
1.59
1.82
(0.66,
3.96)
Erie County
173
2
1.16
1.59
1.56
(0.18,
5.64)
LIJ Medical Center
423
10
2.36
1.82
2.79
(1.34,
5.13)
Lenox Hill
553
23
4.16
2.73
3.28
(2.08,
4.92)
Maimonides
979
30
3.06
2.58
2.56
(1.73,
3.65)
Millard Fillmore
642
6
0.93
1.83
1.10
(0.40,
2.39)
Montefiore - Einstein
305
6
1.97
2.02
2.10
(0.77,
4.57)
Montefiore - Moses
451
5
1.11
2.39
1.00
(0.32,
2.33)
Mount Sinai
433
18
4.16
2.73
3.28
(1.94,
5.19)
NYU Hospitals Center
463
10
2.16
2.26
2.06
(0.99,
3.79)
New York Hospital - Queens
303
6
1.98
1.59
2.69
(0.98,
5.85)
North Shore
784
19
2.42
2.27
2.30
(1.38,
3.59)
Rochester General
920
25
2.72
2.72
2.15
(1.39,
3.17)
St. Elizabeth
294
2
0.68
1.30
1.13
(0.13,
4.08)
St. Francis
1646
26
1.58
2.10
1.62
(1.06,
2.37)
St. Josephs
824
7
0.85
1.98
0.93 **
(0.37,
1.91)
St. Lukes-Roosevelt
300
14
4.67
3.12
3.22
(1.76,
5.40)
St. Peters
584
13
2.23
1.57
3.05
(1.62,
5.22)
St. Vincents
551
25
4.54
1.81
5.39 *
(3.48,
7.95)
Strong Memorial
347
9
2.59
2.41
2.32
(1.06,
4.41)
United Health Services
331
8
2.42
2.32
2.25
(0.97,
4.43)
Univ. Hosp. - Stony Brook
762
15
1.97
1.98
2.14
(1.19,
3.52)
Univ. Hosp. - Upstate
523
15
2.87
2.35
2.63
(1.47,
4.33)
Univ. Hosp. of Brooklyn
183
5
2.73
2.22
2.65
(0.85,
6.17)
Weill Cornell-NYP
861
20
2.32
2.27
2.20
(1.34,
3.40)
Westchester Medical Center
866
17
1.96
2.13
1.98
(1.15,
3.17)
Winthrop Univ. Hosp.
744
8
1.08
2.83
0.82 **
(0.35,
1.61)
18814
405
2.15
Bellevue
Beth Israel
Buffalo General
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, 1998 Discharges (Listed Alphabetically by Hospital)
Albany Medical Center
J
Arnot-Ogden
J
Bellevue*
J
Beth Israel
32.67
J
Buffalo General
J
J
J
J
Columbia Presbyterian-NYP
Ellis Hospital
Erie County
LIJ Medical Center
J
Lenox Hill
J
Maimonides
J
Millard Fillmore
J
Montefiore - Einstein
J
Montefiore - Moses
J
Mount Sinai
J
NYU Hospitals Center
J
New York Hospital - Queens
J
J
J
North Shore
Rochester General
St. Elizabeth
J
St. Francis
J
St. Josephs**
J
St. Lukes-Roosevelt
J
J
St. Peters
St. Vincents*
J
Strong Memorial
J
J
J
J
J
J
J
United Health Services
Univ. Hosp. - Stony Brook
Univ. Hosp. - Upstate
Univ. Hosp. of Brooklyn
Weill Cornell-NYP
Westchester Medical Center
Winthrop Univ. Hosp.**
J
0
2
4
6
8
10
12
14
2.15
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
1996-1998 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 1996-98 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 1996-1998, and/or (b)
who performed at least one isolated CABG
operation in each of the years 1996-1998.
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 1996-1998.
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 risk-adjusted mortality
rates that are significantly lower or higher than
the statewide mortality rate (as judged by a 95%
confidence interval) are noted in Tables 3 and 4.
Table 3: Surgeon Observed, Expected, and Risk-Adjusted Mortality Rates (RAMR) for Coronary Artery Bypass Grafts
in New York State, 1996-1998 Discharges
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Albany Medical Center Hospital
##Banker M
Britton L
Canavan T
Foster E
#Joyce F
Kelley J
Luber J
Miller S
#Sardella G
All Others
TOTAL
7
413
519
239
122
593
329
460
158
105
2945
1
4
2
3
2
18
8
3
0
2
43
14.29
0.97
0.39
1.26
1.64
3.04
2.43
0.65
0.00
1.90
1.46
2.07
1.52
1.50
1.86
1.24
1.71
1.91
2.03
1.25
1.72
1.69
15.69
1.45
0.58 **
1.53
2.99
4.04 *
2.89
0.73 **
0.00
2.52
1.97
(0.21,
(0.39,
(0.07,
(0.31,
(0.34,
(2.39,
(1.24,
(0.15,
(0.00,
(0.28,
(1.42,
87.29)
3.72)
2.11)
4.48)
10.81)
6.38)
5.69)
2.14)
4.21)
9.08)
2.65)
Arnot Ogden Memorial Hospital
Quintos E
Vaughan J
All Others
TOTAL
266
89
14
369
13
2
0
15
4.89
2.25
0.00
4.07
1.98
2.05
1.36
1.97
5.61 *
2.49
0.00
4.68 *
(2.98,
(0.28,
(0.00,
(2.62,
9.59)
9.01)
43.66)
7.72)
11
Cases
No.
of Deaths
OMR
28
38
108
60
7
241
4
2
4
1
0
11
14.29
5.26
3.70
1.67
0.00
4.56
3.16
1.62
2.37
1.10
2.08
2.02
10.29 *
7.36
3.56
3.44
0.00
5.14 *
(2.77,
(0.83,
(0.96,
(0.04,
(0.00,
(2.56,
26.35)
26.59)
9.11)
19.12)
57.18)
9.20)
Beth Israel Medical Center
Harris L
Hoffman D
#Stelzer P
Tranbaugh R
TOTAL
129
237
281
671
1318
1
4
5
11
21
0.78
1.69
1.78
1.64
1.59
1.88
1.80
2.57
2.54
2.35
0.94
2.13
1.58
1.47
1.54
(0.01,
(0.57,
(0.51,
(0.73,
(0.95,
5.22)
5.45)
3.68)
2.63)
2.36)
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Lajos T
Levinsky L
Lewin A
Raza S
Salerno T
All Others
TOTAL
527
245
705
396
379
569
432
269
4
3526
17
6
15
15
6
13
21
7
0
100
3.23
2.45
2.13
3.79
1.58
2.28
4.86
2.60
0.00
2.84
2.55
2.41
1.93
2.36
1.85
1.69
1.97
2.94
2.59
2.14
2.87
2.31
2.50
3.65
1.95
3.07
5.60 *
2.01
0.00
3.01 *
(1.67,
(0.84,
(1.40,
(2.04,
(0.71,
(1.64,
(3.46,
(0.81,
(0.00,
(2.45,
4.60)
5.03)
4.13)
6.02)
4.23)
5.26)
8.56)
4.15)
80.44)
3.66)
Columbia Presbyterian - NY Presbyterian Hospital
#Edwards N
164
5
Michler R
206
6
Oz M
646
15
Rose E
311
4
Smith C
617
4
All Others
46
3
TOTAL
1990
37
3.05
2.91
2.32
1.29
0.65
6.52
1.86
2.57
2.76
2.26
1.60
1.93
2.19
2.13
2.70
2.40
2.34
1.83
0.77 **
6.77
1.99
(0.87,
(0.88,
(1.31,
(0.49,
(0.21,
(1.36,
(1.40,
6.30)
5.23)
3.86)
4.68)
1.96)
19.78)
2.74)
Ellis Hospital
##Banker M
Depan H
McIlduff J
Reich H
Saifi J
All Others
TOTAL
0.00
1.93
1.45
0.34
1.25
0.00
1.30
1.10
1.65
1.48
1.30
1.72
0.74
1.57
0.00
2.65
2.23
0.60
1.66
0.00
1.89
(0.00, 100.00)
(1.14,
5.23)
(0.72,
5.21)
(0.01,
3.32)
(0.60,
3.61)
(0.00, 100.00)
(1.16,
2.93)
Table 3 continued
Bellevue Hospital Center
#Colvin S
#Galloway A
#Glassman L
#Ribakove G
All Others
TOTAL
12
1
415
344
292
480
1
1533
0
8
5
1
6
0
20
EMR
RAMR
95% CI
for RAMR
Table 3 continued
Cases
Erie County Medical Center
#Bell-Thomson J
All Others
TOTAL
No.
of Deaths
OMR
EMR
RAMR
95% CI
for RAMR
500
157
657
6
2
8
1.20
1.27
1.22
1.60
1.44
1.56
1.71
2.01
1.77
(0.62,
(0.23,
(0.76,
3.72)
7.26)
3.50)
127
615
117
165
17
1177
2218
8
15
4
8
1
46
82
6.30
2.44
3.42
4.85
5.88
3.91
3.70
1.73
2.67
1.95
3.33
1.73
2.57
2.57
8.26 *
2.07
3.98
3.31
7.74
3.46 *
3.27 *
(3.56,
(1.16,
(1.07,
(1.43,
(0.10,
(2.53,
(2.60,
16.27)
3.42)
10.19)
6.53)
43.06)
4.61)
4.06)
Long Island Jewish Medical Center
Graver L
600
Kline G
175
Palazzo R
453
TOTAL
1228
17
6
7
30
2.83
3.43
1.55
2.44
2.30
1.59
1.78
2.00
2.80
4.91
1.98
2.77
(1.63,
(1.79,
(0.79,
(1.87,
4.49)
10.69)
4.08)
3.96)
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
377
2
20
649
353
502
62
52
500
157
2674
10
0
2
10
16
16
1
5
10
10
80
2.65
0.00
10.00
1.54
4.53
3.19
1.61
9.62
2.00
6.37
2.99
2.17
4.01
4.84
2.57
2.78
3.16
2.35
2.79
2.30
3.24
2.66
2.78
0.00
4.69
1.36
3.70
2.29
1.56
7.84 *
1.97
4.47
2.56
(1.33,
5.11)
(0.00, 100.00)
(0.53, 16.95)
(0.65,
2.50)
(2.11,
6.01)
(1.31,
3.72)
(0.02,
8.68)
(2.53, 18.30)
(0.95,
3.63)
(2.14,
8.23)
(2.03,
3.18)
Millard Fillmore Hospital
Aldridge J
Ashraf M
#Bell-Thomson J
Guarino R
Guiraudon G
Jennings L
Kerr P
Major W
TOTAL
393
471
13
438
71
483
322
154
2345
9
9
0
9
4
5
15
3
54
2.29
1.91
0.00
2.05
5.63
1.04
4.66
1.95
2.30
1.89
1.83
4.02
1.67
1.34
1.76
2.33
2.10
1.88
2.76
2.37
0.00
2.79
9.54 *
1.34
4.54 *
2.11
2.78
(1.26,
(1.08,
(0.00,
(1.28,
(2.57,
(0.43,
(2.54,
(0.42,
(2.09,
Lenox Hill Hospital
Geller C
#Jacobowitz I
McCabe J
#Sabado M
#Stelzer P
Subramanian V
TOTAL
5.23)
4.50)
15.95)
5.30)
24.43)
3.12)
7.49)
6.16)
3.63)
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
98
#Frymus M
436
##Gold J
20
Sisto D
253
All Others
127
TOTAL
936
0
0
7
0
8
3
18
0.00
0.00
1.61
0.00
3.16
2.36
1.92
0.88
2.01
2.11
1.30
2.57
2.23
2.22
0.00
0.00
1.73
0.00
2.80
2.40
1.97
(0.00, 100.00)
(0.00,
4.24)
(0.69,
3.56)
(0.00, 32.07)
(1.21,
5.52)
(0.48,
7.02)
(1.17,
3.11)
Montefiore Medical Center - Moses Division
Attai L
306
Brodman R
312
#Camacho M
220
#Frymus M
1
##Gold J
134
Merav A
245
All Others
26
TOTAL
1244
7
5
7
1
0
8
0
28
2.29
1.60
3.18
100.00
0.00
3.27
0.00
2.25
2.41
1.99
2.82
0.37
1.62
2.60
2.26
2.33
2.16
1.83
2.56
100.00 *
0.00
2.85
0.00
2.20
(0.87,
4.45)
(0.59,
4.27)
(1.03,
5.28)
(8.12, 100.00)
(0.00,
3.84)
(1.23,
5.62)
(0.00, 14.17)
(1.46,
3.18)
Mount Sinai Hospital
Ergin M
Galla J
Griepp R
Lansman S
Nguyen K
All Others
TOTAL
422
280
45
373
79
181
1380
8
11
0
22
2
8
51
1.90
3.93
0.00
5.90
2.53
4.42
3.70
2.30
2.93
2.25
3.16
2.83
2.95
2.77
1.88
3.05
0.00
4.24 *
2.03
3.41
3.03
(0.81,
(1.52,
(0.00,
(2.66,
(0.23,
(1.47,
(2.26,
6
1
210
469
9
695
0
0
7
7
0
14
0.00
0.00
3.33
1.49
0.00
2.01
1.59
1.86
1.57
1.72
1.20
1.66
0.00
0.00
4.84
1.98
0.00
2.75
(0.00, 87.39)
(0.00, 100.00)
(1.94,
9.97)
(0.79,
4.07)
(0.00, 77.08)
(1.50,
4.62)
New York Hospital - Queens
#Altorki N
#Isom O
#Ko W
#Lang S
#Rosengart T
TOTAL
14
3.70)
5.46)
8.25)
6.43)
7.34)
6.71)
3.98)
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
135
374
329
248
23
143
227
89
15
1583
4
8
7
7
0
7
4
4
1
42
2.96
2.14
2.13
2.82
0.00
4.90
1.76
4.49
6.67
2.65
2.30
2.62
2.46
2.76
2.09
3.37
2.57
4.51
3.35
2.75
2.93
1.86
1.97
2.33
0.00
3.30
1.56
2.27
4.52
2.20
(0.79,
(0.80,
(0.79,
(0.93,
(0.00,
(1.32,
(0.42,
(0.61,
(0.06,
(1.58,
7.50)
3.66)
4.05)
4.80)
17.34)
6.80)
3.99)
5.80)
25.14)
2.97)
North Shore University Hospital
Hall M
#Levy M
Pogo G
#Tortolani A
Vatsia S
All Others
TOTAL
838
253
622
464
248
9
2434
12
10
15
7
5
0
49
1.43
3.95
2.41
1.51
2.02
0.00
2.01
2.56
2.32
2.63
2.83
2.28
6.62
2.59
1.27 **
3.88
2.08
1.21
2.01
0.00
1.77
(0.66,
(1.86,
(1.16,
(0.49,
(0.65,
(0.00,
(1.31,
2.22)
7.14)
3.43)
2.50)
4.70)
14.01)
2.34)
Rochester General Hospital
Cheeran D
Fong J
Kirshner R
Knight P
Kwan S
TOTAL
799
211
680
815
495
3000
13
6
22
21
12
74
1.63
2.84
3.24
2.58
2.42
2.47
2.10
2.57
3.08
3.00
2.86
2.72
1.76
2.51
2.39
1.95
1.93
2.06
(0.94,
(0.92,
(1.50,
(1.21,
(1.00,
(1.62,
3.01)
5.47)
3.62)
2.99)
3.37)
2.58)
St. Elizabeth Medical Center
#Joyce F
All Others
TOTAL
136
187
323
1
1
2
0.74
0.53
0.62
1.18
1.15
1.16
1.42
1.06
1.21
(0.02,
(0.01,
(0.14,
7.91)
5.88)
4.38)
903
207
573
231
759
805
1107
668
5253
13
4
6
4
18
16
15
10
86
1.44
1.93
1.05
1.73
2.37
1.99
1.36
1.50
1.64
2.07
2.24
1.59
3.06
2.58
1.91
2.34
2.24
2.19
1.58
1.96
1.50
1.29
2.09
2.37
1.32 **
1.52
1.70 **
(0.84,
(0.53,
(0.55,
(0.35,
(1.24,
(1.35,
(0.74,
(0.73,
(1.36,
2.70)
5.03)
3.27)
3.29)
3.30)
3.85)
2.18)
2.80)
2.10)
Table 3 continued
St. Francis Hospital
Bercow N
Colangelo R
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
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
583
Nast E
618
Nazem A
688
Rosenberg J
642
TOTAL
2531
0
8
4
6
18
0.00
1.29
0.58
0.93
0.71
1.87
2.10
2.43
2.17
2.16
0.00 **
1.40
0.54 **
0.98 **
0.75 **
(0.00,
(0.60,
(0.15,
(0.36,
(0.44,
0.76)
2.76)
1.39)
2.13)
1.18)
St. Lukes Roosevelt Hospital
Anagnostopoulos C
Aronis M
Connery C
Mindich B
Swistel D
All Others
TOTAL
167
291
102
75
428
40
1103
10
6
3
3
15
3
40
5.99
2.06
2.94
4.00
3.50
7.50
3.63
2.43
2.03
2.39
2.31
3.29
2.97
2.66
5.61 *
2.31
2.80
3.94
2.42
5.74
3.10
(2.68,
(0.84,
(0.56,
(0.79,
(1.36,
(1.15,
(2.21,
10.31)
5.03)
8.18)
11.51)
4.00)
16.77)
4.21)
St. Peters Hospital
##Banker M
Bennett E
Dal Col R
#Edwards N
#Sardella G
All Others
TOTAL
513
398
505
286
226
69
1997
13
6
10
3
3
2
37
2.53
1.51
1.98
1.05
1.33
2.90
1.85
2.14
1.76
1.36
1.50
1.41
2.42
1.70
2.70
1.95
3.32
1.60
2.14
2.73
2.48
(1.43,
(0.71,
(1.59,
(0.32,
(0.43,
(0.31,
(1.74,
4.61)
4.24)
6.10)
4.66)
6.25)
9.85)
3.42)
1
26
11
24
3
65
5.26
5.45
2.04
4.46
11.54
4.06
1.42
2.08
2.21
1.97
1.34
2.07
8.44
5.95 *
2.10
5.14 *
19.57 *
4.47 *
(0.11,
(3.89,
(1.05,
(3.30,
(3.93,
(3.45,
46.97)
8.72)
3.76)
7.66)
57.18)
5.70)
State University Hospital Upstate Medical Center
Alfieris G
266
5
Brandt B
336
7
Parker F
263
7
Picone A
384
11
Ryan P
239
2
All Others
40
3
TOTAL
1528
35
1.88
2.08
2.66
2.86
0.84
7.50
2.29
2.76
2.21
2.42
2.38
1.84
2.05
2.32
1.55
2.14
2.50
2.73
1.04
8.33
2.24
(0.50,
(0.86,
(1.00,
(1.36,
(0.12,
(1.67,
(1.56,
3.62)
4.41)
5.16)
4.89)
3.74)
24.33)
3.12)
St. Vincents Hospital and Medical Center
#Acinapura A
19
Galdieri R
477
McGinn J
540
Tyras D
538
All Others
26
TOTAL
1600
16
Cases
No.
of Deaths
555
538
106
1199
13
19
4
36
2.34
3.53
3.77
3.00
2.70
1.99
2.78
2.39
1.97
4.03 *
3.08
2.85
(1.05,
(2.42,
(0.83,
(2.00,
3.37)
6.29)
7.90)
3.95)
United Health Services - Wilson Division
Cunningham J R
241
Wong K
375
Yousuf M
372
All Others
148
TOTAL
1136
2
9
15
5
31
0.83
2.40
4.03
3.38
2.73
2.21
2.41
3.16
2.29
2.60
0.85
2.27
2.90
3.35
2.39
(0.10,
(1.03,
(1.62,
(1.08,
(1.62,
3.08)
4.30)
4.79)
7.82)
3.39)
University Hospital at Stony Brook
Bilfinger T
498
#Hartman A
17
Krukenkamp I
322
#Levy M
273
Seifert F
618
All Others
190
TOTAL
1918
14
0
8
4
12
3
41
2.81
0.00
2.48
1.47
1.94
1.58
2.14
2.70
1.48
1.65
1.79
2.12
1.36
2.06
2.36
0.00
3.43
1.86
2.08
2.64
2.35
(1.29,
(0.00,
(1.48,
(0.50,
(1.07,
(0.53,
(1.69,
3.97)
33.10)
6.75)
4.76)
3.64)
7.72)
3.19)
University Hospital of Brooklyn
Anderson J
#Burack J
Chiavarelli M
#Cunningham J N
#Ketosugbo A
Piccone V
#Zisbrod Z
TOTAL
200
215
8
1
60
20
77
581
10
6
2
0
1
0
1
20
5.00
2.79
25.00
0.00
1.67
0.00
1.30
3.44
2.40
2.75
4.46
0.21
1.94
1.19
2.16
2.43
4.75
2.31
12.74
0.00
1.95
0.00
1.36
3.22
Weill Cornell - NY Presbyterian Hospital
#Altorki N
114
##Gold J
30
#Isom O
240
#Ko W
102
Krieger K
753
#Lang S
244
#Rosengart T
696
#Tortolani A
176
All Others
136
TOTAL
2491
3
0
5
3
10
10
19
4
2
56
2.63
0.00
2.08
2.94
1.33
4.10
2.73
2.27
1.47
2.25
2.21
1.57
1.87
4.48
2.34
3.18
2.93
3.27
3.89
2.77
2.70
0.00
2.53
1.49
1.29
2.93
2.12
1.58
0.86
1.85
Table 3 continued
Strong Memorial Hospital
Hicks G
Risher W
All Others
TOTAL
OMR
EMR
RAMR
95% CI
for RAMR
(2.27,
8.73)
(0.84,
5.02)
(1.43, 46.01)
(0.00, 100.00)
(0.03, 10.84)
(0.00, 35.17)
(0.02,
7.59)
(1.96,
4.97)
(0.54,
(0.00,
(0.82,
(0.30,
(0.62,
(1.40,
(1.27,
(0.43,
(0.10,
(1.40,
7.90)
17.74)
5.91)
4.36)
2.37)
5.39)
3.31)
4.05)
3.11)
2.40)
17
Cases
No.
of Deaths
Westchester Medical Center
Axelrod H
Fleisher A
Lafaro R
Moggio R
Pooley R
Sarabu M
All Others
TOTAL
407
519
376
407
403
481
154
2747
9
10
12
6
20
5
3
65
2.21
1.93
3.19
1.47
4.96
1.04
1.95
2.37
2.72
1.86
2.18
2.63
2.32
2.70
1.97
2.37
1.85
2.35
3.34
1.28
4.86 *
0.87 **
2.25
2.27
(0.84,
(1.13,
(1.72,
(0.47,
(2.96,
(0.28,
(0.45,
(1.75,
3.51)
4.32)
5.83)
2.78)
7.50)
2.04)
6.57)
2.90)
Winthrop - University Hospital
#Hartman A
Kofsky E
Mohtashemi M
Schubach S
Scott W
Sutaria M
Williams L
All Others
TOTAL
445
621
208
581
263
90
111
70
2389
4
9
3
9
3
3
3
1
35
0.90
1.45
1.44
1.55
1.14
3.33
2.70
1.43
1.47
3.02
2.57
2.43
2.21
2.06
4.48
3.32
3.85
2.64
0.68 **
1.28
1.35
1.59
1.26
1.69
1.85
0.84
1.26 **
(0.18,
(0.58,
(0.27,
(0.73,
(0.25,
(0.34,
(0.37,
(0.01,
(0.88,
1.73)
2.43)
3.94)
3.03)
3.67)
4.95)
5.41)
4.69)
1.75)
59112
1344
2.27
Table 3 continued
Statewide Total
OMR
EMR
RAMR
95% CI
for RAMR
* 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, 1996-1998
Cases
No.
of Deaths
95% CI
for RAMR
OMR
EMR
RAMR
Acinapura A
Maimonides
St. Vincents
396
377
19
11
10
1
2.78
2.65
5.26
2.13
2.17
1.42
2.96
2.78
8.44
(1.48, 5.30)
(1.33,
5.11)
(0.11, 46.97)
Altorki N
New York Hosp-Queens
Weill Cornell
120
6
114
3
0
3
2.50
0.00
2.63
2.18
1.59
2.21
2.61
0.00
2.70
(0.52, 7.62)
(0.00, 87.39)
(0.54,
7.90)
Banker M
Albany Med Ctr
Ellis Hospital
St. Peters Hospital
521
7
1
513
14
1
0
13
2.69
14.29
0.00
2.53
2.13
2.07
1.10
2.14
2.86
15.69
0.00
2.70
(1.56, 4.80)
(0.21, 87.29)
(0.00, 100.00)
(1.43,
4.61)
Bell-Thomson J
Erie County
Millard Fillmore
513
500
13
6
6
0
1.17
1.20
0.00
1.66
1.60
4.02
1.60
1.71
0.00
(0.59, 3.49)
(0.62,
3.72)
(0.00, 15.95)
Burack J
Maimonides
Univ Hosp-Brooklyn
217
2
215
6
0
6
2.76
0.00
2.79
2.76
4.01
2.75
2.27
0.00
2.31
(0.83, 4.95)
(0.00, 100.00)
(0.84,
5.02)
Camacho M
Montefiore Einstein
Montefiore Moses
222
2
220
7
0
7
3.15
0.00
3.18
2.81
0.88
2.82
2.55
0.00
2.56
(1.02, 5.26)
(0.00, 100.00)
(1.03,
5.28)
Colvin S
Bellevue
New York Hosp Ctr
163
28
135
8
4
4
4.91
14.29
2.96
2.45
3.16
2.30
4.56
10.29 *
2.93
(1.96, 8.98)
(2.77, 26.35)
(0.79,
7.50)
Cunningham J N
Maimonides
Univ Hosp-Brooklyn
354
353
1
16
16
0
4.52
4.53
0.00
2.78
2.78
0.21
3.70
3.70
0.00
(2.11, 6.01)
(2.11,
6.01)
(0.00, 100.00)
Edwards N
Columbia Presbyterian
St. Peters
450
164
286
8
5
3
1.78
3.05
1.05
1.89
2.57
1.50
2.14
2.70
1.60
(0.92,
(0.87,
(0.32,
Frymus M
Montefiore Einstein
Montefiore Moses
437
436
1
8
7
1
1.83
1.61
100.00
2.11
2.11
0.37
1.98
1.73
100.00 *
(0.85, 3.89)
(0.69,
3.56)
(8.12, 100.00)
Galloway A
Bellevue
NYU Hosp Ctr
286
38
248
9
2
7
3.15
5.26
2.82
2.60
1.62
2.76
2.75
7.36
2.33
(1.25, 5.21)
(0.83, 26.59)
(0.93,
4.80)
Glassman L
Bellevue
NYU Hosp Ctr
131
108
23
4
4
0
3.05
3.70
0.00
2.32
2.37
2.09
2.99
3.56
0.00
(0.81, 7.66)
(0.96,
9.11)
(0.00, 17.34)
4.22)
6.30)
4.66)
19
Table 4 continued
Cases
No.
of Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Gold J
Montefiore Einstein
Montefiore Moses
Weill Cornell
184
20
134
30
0
0
0
0
0.00
0.00
0.00
0.00
1.58
1.30
1.62
1.57
0.00
0.00
0.00
0.00
(0.00, 2.88)
(0.00, 32.07)
(0.00,
3.84)
(0.00, 17.74)
Hartman A
Univ Hosp Stony Brook
Winthrop Univ Hosp
462
17
445
4
0
4
0.87
0.00
0.90
2.97
1.48
3.02
0.66 **
0.00
0.68 **
(0.18, 1.70)
(0.00, 33.10)
(0.18,
1.73)
Isom O
New York Hosp-Queens
Weill Cornell
241
1
240
5
0
5
2.07
0.00
2.08
1.87
1.86
1.87
2.52
0.00
2.53
(0.81, 5.88)
(0.00, 100.00)
(0.82,
5.91)
1117
615
502
31
15
16
2.78
2.44
3.19
2.89
2.67
3.16
2.18
2.07
2.29
(1.48,
(1.16,
(1.31,
Joyce F
Albany Med Ctr
St. Elizabeth
258
122
136
3
2
1
1.16
1.64
0.74
1.21
1.24
1.18
2.19
2.99
1.42
(0.44, 6.39)
(0.34, 10.81)
(0.02,
7.91)
Ketosugbo A
Maimonides
Univ Hosp-Brooklyn
122
62
60
2
1
1
1.64
1.61
1.67
2.15
2.35
1.94
1.73
1.56
1.95
(0.19, 6.26)
(0.02,
8.68)
(0.03, 10.84)
Ko W
New York Hosp-Queens
Weill Cornell
312
210
102
10
7
3
3.21
3.33
2.94
2.52
1.57
4.48
2.89
4.84
1.49
(1.39,
(1.94,
(0.30,
5.32)
9.97)
4.36)
Lang S
New York Hosp-Queens
Weill Cornell
713
469
244
17
7
10
2.38
1.49
4.10
2.22
1.72
3.18
2.45
1.98
2.93
(1.42,
(0.79,
(1.40,
3.92)
4.07)
5.39)
Levy M
North Shore
Univ Hosp Stony Brook
526
253
273
14
10
4
2.66
3.95
1.47
2.04
2.32
1.79
2.96
3.88
1.86
(1.62,
(1.86,
(0.50,
4.97)
7.14)
4.76)
Ribakove G
Bellevue
NYU Hosp Ctr
287
60
227
5
1
4
1.74
1.67
1.76
2.26
1.10
2.57
1.75
3.44
1.56
(0.56, 4.09)
(0.04, 19.12)
(0.42,
3.99)
Rosengart T
New York Hosp-Queens
Weill Cornell
705
9
696
19
0
19
2.70
0.00
2.73
2.91
1.20
2.93
2.11
0.00
2.12
(1.27, 3.29)
(0.00, 77.08)
(1.27,
3.31)
Sabado M
Lenox Hill
Maimonides
217
165
52
13
8
5
5.99
4.85
9.62
3.20
3.33
2.79
4.26
3.31
7.84 *
(2.27, 7.28)
(1.43,
6.53)
(2.53, 18.30)
Jacobowitz I
Lenox Hill
Maimonides
20
3.10)
3.42)
3.72)
Table 4 continued
Cases
No.
of Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Sardella G
Albany Med Ctr
St. Peters
384
158
226
3
0
3
0.78
0.00
1.33
1.35
1.25
1.41
1.32
0.00
2.14
(0.27,
(0.00,
(0.43,
3.86)
4.21)
6.25)
Stelzer P
Beth Israel
Lenox Hill
298
281
17
6
5
1
2.01
1.78
5.88
2.52
2.57
1.73
1.82
1.58
7.74
(0.66, 3.96)
(0.51,
3.68)
(0.10, 43.06)
Tortolani A
North Shore
Weill Cornell
640
464
176
11
7
4
1.72
1.51
2.27
2.95
2.83
3.27
1.33
1.21
1.58
(0.66,
(0.49,
(0.43,
2.37)
2.50)
4.05)
Zisbrod Z
Maimonides
Univ Hosp-Brooklyn
577
500
77
11
10
1
1.91
2.00
1.30
2.28
2.30
2.16
1.90
1.97
1.36
(0.95,
(0.95,
(0.02,
3.40)
3.63)
7.59)
* 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.
21
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC SURGERY AND FOR ISOLATED
CABG SURGERY (1996-1998)
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 1996-1998
and/or performing one or more isolated CABG
operations in each of the years 1996- 1998,
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 1996-1998 was 71.85 percent
(59,112 CABG operations out of a total of 82,264
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, 1996-1998
Total
%
Cardiac
Isolated
Isolated
Surgery
CABGs
CABG
Albany Medical Center Hospital
Banker M
Britton L
Canavan T
Foster E
Joyce F
Kelley J
Luber J
Miller S
Sardella G
All Others
TOTAL
22
8
596
617
376
149
798
467
574
166
138
3889
7
413
519
239
122
593
329
460
158
105
2945
87.50
69.30
84.12
63.56
81.88
74.31
70.45
80.14
95.18
76.09
75.73
Arnot-Ogden Memorial Hospital
Quintos E
Vaughan J
All Others
TOTAL
313
108
18
439
266
89
14
369
84.98
82.41
77.78
84.05
Bellevue Hospital Center
Colvin S
Galloway A
Glassman L
Ribakove G
All Others
TOTAL
92
82
134
141
20
469
28
38
108
60
7
241
30.43
46.34
80.60
42.55
35.00
51.39
Table 5 continued
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
165
271
628
919
1983
129
237
281
671
1318
78.18
87.45
44.75
73.01
66.46
620
553
786
527
245
705
85.00
44.30
89.69
445
393
596
562
345
54
4354
396
379
569
432
269
4
3526
88.99
96.44
95.47
76.87
77.97
7.41
80.98
Columbia Presbyterian - NY Presbyterian Hospital
Edwards N
Michler R
Oz M
Rose E
Smith C
All Others
TOTAL
264
363
1104
546
1056
363
3696
164
206
646
311
617
46
1990
62.12
56.75
58.51
56.96
58.43
12.67
53.84
Ellis Hospital
Banker M
Depan H
McIlduff J
Reich H
Saifi J
All Others
TOTAL
1
626
431
329
626
3
2016
1
415
344
292
480
1
1533
100.00
66.29
79.81
88.75
76.68
33.33
76.04
602
179
781
500
157
657
83.06
87.71
84.12
Beth Israel Medical Center
Harris L
Hoffman D
Stelzer P
Tranbaugh R
TOTAL
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Lajos T
Levinsky L
Lewin A
Raza S
Salerno T
All Others
TOTAL
Erie County Medical Center
Bell-Thomson J
All Others
TOTAL
23
Table 5 continued
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Lenox Hill Hospital
Geller C
Jacobowitz I
McCabe J
Sabado M
151
771
165
271
127
615
117
165
84.11
79.77
70.91
60.89
Stelzer P
Subramanian V
TOTAL
46
1434
2838
17
1177
2218
36.96
82.08
78.15
Long Island Jewish Medical Center
Graver L
Kline G
Palazzo R
All Others
TOTAL
836
208
559
8
1611
600
175
453
0
1228
71.77
84.13
81.04
0.00
76.23
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
481
3
25
796
507
626
73
64
559
175
3309
377
2
20
649
353
502
62
52
500
157
2674
78.38
66.67
80.00
81.53
69.63
80.19
84.93
81.25
89.45
89.71
80.81
Millard Fillmore Hospital
Aldridge J
Ashraf M
Bell-Thomson J
Guarino R
Guiraudon G
Jennings L
Kerr P
Major W
TOTAL
478
541
16
494
94
524
393
166
2706
393
471
13
438
71
483
322
154
2345
82.22
87.06
81.25
88.66
75.53
92.18
81.93
92.77
86.66
24
Table 5 continued
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Montefiore Medical Center - Einstein Division
Camacho M
Frater R
Frymus M
Gold J
Sisto D
All Others
TOTAL
2
214
523
32
366
176
1313
2
98
436
20
253
127
936
100.00
45.79
83.37
62.50
69.13
72.16
71.29
Montefiore Medical Center - Moses Division
Attai L
Brodman R
Camacho M
Frymus M
Gold J
Merav A
All Others
TOTAL
419
446
286
1
197
336
39
1724
306
312
220
1
134
245
26
1244
73.03
69.96
76.92
100.00
68.02
72.92
66.67
72.16
Mount Sinai Hospital
Ergin M
Galla J
Griepp R
Lansman S
Nguyen K
All Others
TOTAL
733
504
380
622
145
302
2686
422
280
45
373
79
181
1380
57.57
55.56
11.84
59.97
54.48
59.93
51.38
7
1
265
587
11
871
6
1
210
469
9
695
85.71
100.00
79.25
79.90
81.82
79.79
New York Hospital - Queens
Altorki N
Isom O
Ko W
Lang S
Rosengart T
TOTAL
25
Table 5 continued
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
NYU Hospitals Center
Colvin S
Culliford A
Esposito R
Galloway A
Glassman L
Grossi E
Ribakove G
Spencer F
All Others
TOTAL
619
664
468
495
39
271
349
210
16
3131
135
374
329
248
23
143
227
89
15
1583
21.81
56.33
70.30
50.10
58.97
52.77
65.04
42.38
93.75
50.56
North Shore University Hospital
Hall M
Levy M
Pogo G
Tortolani A
Vatsia S
All Others
TOTAL
1217
338
830
548
372
35
3340
838
253
622
464
248
9
2434
68.86
74.85
74.94
84.67
66.67
25.71
72.87
Rochester General Hospital
Cheeran D
Fong J
Kirshner R
Knight P
Kwan S
TOTAL
1053
224
864
1179
583
3903
799
211
680
815
495
3000
75.88
94.20
78.70
69.13
84.91
76.86
St. Elizabeth Medical Center
Joyce F
All Others
TOTAL
172
250
422
136
187
323
79.07
74.80
76.54
1216
263
1155
308
1013
1145
1466
852
7418
903
207
573
231
759
805
1107
668
5253
74.26
78.71
49.61
75.00
74.93
70.31
75.51
78.40
70.81
St. Francis Hospital
Bercow N
Colangelo R
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
TOTAL
26
Table 5 continued
Total
Cardiac
Surgery
St. Josephs Hospital Health Center
Marvasti M
Nast E
Nazem A
Rosenberg J
TOTAL
Isolated
CABGs
%
Isolated
CABG
808
751
820
976
3355
583
618
688
642
2531
72.15
82.29
83.90
65.78
75.44
300
399
145
124
534
63
167
291
102
75
428
40
55.67
72.93
70.34
60.48
80.15
63.49
1565
1103
70.48
597
656
513
398
85.93
60.67
683
337
271
99
2643
505
286
226
69
1997
73.94
84.87
83.39
69.70
75.56
St. Vincents Hospital and Medical Center
Acinapura A
Galdieri R
McGinn J
Tyras D
All Others
TOTAL
21
608
705
667
36
2037
19
477
540
538
26
1600
90.48
78.45
76.60
80.66
72.22
78.55
State University Hospital Upstate Medical Center
Alfieris G
Brandt B
Parker F
Picone A
Ryan P
All Others
TOTAL
465
442
400
512
325
45
2189
266
336
263
384
239
40
1528
57.20
76.02
65.75
75.00
73.54
88.89
69.80
St. Lukes Roosevelt Hospital-St. Lukes Div.
Anagnostopoulos C
Aronis M
Connery C
Mindich B
Swistel D
All Others
TOTAL
St. Peters Hospital
Banker M
Bennett E
Dal Col R
Edwards N
Sardella G
All Others
TOTAL
27
Table 5 continued
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Strong Memorial Hospital
Hicks G
Risher W
All Others
TOTAL
835
915
156
1906
555
538
106
1199
66.47
58.80
67.95
62.91
United Health Services - Wilson Division
Cunningham J R
Wong K
Yousuf M
All Others
TOTAL
310
484
479
175
1448
241
375
372
148
1136
77.74
77.48
77.66
84.57
78.45
University Hospital at Stony Brook
Bilfinger T
Hartman A
Krukenkamp I
Levy M
Seifert F
All Others
TOTAL
592
26
391
321
805
213
2348
498
17
322
273
618
190
1918
84.12
65.38
82.35
85.05
76.77
89.20
81.69
348
261
17
5
68
29
98
826
200
215
8
1
60
20
77
581
57.47
82.38
47.06
20.00
88.24
68.97
78.57
70.34
135
58
586
209
1113
382
1019
221
349
4072
114
30
240
102
753
244
696
176
136
2491
84.44
51.72
40.96
48.80
67.65
63.87
68.30
79.64
38.97
61.17
University Hospital of Brooklyn
Anderson J
Burack J
Chiavarelli M
Cunningham J N
Ketosugbo A
Piccone V
Zisbrod Z
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
28
Table 5 continued
Total
Cardiac
Surgery
Isolated
CABGs
%
Isolated
CABG
Westchester Medical Center
Axelrod H
Fleisher A
Lafaro R
Moggio R
Pooley R
Sarabu M
All Others
TOTAL
500
677
547
565
511
703
185
3688
407
519
376
407
403
481
154
2747
81.40
76.66
68.74
72.04
78.86
68.42
83.24
74.48
Winthrop - University Hospital
Hartman A
Kofsky E
Mohtashemi M
Schubach S
Scott W
Sutaria M
Williams L
All Others
TOTAL
755
749
263
816
358
128
142
77
3288
445
621
208
581
263
90
111
70
2389
58.94
82.91
79.09
71.20
73.46
70.31
78.17
90.91
72.66
82264
59112
71.85
Statewide Total
29
Criteria Used in Reporting Significant Risk Factors (1998)
Based on Documentation in Medical Record
Patient Risk Factor
Definitions
Hemodynamic State
• Unstable
Determined just prior to surgery
Patient requires pharmacologic or mechanical support to
maintain blood pressure or output
Acute hypotension (systolic blood pressure <80 mmHg)
or low cardiac index (<2.0 liters/min/m2), despite
pharmacologic or mechanical support
• Shock
Comorbidities
• Diabetes Requiring Medication
• Malignant Ventricular Arrhythmia
• Hepatic Failure
• Chronic Obstructive
Pulmonary Disease
• Renal Failure, Dialysis
• Renal Failure,Creatinine>2.5
The patient is receiving either oral hypoglycemics or insulin
Recent (within the past 7 days) recurrent ventricular
tachycardia or ventricular fibrillation requiring electrical
defibrillation or the use of intravenous antiarrhythmic
agents. Excludes a single episode of VT or VF occurring
in the early phase of acute myocardial infarction and
responding well to treatment
The patient has cirrhosis or other liver disease and has a
bilirubin greater than 2 mg/dl and a serum albumin less
than 3.5 grams/dl.
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
The patient is on chronic peritoneal or hemodialysis
Pre-operative creatinine greater than 2.5 mg/dl.
Severity of Atherosclerotic Process
• Aortoiliac Disease
• Stroke
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
A history of stroke, with or without residual deficit
Ventricular Function
• 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
30
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.
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.
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
Columbia Presbyterian Medical
Center – NY Presbyterian
161 Fort Washington Avenue
New York, New York 10032
Ellis Hospital
1101 Nott Street
Schenectady, New York 12308
Erie County Medical Center
462 Grider Street
Buffalo, New York 14215
Lenox Hill Hospital
100 East 77th Street
New York, New York 10021
Long Island Jewish
Medical Center
270-05 76th Avenue
New Hyde Park, New York 11040
Maimonides Medical Center
4802 Tenth Avenue
Brooklyn, New York 11219
Millard Fillmore Hospital
3 Gates Circle
Buffalo, New York 14209
32
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. Luke’s Roosevelt
Hospital Center
11-11 Amsterdam Avenue at
114th Street
New York, New York 10025
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
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
35
State of New York
George E. Pataki, Governor
Department of Health
Antonia C. Novello, M.D., M.P.H., Dr.P.H., Commissioner
01/01