CORONARY
ARTERY
BYPASS
SURGERY
in
New York State
1997-1999
New York State Department of Health
September 2002
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
Members
Djavad T. Arani, M.D.
Clinical Professor of Medicine
SUNY at Buffalo School of Medicine
The Buffalo General Hospital, Buffalo, NY
Jan M. Quaegebeur, M.D., Ph.D.
Department of Surgery
Columbia-Presbyterian Medical Center
New York, NY
Edward V. Bennett, M.D.
Chief of Cardiac Surgery
St. Peter’s Hospital, Albany, NY
Eric A. Rose, M.D.
Professor, Chair and Surgeon-in-Chief,
Department of Surgery
Columbia-Presbyterian Medical Center
New York, 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
Michael H. Gewitz, M.D.
Director of Pediatrics
Westchester Medical Center
Valhalla, 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
Stanley Katz, M.D.
Chief, Division of Cardiology
North Shore - LIJ Health System
Manhasset, NY
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
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
Consultant
Edward L. Hannan, Ph.D.
Professor & Chair
Department of Health Policy,
Management & Behavior
University at Albany School of Public Health
Administrator
Donna R. Doran
Cardiac Services Program
NYS Department of Health
Cardiac Surgery Reporting System Analysis Workgroup
Members
Thomas J. Ryan, M.D. (Chair)
Professor of Medicine
Boston University Medical Center
Robert Jones, M.D.
Mary & Deryl Hart Professor of Surgery
Duke University Medical Center
Edward V. Bennett, M.D.
Chief of Cardiac Surgery
St. Peter's Hospital
Barbara J. McNeil, M.D., Ph. D.
Head, Department of Health Care Policy
Harvard Medical School
Alfred T. Culliford, M.D.
Professor of Clinical Surgery
NYU Medical Center
Alvin Mushlin, M.D., Sc.M.
Professor & Chair
Department of Public Health
Weill Medical College of Cornell University
Jeffrey P. Gold, M.D.
Chairman, Cardiac & Thoracic Surgery
Montefiore Medical Center
Alan Hartman, M.D.
Department of Cardiovascular Surgery
Winthrop University Hospital
O. Wayne Isom, M.D.
Professor & Chairman
Department of Cardiothoracic Surgery
Weill – Cornell Medical Center
Eric Rose, M.D.
Professor, Chair & Surgeon-in-Chief
Department of Surgery
Columbia Presbyterian Medical Center
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
Casey S. Roark, M.P.H.
Cardiac Databases Coordinator
Cardiac Services Program
Rosemary Lombardo
CSRS Coordinator
Cardiac Services Program
Edward Hannan, Ph.D.
Professor & Chair
Department of Health Policy,
Management & Behavior
University at Albany School of Public Health
Michael Racz, M.A.
Research Scientist
Department of Health Policy,
Management & Behavior
University at Albany School of Public Health
TABLE OF CONTENTS
INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CORONARY ARTERY BYPASS GRAFT SURGERY (CABG) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
THE HEALTH DEPARTMENT PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
PATIENT POPULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
RISK ADJUSTMENT FOR ASSESSING PROVIDER PERFORMANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Data Collection, Data Validation and Identifying In-Hospital Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Assessing Patient Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Predicting Patient Mortality Rates for Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Computing the Risk-Adjusted Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Interpreting the Risk-Adjusted Mortality Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
How This Contributes to Quality Improvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
RESULTS
...............................................................................6
1999 Risk Factors for CABG Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Table 1
Multivariable Risk Factor Equation for CABG Hospital
Deaths in New York State in 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1999 HOSPITAL OUTCOMES FOR CABG SURGERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Table 2
Hospital Observed, Expected and Risk-Adjusted Mortality
Rates (RAMR) for CABG Surgery in New York State, 1999 Discharges . . . . . . . . . . . . . . . . . . . . . . . 9
Figure 1
Risk-Adjusted Mortality Rates for CABG in
New York State, 1999 Discharges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1997-1999 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,
1997-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Table 4
Summary Information for Surgeons Practicing at More
Than One Hospital, 1997-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC
SURGERY AND FOR ISOLATED CABG SURGERY (1997-1999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Table 5
Total Cardiac Surgery and Isolated CABG Surgery
Volumes by Hospital and Surgeon, 1997-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
CRITERIA USED IN REPORTING SIGNIFICANT RISK FACTORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
MEDICAL TERMINOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
NYS CARDIAC SURGERY CENTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
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 1999. 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 coronary interventions (PCI).
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.
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.
3
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 1999 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, 1997 and December 31, 1999 are included
in the three-year results.
Isolated CABG surgery represented 70.24 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 1997 through
1999.
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 characteristics (called risk
factors) are collected for each patient. Along with
information about the procedure, physician and the
patient’s status at discharge, these data are entered into
a computer, and sent to the Department of Health for
analysis.
Data are verified through review of unusual reporting
frequencies, cross-matching of cardiac surgery data
with other Department of Health databases and a
review of medical records for a selected sample of
cases. These activities are extremely helpful in ensuring
4
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 factors 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 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 (2.25% in 1999) 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 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 risk-adjusted
rate may not be reflective of quality of care. The
Department of Health monitors the quality of coded
data by reviewing patients’ medical records to ascertain
the presence of key risk factors. When significant
coding problems have been discovered, hospitals have
been required to recode these data and have been
subjected to subsequent monitoring.
A final reason that risk-adjusted rates may be
misleading is that overall preprocedural severity
of illness may not be accurately estimated because
important risk factors are missing. This is not
considered to be an important factor, however, because
the New York State data system contains virtually
every risk factor that has ever been demonstrated
to be related to patient mortality in national and
international studies.
Although there are reasons that risk-adjusted mortality
rates presented here may not be a perfect reflection of
quality of care, the Department of Health feels that
5
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. Committee
members assist with interpretation and advise the
Department of Health regarding which hospitals
and surgeons may need special attention. Committee
members have also conducted site visits to particular
hospitals, and have recommended that some hospitals
obtain the expertise of outside consultants to design
improvements for their programs.
The overall results of this program of ongoing review
in CABG surgery show that significant progress is
being made. In response to the program’s results for
CABG surgery, facilities have refined patient criteria,
evaluated patients more closely for preoperative risks
and directed them to the appropriate surgeon. More
importantly, many hospitals have identified medical
care process problems that have led to less than
optimal outcomes, and have altered those processes to
achieve improved results.
RESULTS
1999 Risk Factors for CABG Surgery
The significant preoperative risk factors for coronary
artery bypass surgery in 1999 are presented in Table 1.
Roughly speaking, the odds ratio for a risk factor
represents the number of times more likely a patient
with that risk factor is of dying in the hospital during
or after CABG surgery than a patient without the
risk factor, all other risk factors being the same. For
example, the odds ratio for the risk factor diabetes is
1.522. This means that a patient who had diabetes
prior to surgery is approximately 1.522 times as likely
to die in the hospital as a patient who did not have
diabetes but who has the same other significant risk
factors.
For most of the risk factors in the table, there are only
two possibilities: having the risk factor or not having
it (for example, a patient either has had diabetes or has
not had diabetes). Exceptions are age 55 years and,
6
ejection fraction (which is a measure of the heart’s
ability to pump blood).
For age, the odds ratio roughly represents the number
of times more likely a patient who is older than 55 is
to die in the hospital than a patient who is one year
younger. Thus, a patient undergoing CABG Surgery
who is 72 years old has a chance of dying that is
approximately 1.053 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 2.071
times the odds of a person with an ejection fraction of
40% or higher, all other risk factors being the same.
Table 1: Multivariable risk factor equation for CABG hospital deaths in New York State in 1999.
Logistic Regression
Patient Risk Factor
Prevalence (%)
Coefficient
P-Value
Odds Ratio
…
28.54
0.0513
0.5333
<.0001
<.0001
1.053
1.705
1.25
0.43
0.20
1.0654
2.1982
2.2085
<.0001
<.0001
<.0001
2.902
9.009
9.102
31.73
0.4199
<.0001
1.522
5.55
0.14
1.27
0.7242
2.2622
2.0061
<.0001
<.0001
<.0001
2.063
9.605
7.435
14.40
4.89
0.4543
0.6444
0.0002
<.0001
1.575
1.905
1.84
20.74
1.74
15.81
36.94
0.7278
0.4272
1.0792
0.8621
0.3739
0.0039
0.0003
<.0001
<.0001
0.0045
2.071
1.533
2.942
2.368
1.453
5.82
1.0936
<.0001
2.985
Demographic
Age > 55 years of age
Female Gender
Hemodynamic State
Unstable
Shock
CPR
Comorbidities
Diabetes
Extensively Calcified Aorta
Hepatic Failure
Renal Failure requiring Dialysis
Severity of Atherosclerotic Process
Carotid/Cerebrovascular Disease
Aortoiliac Disease
Ventricular Function
Ejection Fraction < 20
Ejection Fraction 20-39
Previous MI < 24 hours
Previous MI 1-7 days
Previous MI > 7 days
Previous Open Heart Operations
Intercept
C Statistic
= -5.8622
= 0.793
7
1999 HOSPITAL OUTCOMES FOR CABG SURGERY
Table 2 and Figure 1 present the 1999 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 1999 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 18,116 CABG operations performed at the
33 hospitals was 2.24%. Observed mortality rates
ranged from 0.50% to 7.75%. The range in expected
mortality rates, which measure patient severity of
illness, was 1.52% to 3.11%.
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 0.68% to 7.00%.
One hospital, University Hospital of Brooklyn, had
a risk-adjusted mortality rate that was significantly
higher than the statewide rate. Two hospitals,
St. Francis Hospital and St. Peter's Hospital had
significantly lower risk-adjusted rates than the
statewide average.
Table 2: Observed, Expected, and Risk-Adjusted Mortality Rates (RAMR) for CABG Surgery in New York State, 1999
Discharges (Listed Alphabetically by Hospital)
Hospital
Cases
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Albany Medical Center
Arnot-Ogden
Bellevue
Beth Israel
Buffalo General
Columbia Presbyterian
Ellis Hospital
Erie County
LIJ Medical Center
Lenox Hill
759
88
80
381
1042
553
452
106
375
612
16
3
2
9
32
13
9
3
3
14
2.11
3.41
2.50
2.36
3.07
2.35
1.99
2.83
0.80
2.29
1.69
1.52
1.86
2.15
2.17
1.91
1.99
1.56
1.83
2.15
2.79
5.03
3.01
2.47
3.16
2.76
2.25
4.06
0.98
2.38
(1.59, 4.53)
(1.01, 14.69)
(0.34, 10.85)
(1.13, 4.68)
(2.16, 4.47)
(1.47, 4.72)
(1.03, 4.27)
(0.82,11.86)
(0.20, 2.86)
(1.30, 4.00)
Maimonides
Millard Fillmore
Montefiore - Einstein
Montefiore - Moses
Mount Sinai
NY Hospital - Queens
NYU Hospitals Center
North Shore
Rochester General
St. Elizabeth
St. Francis
St. Josephs
St. Lukes-Roosevelt
St. Peters
St. Vincents
Strong Memorial
United Health Services
Univ Hosp-Stony Brook
Univ. Hosp. - Upstate
Univ. Hosp. of Brooklyn
Weill Cornell-NYP
Westchester Med. Ctr.
Winthrop Univ. Hosp.
930
748
278
376
410
280
366
816
874
352
1804
724
245
605
545
329
320
719
473
284
704
816
670
34
19
9
4
7
3
10
11
16
4
23
10
7
3
20
13
9
13
8
22
14
29
14
3.66
2.54
3.24
1.06
1.71
1.07
2.73
1.35
1.83
1.14
1.27
1.38
2.86
0.50
3.67
3.95
2.81
1.81
1.69
7.75
1.99
3.55
2.09
3.11
1.89
1.91
2.11
2.36
1.87
3.02
1.84
2.79
1.69
2.22
2.35
2.75
1.64
2.52
2.13
2.43
2.01
2.30
2.48
2.64
2.57
2.46
2.64
3.01
3.80
1.13
1.62
1.28
2.03
1.65
1.47
1.51
1.29 **
1.32
2.33
0.68 **
3.27
4.16
2.59
2.02
1.64
7.00 *
1.69
3.10
1.91
(1.83, 3.69)
(1.81, 4.70)
(1.74, 7.22)
(0.30, 2.90)
(0.65, 3.34)
(0.26, 3.75)
(0.97, 3.73)
(0.82, 2.94)
(0.84, 2.38)
(0.41, 3.87)
(0.81, 1.93)
(0.63, 2.42)
(0.93, 4.80)
(0.14, 1.98)
(1.99, 5.05)
(2.21, 7.11)
(1.18, 4.92)
(1.07, 3.45)
(0.71, 3.24)
(4.39,10.60)
(0.92, 2.83)
(2.08, 4.46)
(1.04, 3.20)
406
2.24
Total
18116
* 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, 1999 Discharges (Listed Alphabetically by Hospital)
10
1997-1999 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 1997-99 for each of the 33 hospitals
performing CABG surgery during the time period.
during the period 1997-1999 are noted in the table
and are listed in all hospitals in which they performed
CABG operations.
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.
This hospital information is presented for each
surgeon (a) who performed 200 or more isolated
CABG operations during 1997-1999, and/or (b)
who performed at least one isolated CABG operation
in each of the years 1997-1999.
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 met the above criteria and
who performed operations in more than one hospital
Table 3: Surgeon Observed, Expected, and Risk-Adjusted Mortality Rates (RAMR) for Coronary Artery Bypass Grafts in
New York State, 1997-1999 Discharges
Cases
No of
Deaths
OMR
EMR
Albany Medical Center Hospital
Britton L
Canavan T
#Joyce F
Kelley J
Miller S
#Sardella G
All Others
TOTAL
362
480
82
577
434
106
527
2568
3
2
2
19
7
0
12
45
0.83
0.42
2.44
3.29
1.61
0.00
2.28
1.75
1.55
1.58
1.34
1.59
1.84
1.27
1.69
1.63
1.18
0.58**
4.02
4.56*
1.94
0.00
2.96
2.38
(0.24, 3.44)
(0.07, 2.10)
(0.45, 14.53)
(2.75, 7.13)
(0.78, 3.99)
(0.00, 6.00)
(1.53, 5.18)
(1.73, 3.18)
Arnot-Ogden Memorial Hospital
#Quintos E
All Others
TOTAL
222
100
322
12
0
12
5.41
0.00
3.73
1.92
1.79
1.88
6.22*
0.00
4.38*
(3.21, 10.86)
(0.00, 4.53)
(2.26, 7.65)
RAMR
95% CI
for RAMR
11
Table 3 continued:
No of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Bellevue Hospital Center
#Colvin S
#Galloway A
#Glassman L
#Ribakove G
All Others
TOTAL
14
23
89
57
44
227
0
1
3
3
0
7
0.00
4.35
3.37
5.26
0.00
3.08
2.82
0.98
1.72
1.60
1.36
1.61
0.00
9.79
4.32
7.27
0.00
4.22
(0.00, 20.47)
(0.13, 54.48)
(0.87, 12.63)
(1.46, 21.25)
(0.00, 13.53)
(1.69, 8.69)
Beth Israel Medical Center
##Geller C
Harris L
Hoffman D
#Stelzer P
11
204
272
206
0
3
6
6
0.00
1.47
2.21
2.91
1.64
1.90
1.96
2.33
0.00
1.70
2.48
2.76
(0.00, 44.93)
(0.34, 4.98)
(0.90, 5.39)
(1.01, 6.00)
578
1271
8
23
1.38
1.81
2.46
2.23
1.24
1.79
(0.54, 2.45)
(1.13, 2.68)
549
221
679
2
2
351
413
503
366
207
48
3341
19
5
11
0
0
14
9
13
17
8
3
99
3.46
2.26
1.62
0.00
0.00
3.99
2.18
2.58
4.64
3.86
6.25
2.96
2.51
2.10
1.93
0.94
1.67
2.28
1.72
1.60
1.84
3.57
3.54
2.11
3.04
2.37
1.85
0.00
0.00
3.86
2.79
3.56
5.56*
2.39
3.90
3.09*
(1.83, 4.75)
(0.77, 5.54)
(0.92, 3.31)
(0.00, 100.0)
(0.00, 100.0)
(2.11, 6.48)
(1.27, 5.30)
(1.89, 6.08)
(3.24, 8.91)
(1.03, 4.70)
(0.78, 11.38)
(2.51, 3.77)
Columbia Presbyterian - NY Presbyterian Hospital
#Edwards N
270
8
Oz M
644
13
Rose E
223
3
Smith C
564
7
All Others
153
7
TOTAL
1854
38
2.96
2.02
1.35
1.24
4.58
2.05
2.28
2.00
1.54
1.70
2.35
1.92
2.87
2.22
1.92
1.61
4.29
2.35
(1.24, 5.65)
(1.18, 3.80)
(0.39, 5.62)
(0.64, 3.32)
(1.72, 8.84)
(1.66, 3.23)
Tranbaugh R
TOTAL
Buffalo General Hospital
#Bergsland J
Bhayana J
Grosner G
##Guarino R
##Kerr P
Lajos T
Levinsky L
Lewin A
#Raza S
Salerno T
All Others
TOTAL
12
Cases
Cases
No of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
1
384
393
480
179
1437
0
8
5
5
2
20
0.00
2.08
1.27
1.04
1.12
1.39
0.41
1.55
1.57
1.80
1.42
1.62
0.00
2.96
1.79
1.28
1.73
1.89
(0.00, 100.0)
(1.27, 5.83)
(0.58, 4.18)
(0.41, 2.98)
(0.19, 6.26)
(1.15, 2.92)
241
153
4
1
3
3
0
0
1.24
1.96
0.00
0.00
1.42
1.22
1.07
4.72
1.93
3.53
0.00
0.00
(0.39, 5.65)
(0.71, 10.32)
(0.00, 100.0)
(0.00, 100.0)
105
504
2
8
1.90
1.59
1.64
1.41
2.57
2.48
(0.29, 9.26)
(1.07, 4.90)
233
72
47
360
52
146
1044
16
1970
5
3
2
10
2
7
35
0
64
2.15
4.17
4.26
2.78
3.85
4.79
3.35
0.00
3.25
2.12
1.68
2.12
2.54
1.34
3.18
2.58
1.25
2.47
2.23
5.48
4.42
2.41
6.34
3.33
2.87
0.00
2.90*
(0.72, 5.21)
(1.10, 16.02)
(0.50, 15.96)
(1.16, 4.44)
(0.71, 22.90)
(1.33, 6.86)
(2.00, 3.99)
(0.00, 40.58)
(2.23, 3.70)
Long Island Jewish Medical Center
Graver L
619
Kline G
119
Palazzo R
458
TOTAL
1196
15
5
4
24
2.42
4.20
0.87
2.01
2.07
1.14
1.66
1.82
2.58
8.15*
1.16
2.43
(1.45, 4.26)
(2.63, 19.03)
(0.31, 2.97)
(1.56, 3.62)
Maimonides Medical Center
#Acinapura A
#Anderson J
#Connolly M
#Cunningham J N
8
0
9
18
2.11
0.00
1.80
5.90
2.20
2.76
2.31
2.81
2.11
0.00
1.72
4.63*
(0.91, 4.15)
(0.00, 73.12)
(0.79, 3.27)
(2.74, 7.32)
Table 3 continued:
Ellis Hospital
#Dal Col R
Depan H
Reich H
Saifi J
All Others
TOTAL
Erie County Medical Center
Bell-Thomson J
Datta S
##Guarino R
##Kerr P
All Others
TOTAL
Lenox Hill Hospital
#Connolly M
##Geller C
#Genovesi M
##Jacobowitz I
McCabe J
##Sabado M
Subramanian V
All Others
TOTAL
380
4
500
305
13
No of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Maimonides Medical Center continued:
#Genovesi M
119
##Jacobowitz I
645
#Ketosugbo A
30
##Sabado M
46
#Zisbrod Z
640
All Others
114
TOTAL
2783
5
19
1
3
15
8
86
4.20
2.95
3.33
6.52
2.34
7.02
3.09
2.89
3.12
2.34
3.10
2.50
3.29
2.66
3.21
2.08
3.14
4.64
2.07
4.70
2.56
(1.03, 7.49)
(1.25, 3.25)
(0.04, 17.50)
(0.93, 13.56)
(1.16, 3.41)
(2.02, 9.26)
(2.05, 3.16)
Millard Fillmore Hospital
Aldridge J
Ashraf M
#Bergsland J
336
633
5
7
11
0
2.08
1.74
0.00
1.86
1.99
4.83
2.47
1.92
0.00
(0.99, 5.09)
(0.96, 3.44)
(0.00, 33.51)
473
413
219
1
140
2220
8
7
9
0
6
48
1.69
1.69
4.11
0.00
4.29
2.16
1.60
1.81
2.20
1.89
1.99
1.88
2.34
2.06
4.12
0.00
4.74
2.54
(1.01, 4.60)
(0.83, 4.25)
(1.88, 7.82)
(0.00, 100.0)
(1.73, 10.32)
(1.87, 3.36)
Montefiore Medical Center - Einstein Division
#Brodman R
1
#Camacho M
1
#Crooke G
2
Frater R
87
#Frymus M
414
#Gold J
34
##Tortolani A
63
All Others
291
TOTAL
893
0
0
0
1
11
0
2
5
19
0.00
0.00
0.00
1.15
2.66
0.00
3.17
1.72
2.13
0.78
0.80
1.41
2.52
1.99
1.55
1.82
2.22
2.08
0.00
0.00
0.00
1.01
2.94
0.00
3.85
1.71
2.25
(0.00, 100.0)
(0.00, 100.0)
(0.00, 100.0)
(0.01, 5.61)
(1.46, 5.26)
(0.00, 15.34)
(0.43, 13.89)
(0.55, 3.99)
(1.35, 3.51)
Montefiore Medical Center - Moses Division
Attai L
317
#Brodman R
293
#Camacho M
201
#Crooke G
23
#Frymus M
1
#Gold J
152
Merav A
245
All Others
10
TOTAL
1242
5
3
3
0
1
0
6
0
18
1.58
1.02
1.49
0.00
100.00
0.00
2.45
0.00
1.45
2.24
2.21
2.91
2.06
0.56
1.72
2.27
1.36
2.27
1.56
1.02
1.13
0.00
100.00*
0.00
2.38
0.00
1.41
(0.50, 3.63)
(0.21, 2.99)
(0.23, 3.30)
(0.00, 17.04)
(5.11, 100.0)
(0.00, 3.09)
(0.87, 5.18)
(0.00,59.54)
(0.83, 2.23)
Table 3 continued:
##Guarino R
Jennings L
##Kerr P
#Raza S
All Others
TOTAL
14
Cases
Cases
No of
Deaths
OMR
EMR
RAMR
342
242
28
320
241
91
32
1296
6
8
0
18
9
3
0
44
1.75
3.31
0.00
5.63
3.73
3.30
0.00
3.40
2.14
2.62
2.19
3.18
2.36
3.04
2.72
2.61
1.81
2.78
0.00
3.89*
3.49
2.39
0.00
2.87
(0.66, 3.93)
(1.20, 5.49)
(0.00, 13.19)
(2.31, 6.15)
(1.59, 6.62)
(0.48, 6.99)
(0.00, 9.29)
(2.09, 3.85)
0
0
0.00
0.00
1.30
2.36
0.00
0.00
(0.00,100.0)
(0.00, 8.34)
2
329
498
6
881
0
8
8
0
16
0.00
2.43
1.61
0.00
1.82
5.54
1.55
1.80
0.85
1.73
0.00
3.46
1.97
0.00
2.31
(0.00,72.93)
(1.49, 6.81)
(0.85, 3.88)
(0.00,100.0)
(1.32, 3.75)
New York University Medical Center
#Colvin S
98
Culliford A
343
Esposito R
313
#Galloway A
225
#Glassman L
8
Grossi E
98
#Ribakove G
214
All Others
65
TOTAL
1364
4
10
8
5
0
4
4
2
37
4.08
2.92
2.56
2.22
0.00
4.08
1.87
3.08
2.71
2.20
2.25
2.15
2.68
2.05
3.72
2.84
4.27
2.59
4.09
2.86
2.62
1.83
0.00
2.42
1.45
1.59
2.31
(1.10,10.46)
(1.37, 5.26)
(1.13, 5.16)
(0.59, 4.27)
(0.00,49.42)
(0.65, 6.20)
(0.39, 3.71)
(0.18, 5.74)
(1.63, 3.19)
North Shore University Hospital
Hall M
#Levy M
Pogo G
##Tortolani A
Vatsia S
All Others
TOTAL
12
15
10
2
6
0
45
1.54
3.34
1.43
1.09
1.95
0.00
1.86
2.27
2.15
2.58
2.98
2.11
11.69
2.38
1.50
3.43
1.22
0.81
2.04
0.00
1.72
(0.77, 2.61)
(1.92, 5.65)
(0.59, 2.25)
(0.09, 2.91)
(0.74, 4.44)
(0.00,34.59)
(1.26, 2.31)
Table 3 continued:
Mount Sinai Hospital
Ergin M
Galla J
Griepp R
Lansman S
McCollough J
Nguyen K
All Others
TOTAL
New York Hospital - Queens
#Altorki N
#Aronis M
#Isom O
#Ko W
##Lang S
#Rosengart T
TOTAL
5
41
779
449
698
183
308
2
2419
95% CI
for RAMR
15
Cases
No of
Deaths
OMR
EMR
801
203
647
738
478
2867
11
7
14
16
7
55
1.37
3.45
2.16
2.17
1.46
1.92
2.21
2.63
3.05
2.73
2.59
2.63
1.37
(0.68, 2.46)
2.89
(1.16, 5.96)
1.56
(0.85, 2.62)
1.75
(1.00, 2.84)
1.25
(0.50, 2.57)
1.61** (1.21, 2.10)
292
266
117
675
3
2
1
6
1.03
0.75
0.85
0.89
1.48
1.37
1.29
1.41
1.53
1.21
1.46
1.39
891
458
537
190
766
826
1043
532
5243
16
9
4
3
15
16
10
5
78
1.80
1.97
0.74
1.58
1.96
1.94
0.96
0.94
1.49
2.16
2.34
1.47
3.06
2.52
1.76
2.13
2.07
2.11
1.83
(1.05, 2.98)
1.85
(0.85, 3.52)
1.12
(0.30, 2.86)
1.14
(0.23, 3.32)
1.71
(0.96, 2.82)
2.42
(1.39, 3.94)
0.99** (0.47, 1.82)
1.00
(0.32, 2.34)
1.55** (1.23, 1.94)
St. Joseph’s Hospital Health Center
Marvasti M
568
Nast E
578
Nazem A
660
Rosenberg J
637
TOTAL
2443
2
5
3
11
21
0.35
0.87
0.45
1.73
0.86
1.95
2.31
2.44
2.49
2.31
0.40** (0.04, 1.43)
0.82** (0.27, 1.92)
0.41** (0.08, 1.20)
1.53
(0.76, 2.73)
0.82** (0.51, 1.25)
St. Luke’s Roosevelt Hospital - St. Luke’s Div.
#Aronis M
142
Connery C
81
##Geller C
24
Mindich B
54
#Stelzer P
5
Swistel D
469
All Others
143
TOTAL
918
4
4
1
1
0
13
7
30
2.82
4.94
4.17
1.85
0.00
2.77
4.90
3.27
2.05
2.61
2.68
2.17
5.35
3.26
2.58
2.84
3.03
4.16
3.43
1.88
0.00
1.88
4.18
2.54
Table 3 continued:
Rochester General Hospital
Cheeran D
Fong J
Kirshner R
Knight P
Kwan S
TOTAL
St. Elizabeth Hospital
Hatton P
#Joyce F
All Others
TOTAL
St. Francis Hospital
Bercow N
Colangelo R
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
TOTAL
16
RAMR
95% CI
for RAMR
(0.31, 4.46)
(0.14, 4.37)
(0.02, 8.11)
(0.51, 3.04)
(0.81, 7.75)
(1.12, 10.66)
(0.04, 19.10)
(0.02, 10.45)
(0.00, 30.25)
(1.00, 3.21)
(1.67, 8.61)
(1.71, 3.62)
Cases
No of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
496
362
472
118
391
22
1861
13
3
5
1
4
1
27
2.62
0.83
1.06
0.85
1.02
4.55
1.45
1.95
1.56
1.23
1.62
1.52
4.24
1.61
2.96
1.17
1.90
1.15
1.48
2.37
1.99
(1.57, 5.06)
(0.24, 3.42)
(0.61, 4.44)
(0.02, 6.40)
(0.40, 3.79)
(0.03, 13.16)
(1.31, 2.89)
St. Vincent’s Hospital and Medical Center
#Acinapura A
1
Galdieri R
437
##Lang S
91
0
21
4
0.00
4.81
4.40
0.55
1.80
3.00
0.00
5.88*
3.23
(0.00, 100.0)
(3.64, 8.99)
(0.87, 8.28)
15
18
4
62
2.72
3.83
5.56
3.82
2.33
1.85
1.61
2.05
2.57
4.56*
7.59
4.10*
(1.44, 4.24)
(2.70, 7.20)
(2.04, 19.43)
(3.14, 5.25)
State University Hospital Upstate Medical Center
Alfieris G
244
Brandt B
410
Parker F
232
Picone A
387
All Others
234
TOTAL
1507
6
4
6
10
5
31
2.46
0.98
2.59
2.58
2.14
2.06
2.67
2.29
2.55
2.30
2.22
2.38
2.03
0.94
2.24
2.48
2.12
1.90
(0.74, 4.42)
(0.25, 2.40)
(0.82, 4.87)
(1.19, 4.55)
(0.68, 4.95)
(1.29, 2.70)
Strong Memorial Hospital
Hicks G
Risher W
Snider J
TOTAL
468
466
146
1080
14
11
6
31
2.99
2.36
4.11
2.87
2.42
2.02
2.41
2.24
2.73
2.58
3.75
2.82
(1.49, 4.58)
(1.29, 4.61)
(1.37, 8.17)
(1.92, 4.00)
United Health Services - Wilson Division
McLoughlin D
196
#Quintos E
57
Wong K
352
Yousuf M
333
All Others
109
TOTAL
1047
10
1
5
13
0
29
5.10
1.75
1.42
3.90
0.00
2.77
2.23
2.83
2.36
2.94
2.18
2.53
5.05*
1.37
1.32
2.92
0.00
2.41
(2.42, 9.29)
(0.02, 7.60)
(0.43, 3.09)
(1.56, 5.00)
(0.00, 3.40)
(1.62, 3.47)
Table 3 continued:
St. Peter’s Hospital
Banker M
Bennett E
#Dal Col R
#Edwards N
#Sardella G
All Others
TOTAL
McGinn J
Tyras D
All Others
TOTAL
552
470
72
1623
17
No of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
University Hospital at Stony Brook
Bilfinger T
454
Krukenkamp I
475
#Levy M
83
McLarty A
263
Seifert F
725
All Others
139
TOTAL
2139
11
12
1
4
12
3
43
2.42
2.53
1.20
1.52
1.66
2.16
2.01
2.71
1.76
2.00
1.44
1.87
1.67
1.96
1.97
3.17
1.33
2.33
1.95
2.85
2.26
(0.98, 3.53)
(1.63, 5.53)
(0.02, 7.40)
(0.63, 5.97)
(1.01, 3.41)
(0.57, 8.33)
(1.63, 3.04)
University Hospital of Brooklyn
#Anderson J
Burack J
#Cunningham J N
160
194
1
11
3
0
6.88
1.55
0.00
2.15
2.55
0.28
7.04*
1.34
0.00
(3.51, 12.60)
(0.27, 3.91)
(0.00, 100.0)
35
98
17
23
2
118
648
3
3
1
3
0
10
34
8.57
3.06
5.88
13.04
0.00
8.47
5.25
1.90
1.64
1.68
1.94
0.83
2.24
2.17
9.96
4.12
7.72
14.85*
0.00
8.33*
5.33*
(2.00, 29.09)
(0.83, 12.04)
(0.10, 42.93)
(2.98, 43.38)
(0.00, 100.0)
(3.99,15.31)
(3.69, 7.45)
Weill Cornell - NY Presbyterian Hospital
#Altorki N
92
Girardi L
338
#Isom O
207
#Ko W
95
Krieger K
707
##Lang S
102
#Rosengart T
632
##Tortolani A
224
TOTAL
2397
3
5
3
2
10
8
19
5
55
3.26
1.48
1.45
2.11
1.41
7.84
3.01
2.23
2.29
2.38
3.14
1.49
3.73
2.31
2.63
2.87
2.90
2.63
3.02
1.04
2.14
1.24
1.35
6.58*
2.31
1.70
1.92
(0.61, 8.81)
(0.33, 2.42)
(0.43, 6.26)
(0.14, 4.49)
(0.65, 2.48)
(2.83,12.96)
(1.39, 3.61)
(0.55, 3.97)
(1.45, 2.50)
Westchester Medical Center
Axelrod H
Fleisher A
Lafaro R
Moggio R
Pooley R
Sarabu M
Zias E
TOTAL
10
10
13
8
16
5
10
72
2.43
2.11
4.00
2.04
6.23
1.06
3.24
2.73
2.64
1.93
2.23
2.62
2.18
2.59
1.99
2.33
2.03
2.41
3.95
1.72
6.29*
0.90**
3.59
2.58
(0.97, 3.74)
(1.15, 4.43)
(2.10, 6.75)
(0.74, 3.39)
(3.59,10.22)
(0.29, 2.11)
(1.72, 6.61)
(2.02, 3.25)
Table 3 continued:
##Jacobowitz I
#Ketosugbo A
Piccone V
##Sabado M
#Zisbrod Z
All Others
TOTAL
18
Cases
411
474
325
392
257
471
309
2639
Table 3 continued:
Winthrop - University Hospital
Hartman A
Kofsky E
Mohtashemi M
Schubach S
Scott W
Williams L
All Others
TOTAL
Statewide Total
Cases
No of
Deaths
OMR
EMR
427
621
153
595
234
83
162
2275
3
12
3
8
4
0
3
33
0.70
1.93
1.96
1.34
1.71
0.00
1.85
1.45
2.90
2.78
2.40
2.19
2.29
3.33
3.43
2.64
57150
1260
2.20
*
Risk-adjusted mortality rate is significantly higher than statewide rate.
**
Risk-adjusted mortality rate is significantly lower than statewide rate.
#
##
RAMR
95% CI
for RAMR
0.53** (0.11, 1.56)
1.53
(0.79, 2.68)
1.80
(0.36, 5.26)
1.36
(0.58, 2.67)
1.65
(0.44, 4.21)
0.00
(0.00, 2.92)
1.19
(0.24, 3.48)
1.21** (0.83, 1.70)
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.
19
Table 4: Summary Information for Surgeons Practicing at More than One Hospital, 1997-1999.
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
381
380
1
8
8
0
2.10
2.11
0.00
2.20
2.20
0.55
2.10
2.11
0.00
(0.91, 4.15)
(0.91, 4.15)
(0.00, 100.0)
97
5
92
3
0
3
3.09
0.00
3.26
2.33
1.30
2.38
2.93
0.00
3.02
(0.59, 8.56)
(0.00,100.0)
(0.61, 8.81)
Anderson J
Maimonides
Univ Hosp-Brooklyn
164
4
160
11
0
11
6.71
0.00
6.88
2.17
2.76
2.15
6.82*
0.00
7.04*
(3.40, 12.21)
(0.00, 73.12)
(3.51, 12.60)
Aronis M
183
4
2.19
2.12
2.27
(0.61, 5.81)
41
142
0
4
0.00
2.82
2.36
2.05
0.00
3.03
(0.00, 8.34)
(0.81, 7.75)
Bergsland J
Buffalo General
Millard Fillmore
554
549
5
19
19
0
3.43
3.46
0.00
2.53
2.51
4.83
2.99
3.04
0.00
(1.80, 4.67)
(1.83, 4.75)
(0.00, 33.51)
Brodman R
Montefiore Einstein
Montefiore Moses
294
1
293
3
0
3
1.02
0.00
1.02
2.20
0.78
2.21
1.02
0.00
1.02
(0.21, 2.99)
(0.00, 100.0)
(0.21, 2.99)
Camacho M
Montefiore Einstein
Montefiore Moses
202
1
201
3
0
3
1.49
0.00
1.49
2.90
0.80
2.91
1.13
0.00
1.13
(0.23, 3.30)
(0.00,100.0)
(0.23, 3.30)
Colvin S
Bellevue
NYU Hosp Ctr
112
14
98
4
0
4
3.57
0.00
4.08
2.28
2.82
2.20
3.45
0.00
4.09
(0.93, 8.84)
(0.00, 20.47)
(1.10, 10.46)
Connolly M
Lenox Hill
Maimonides
733
233
500
14
5
9
1.91
2.15
1.80
2.25
2.12
2.31
1.88
2.23
1.72
(1.02, 3.15)
(0.72, 5.21)
(0.79, 3.27)
Crooke G
Montefiore Einstein
Montefiore Moses
25
2
23
0
0
0
0.00
0.00
0.00
2.01
1.41
2.06
0.00
0.00
0.00
(0.00, 16.08)
(0.00, 100.0)
(0.00, 17.04)
Cunningham J N
Maimonides
Univ Hosp-Brooklyn
306
305
1
18
18
0
5.88
5.90
0.00
2.80
2.81
0.28
4.63*
4.63*
0.00
(2.74, 7.32)
(2.74, 7.32)
(0.00, 100.0)
Dal Col R
Ellis Hospital
St. Peter’s Hospital
473
1
472
5
0
5
1.06
0.00
1.06
1.23
0.41
1.23
1.90
0.00
1.90
(0.61, 4.43)
(0.00, 100.0)
(0.61, 4.44)
Cases
Acinapura A
Maimonides
St. Vincent’s
Altorki N
New York Hosp-Queens
Weill Cornell
New York Hosp-Queens
St. Luke’s
20
Table 4 continued:
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Edwards N
Columbia Presbyterian
St. Peter’s Hospital
388
270
118
9
8
1
2.32
2.96
0.85
2.08
2.28
1.62
2.46
2.87
1.15
(1.12, 4.67)
(1.24, 5.65)
(0.02, 6.40)
Frymus M
Montefiore Einstein
Montefiore Moses
415
414
1
12
11
1
2.89
2.66
100.00
1.99
1.99
0.56
3.20
2.94
100.00*
(1.65, 5.59)
(1.46, 5.26)
(5.11, 100.0)
Galloway A
Bellevue
NYU Hosp Ctr
248
23
225
6
1
5
2.42
4.35
2.22
2.52
0.98
2.68
2.12
9.79
1.83
(0.77, 4.61)
(0.13, 54.48)
(0.59, 4.27)
Geller C
Beth Israel
Lenox Hill
107
11
72
4
0
3
3.74
0.00
4.17
1.90
1.64
1.68
4.35
0.00
5.48
(1.17, 11.13)
(0.00, 44.93)
(1.10, 16.02)
24
1
4.17
2.68
3.43
(0.04, 19.10)
166
47
119
7
2
5
4.22
4.26
4.20
2.67
2.12
2.89
3.48
4.42
3.21
(1.39, 7.17)
(0.50,15.96)
(1.03, 7.49)
97
89
8
3
3
0
3.09
3.37
0.00
1.75
1.72
2.05
3.90
4.32
0.00
(0.78, 11.41)
(0.87, 12.63)
(0.00, 49.42)
Gold J
Montefiore Einstein
Montefiore Moses
186
34
152
0
0
0
0.00
0.00
0.00
1.69
1.55
1.72
0.00
0.00
0.00
(0.00, 2.57)
(0.00, 15.34)
(0.00, 3.09)
Guarino R
Buffalo General
Erie County
Millard Fillmore
479
2
4
473
8
0
0
8
1.67
0.00
0.00
1.69
1.59
0.94
1.07
1.60
2.32
0.00
0.00
2.34
(1.00, 4.57)
(0.00, 100.0)
(0.00, 100.0)
(1.01, 4.60)
Isom O
New York Hosp-Queens
Weill Cornell
209
2
207
3
0
3
1.44
0.00
1.45
1.53
5.54
1.49
2.07
0.00
2.14
(0.42, 6.05)
(0.00, 72.93)
(0.43,6.26)
1040
360
645
35
32
10
19
3
3.08
2.78
2.95
8.57
2.88
2.54
3.12
1.90
2.36
2.41
2.08
9.96
(1.61, 3.33)
(1.16, 4.44)
(1.25, 3.25)
(2.00, 29.09)
348
82
266
4
2
2
1.15
2.44
0.75
1.36
1.34
1.37
1.86
4.02
1.21
(0.50, 4.77)
(0.45, 14.53)
(0.14, 4.37)
St. Luke’s
Genovesi M
Lenox Hill
Maimonides
Glassman L
Bellevue
NYU Hosp Ctr
Jacobowitz I
Lenox Hill
Maimonides
Univ Hosp-Brooklyn
Joyce F
Albany Med Ctr
St. Elizabeth
21
Kerr P
Buffalo General
Erie County
Millard Fillmore
222
2
1
219
9
0
0
9
4.05
0.00
0.00
4.11
2.21
1.67
4.72
2.20
4.05
0.00
0.00
4.12
(1.85, 7.69)
(0.00, 100.0)
(0.00, 100.0)
(1.88, 7.82)
Ketosugbo A
Maimonides
Univ Hosp-Brooklyn
128
30
98
4
1
3
3.13
3.33
3.06
1.80
2.34
1.64
3.82
3.14
4.12
(1.03, 9.79)
(0.04, 17.50)
(0.83, 12.04)
Ko W
New York Hosp-Queens
Weill Cornell
424
329
95
10
8
2
2.36
2.43
2.11
2.04
1.55
3.73
2.55
3.46
1.24
(1.22, 4.69)
(1.49, 6.81)
(0.14, 4.49)
Lang S
New York Hosp-Queens
St. Vincent’s
Weill Cornell
691
498
91
102
20
8
4
8
2.89
1.61
4.40
7.84
2.08
1.80
3.00
2.63
3.07
1.97
3.23
6.58*
(1.87, 4.74)
(0.85, 3.88)
(0.87, 8.28)
(2.83, 12.96)
Levy M
North Shore
Univ Hosp Stony Brook
532
449
83
16
15
1
3.01
3.34
1.20
2.13
2.15
2.00
3.12
3.43
1.33
(1.78, 5.07)
(1.92, 5.65)
(0.02, 7.40)
Quintos E
Arnot-Ogden
United Health Serv
279
222
57
13
12
1
4.66
5.41
1.75
2.10
1.92
2.83
4.88*
6.22*
1.37
(2.60, 8.35)
(3.21, 10.86)
(0.02, 7.60)
Raza S
Buffalo General
Millard Fillmore
367
366
1
17
17
0
4.63
4.64
0.00
1.84
1.84
1.89
5.55*
5.56*
0.00
(3.23, 8.88)
(3.24, 8.91)
(0.00, 100.0)
Ribakove G
Bellevue
NYU Hosp Ctr
271
57
214
7
3
4
2.58
5.26
1.87
2.58
1.60
2.84
2.21
7.27
1.45
(0.88, 4.55)
(1.46, 21.25)
(0.39, 3.71)
Rosengart T
New York Hosp-Queens
Weill Cornell
638
6
632
19
0
19
2.98
0.00
3.01
2.85
0.85
2.87
2.31
0.00
2.31
(1.39, 3.60)
(0.00, 100.0)
(1.39, 3.61)
Sabado M
Lenox Hill
Maimonides
Univ Hosp-Brooklyn
215
146
46
23
13
7
3
3
6.05
4.79
6.52
13.04
3.03
3.18
3.10
1.94
4.41*
3.33
4.64
14.85*
(2.34, 7.53)
(1.33, 6.86)
(0.93, 13.56)
(2.98, 43.38)
Sardella G
Albany Med Ctr
St. Peter’s Hospital
497
106
391
4
0
4
0.80
0.00
1.02
1.47
1.27
1.52
1.21
0.00
1.48
(0.32,3.09)
(0.00, 6.00)
(0.40, 3.79)
Stelzer P
211
6
2.84
2.40
2.61
(0.95, 5.69)
206
5
6
0
2.91
0.00
2.33
5.35
2.76
0.00
(1.01, 6.00)
(0.00, 30.25)
Beth Israel
St. Luke’s
22
Table 4 continued:
Cases
No. of
Deaths
OMR
EMR
RAMR
95% CI
for RAMR
Tortolani A
Montefiore Einstein
North Shore
Weill Cornell
470
63
183
224
9
2
2
5
1.91
3.17
1.09
2.23
2.79
1.82
2.98
2.90
1.52
3.85
0.81
1.70
(0.69, 2.88)
(0.43, 13.89)
(0.09, 2.91)
(0.55, 3.97)
Zisbrod Z
Maimonides
Univ Hosp Brooklyn
642
640
2
15
15
0
2.34
2.34
0.00
2.50
2.50
0.83
2.06
2.07
0.00
(1.15, 3.40)
(1.16, 3.41)
(0.00, 100.0)
*
Risk-adjusted mortality rate is significantly higher than statewide rate.
**
Risk-adjusted mortality rate is significantly lower than statewide rate.
OMR
The observed mortality rate is the number of observed deaths divided by the number of patients.
EMR
The expected mortality rate is the sum of the predicted probabilities of death for 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.
23
SURGEON AND HOSPITAL VOLUMES FOR ADULT CARDIAC
SURGERY AND FOR ISOLATED CABG SURGERY (1997-1999)
Table 5 presents, for each hospital and for each
surgeon performing at least 200 isolated CABG
operations at that hospital in 1997-1999 and/or
performing one or more isolated CABG operations
in each of the years 1997-1999, 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.
other major heart surgery during the same admission.
Total adult cardiac surgery cases include isolated
CABG, CABG combined with another cardiac
procedure such as valve repair or replacement, single or
multiple valve replacements and any other surgery on
the heart or great vessels.
As indicated, the statewide percentage of adult cardiac
surgeries that were isolated CABG operations in
1997-1999 was 70.24 percent (57,151 CABG
operations out of a total of 81,362 total adult cardiac
surgeries).
Isolated CABG volumes include patients who undergo
bypass of one or more of the coronary arteries with no
Table 5: Total Cardiac Surgery and Isolated CABG Surgery Volumes by Hospital and Surgeon, 1997-1999.
24
Total
Cardiac
Surgery
Isolated
CABG
%
Isolated
CABG
Albany Medical Center Hospital
Britton L
Canavan T
Joyce F
Kelley J
Miller S
Sardella G
All Others
TOTAL
535
581
104
800
570
113
749
3452
362
480
82
577
434
106
527
2568
67.66
82.62
78.85
72.13
76.14
93.81
70.36
74.39
Arnot-Ogden Memorial Hospital
Quintos E
All Others
TOTAL
258
119
377
222
100
322
86.05
84.03
85.41
Bellevue Hospital Center
Colvin S
Galloway A
Glassman L
Ribakove G
All Others
TOTAL
54
59
113
132
97
455
14
23
89
57
44
227
25.93
38.98
78.76
43.18
45.36
49.89
Total
Cardiac
Surgery
Isolated
CABG
%
Isolated
CABG
13
280
334
536
817
1980
11
204
272
206
578
1271
84.62
72.86
81.44
38.43
70.75
64.19
622
532
761
2
549
221
679
2
88.26
41.54
89.22
100.00
6
387
427
524
484
291
90
4126
2
351
413
503
366
207
48
3341
33.33
90.70
96.72
95.99
75.62
71.13
53.33
80.97
Columbia Presbyterian - NY Presbyterian Hospital
Edwards N
444
Oz M
1132
Rose E
436
Smith C
1021
All Others
558
TOTAL
3591
270
644
223
564
153
1854
60.81
56.89
51.15
55.24
27.42
51.63
Ellis Hospital
Dal Col R
Depan H
Reich H
Saifi J
All Others
TOTAL
1
641
440
626
225
1933
1
384
393
480
179
1437
100.00
59.91
89.32
76.68
79.56
74.34
308
159
4
1
143
615
241
153
4
1
105
504
78.25
96.23
100.00
100.00
73.43
81.95
Table 5 continued:
Beth Israel Medical Center
Geller C
Harris L
Hoffman D
Stelzer P
Tranbaugh R
TOTAL
Buffalo General Hospital
Bergsland J
Bhayana J
Grosner G
Guarino R
Kerr P
Lajos T
Levinsky L
Lewin A
Raza S
Salerno T
All Others
TOTAL
Erie County Medical Center
Bell-Thomson J
Datta S
Guarino R
Kerr P
All Others
TOTAL
25
Total
Cardiac
Surgery
Isolated
CABG
%
Isolated
CABG
365
84
58
465
79
257
1284
19
2611
233
72
47
360
52
146
1044
16
1970
63.84
85.71
81.03
77.42
65.82
56.81
81.31
84.21
75.45
887
619
69.79
154
571
5
1617
119
458
0
1196
77.27
80.21
0.00
73.96
Maimonides Medical Center
Acinapura A
Anderson J
Connolly M
Cunningham J N
Genovesi M
Jacobowitz I
Ketosugbo A
Sabado M
Zisbrod Z
All Others
TOTAL
480
6
621
437
131
820
34
64
738
131
3462
380
4
500
305
119
645
30
46
640
114
2783
79.17
66.67
80.52
69.79
90.84
78.66
88.24
71.88
86.72
87.02
80.39
Millard Fillmore Hospital
Aldridge J
Ashraf M
Bergsland J
Guarino R
Jennings L
Kerr P
Raza S
All Others
TOTAL
420
748
5
528
456
275
1
165
2598
336
633
5
473
413
219
1
140
2220
80.00
84.63
100.00
89.58
90.57
79.64
100.00
84.85
85.45
Table 5 continued:
Lenox Hill Hospital
Connolly M
Geller C
Genovesi M
Jacobowitz I
McCabe J
Sabado M
Subramanian V
All Others
TOTAL
Long Island Jewish Medical Center
Graver L
Kline G
Palazzo R
All Others
TOTAL
26
Total
Cardiac
Surgery
Isolated
CABG
%
Isolated
CABG
2
3
2
184
502
56
88
418
1255
1
1
2
87
414
34
63
291
893
50.00
33.33
100.00
47.28
82.47
60.71
71.59
69.62
71.16
427
317
74.24
420
288
36
1
237
322
16
1747
293
201
23
1
152
245
10
1242
69.76
69.79
63.89
100.00
64.14
76.09
62.50
71.09
Mount Sinai Hospital
Ergin M
Galla J
Griepp R
Lansman S
McCollough J
Nguyen K
All Others
TOTAL
647
482
375
558
362
162
79
2665
342
242
28
320
241
91
32
1296
52.86
50.21
7.47
57.35
66.57
56.17
40.51
48.63
New York Hospital - Queens
Altorki N
Aronis M
Isom O
Ko W
Lang S
Rosengart T
TOTAL
6
61
2
417
652
8
1146
5
41
2
329
498
6
881
83.33
67.21
100.00
78.90
76.38
75.00
76.88
Table 5 continued:
Montefiore Medical Center - Einstein Division
Brodman R
Camacho M
Crooke G
Frater R
Frymus M
Gold J
Tortolani A
All Others
TOTAL
Montefiore Medical Center - Moses Division
Attai L
Brodman R
Camacho M
Crooke G
Frymus M
Gold J
Merav A
All Others
TOTAL
27
Total
Cardiac
Surgery
Isolated
CABG
%
Isolated
CABG
NYU Hospitals Medical Center
Colvin S
Culliford A
Esposito R
Galloway A
Glassman L
Grossi E
Ribakove G
All Others
TOTAL
638
629
466
510
28
220
364
157
3012
98
343
313
225
8
98
214
65
1364
15.36
54.53
67.17
44.12
28.57
44.55
58.79
41.40
45.29
North Shore University Hospital
Hall M
1209
779
64.43
606
958
224
489
21
3507
449
698
183
308
2
2419
74.09
72.86
81.70
62.99
9.52
68.98
1028
224
805
1130
577
3764
801
203
647
738
478
2867
77.92
90.63
80.37
65.31
82.84
76.17
395
352
147
894
292
266
117
675
73.92
75.57
79.59
75.50
1211
589
1121
264
1034
1196
1402
675
7492
891
458
537
190
766
826
1043
532
5243
73.58
77.76
47.90
71.97
74.08
69.06
74.39
78.81
69.98
Table 5 continued:
Levy M
Pogo G
Tortolani A
Vatsia S
All Others
TOTAL
Rochester General Hospital
Cheeran D
Fong J
Kirshner R
Knight P
Kwan S
TOTAL
St. Elizabeth Hospital
Hatton P
Joyce F
All Others
TOTAL
St. Francis Hospital
Bercow N
Colangelo R
Damus P
Durban L
Lamendola C
Robinson N
Taylor J
Weisz D
TOTAL
28
Total
Cardiac
Surgery
Isolated
CABG
%
Isolated
CABG
787
719
822
1004
3332
568
578
660
637
2443
72.17
80.39
80.29
63.45
73.32
204
122
51
78
53
142
81
24
54
5
69.61
66.39
47.06
69.23
9.43
585
248
1341
469
143
918
80.17
57.66
68.46
St. Peter’s Hospital
Banker M
Bennett E
Dal Col R
Edwards N
Sardella G
All Others
TOTAL
593
649
689
150
478
32
2591
496
362
472
118
391
22
1861
83.64
55.78
68.51
78.67
81.80
68.75
71.83
St. Vincent’s Hospital and Medical Center
Acinapura A
Galdieri R
Lang S
McGinn J
Tyras D
All Others
TOTAL
1
545
115
712
596
96
2065
1
437
91
552
470
72
1623
100.00
80.18
79.13
77.53
78.86
75.00
78.60
State University Hospital Upstate Medical Center
Alfieris G
454
Brandt B
525
Parker F
353
Picone A
515
All Others
293
TOTAL
2140
244
410
232
387
234
1507
53.74
78.10
65.72
75.15
79.86
70.42
Table 5 continued:
St. Joseph’s Hospital Health Center
Marvasti M
Nast E
Nazem A
Rosenberg J
TOTAL
St. Luke’s Roosevelt Hospital - St. Luke’s D iv.
Aronis M
Connery C
Geller C
Mindich B
Stelzer P
Swistel D
All Others
TOTAL
29
Table 5 continued:
Strong Memorial Hospital
Hicks G
Risher W
Snider J
All Others
TOTAL
United Health Services - Wilson Division
McLoughlin D
Quintos E
Wong K
Yousuf M
All Others
TOTAL
University Hospital at Stony Brook
Bilfinger T
Krukenkamp I
Levy M
McLarty A
Seifert F
All Others
TOTAL
University Hospital of Brooklyn
Anderson J
Burack J
Cunningham J N
Jacobowitz I
Ketosugbo A
Piccone V
Sabado M
Zisbrod Z
All Others
TOTAL
30
Total
Cardiac
Surgery
Isolated
CABG
%
Isolated
CABG
753
859
182
31
1825
468
466
146
0
1080
62.15
54.25
80.22
0.00
59.18
230
66
470
467
140
196
57
352
333
109
85.22
86.36
74.89
71.31
77.86
1373
1047
76.26
553
607
91
299
896
156
2602
454
475
83
263
725
139
2139
82.10
78.25
91.21
87.96
80.92
89.10
82.21
279
249
3
47
117
24
30
3
179
931
160
194
1
35
98
17
23
2
118
648
57.35
77.91
33.33
74.47
83.76
70.83
76.67
66.67
65.92
69.60
Table 5 continued:
Weill Cornell - NY Presbyterian Hospital
Altorki N
Girardi L
Isom O
Ko W
Krieger K
Lang S
Rosengart T
Tortolani A
All Others
TOTAL
Total
Cardiac
Surgery
Isolated
CABG
%
Isolated
CABG
110
716
512
186
1063
173
970
282
24
4036
92
338
207
95
707
102
632
224
0
2397
83.64
47.21
40.43
51.08
66.51
58.96
65.15
79.43
0.00
59.39
512
621
491
552
329
700
372
4
3581
411
474
325
392
257
471
309
0
2639
80.27
76.33
66.19
71.01
78.12
67.29
83.06
0.00
73.69
809
776
198
828
331
103
201
3246
427
621
153
595
234
83
162
2275
52.78
80.03
77.27
71.86
70.69
80.58
80.60
70.09
81362
57150
70.24
Westchester Medical Center
Axelrod H
Fleisher A
Lafaro R
Moggio R
Pooley R
Sarabu M
Zias E
All Others
TOTAL
Winthrop - University Hospital
Hartman A
Kofsky E
Mohtashemi M
Schubach S
Scott W
Williams L
All Others
TOTAL
Statewide Total
31
Criteria Used in Reporting Significant Risk Factors (1999)
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.
Acute hypotension (systolic blood pressure < 80 mmHg) or low
cardiac index (< 2.0 liters/min/m2), despite pharmacologic or
mechanical support.
Patient requires cardiopulmonary resuscitation within one hour of
the procedure.
• Shock
• CPR
Comorbidities
• Diabetes Requiring Medication
• Extensively Calcified Aorta
• Hepatic Failure
• Renal Failure, Dialysis
The patient is receiving either oral hypoglycemics or insulin.
More than the usual amount (for age) of calcification or plaque
formation in the ascending aorta, or plaque, palpable at surgery, in
the ascending aorta.
The patient has cirrhosis or other liver disease and has a bilirubin >
2 mg/dl and a serum albumin < 3.5 g/dl.
The patient is on chronic peritoneal or hemodialysis
Severity of Atherosclerotic Process
• Aortoiliac Disease
• Carotid/Cerebrovascular Disease
Angiographic demonstration of at least 50% narrowing in a major
aortoiliac vessel, previous surgery for such disease, absent femoral
pulses, or the inability to insert a catheter or intra-aortic balloon
due to iliac aneurysm or obstruction of the aortoiliac arteries.
Angiographic or ultrasound demonstration of at least 50%
narrowing in a major cerebral or carotid artery (common or
internal), history of a non-embolic stroke, or previous surgery for
such disease. A history of bruits or transient ischemic attacks (TIA)
is not sufficient evidence of carotid/cerebrovascular disease.
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.
32
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.
33
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
34
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
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 Road
Valhalla, New York 10595
Winthrop – University Hospital
259 First Street
Mineola, New York 11501
35
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
State of New York
George E. Pataki, Governor
Department of Health
Antonia C. Novello, M.D., M.P.H., Dr.P.H., Commissioner
10/02