There is good news for Pennsylvanians facing coronary artery bypass graft (CABG) surgery. In 1994-95, the years covered by this study, 97% of the health plans, 91% of the hospitals, and 90% of the surgeons had risk-adjusted patient mortality rates that were well within what was expected or better after accounting for patient risk.
In-hospital mortality was 22% lower in 1995 than it was in 1991 (4.9% of the patients died in 1991 compared to 3.8% in 1995). At the same time, patient risk has remained constant and the total number of CABG surgeries has increased (up almost 25% since 1991).
Charges are Decreasing
Statewide, the average charge was 3.9% lower in 1994-95 than it was in 1993, the first decrease since public reporting began with 1990 data. In general, a number of hospitals with higher charges decreased their charges while a number of hospitals with lower charges increased their charges.
Of the cases reported in the payor analysis, 89.2% were covered by fee-for-service plans (or some variation); only 10.8% were covered by HMO plans during 1994-95.
The patient's insurance plan was not a determinant of in-hospital mortality.
Of those discharged alive from the hospital in 1994-95, 98.6% were alive 3 months later; 97.4% were alive 9 months later. Of those who died after discharge, 58% died of heart-related causes.
In 1992, 1.87 out of every 1,000 adult residents underwent CABG surgery. In 1995, 2.21 out of every 1,000 adult residents had this procedure. For males, the figures were 2.77 per 1,000 in 1992 and 3.20 per 1,000 in 1995. For females, they were 1.07 per 1,000 in 1992 and 1.32 per 1,000 in 1995.
70% of the CABG patients were men; 30% were women.
Men tended to undergo CABG at an earlier age than women. Of those under 65 years of age, 78% were men and 22% were women. The average age for women was 68, compared to 64 for men.
The most common risk factor for the patients in this study was heart failure. The next most common was having had previous CABG and/or valve surgery.
The majority of patients had a relatively low risk (1.6%) of in-hospital death. Only 5% of the cases had a risk of in-hospital mortality of 10% or higher.
After accounting for patient risk, average post-surgical length of stay ranged across hospitals from 5.2 days to 8.6 days.
There are regional differences in how long a patient stayed in the hospital following CABG surgery:
The patients in hospitals located in Central & Northeastern Pennsylvania had shorter stays than expected.
The patients in hospitals located in Southeastern Pennsylvania or Western Pennsylvania had longer stays than expected.
The number of hospitals performing CABG surgery in Pennsylvania has increased since 1990.
The number of surgeons performing CABG surgery in Pennsylvania has increased since 1990.
The surgeon's volume of open heart surgery cases was an important determinant of in-hospital survival. Higher volume was associated with increased survival. The number of open-heart surgeries performed, on average, by a Pennsylvania cardiac surgeon in 1994-95 was 127 per year.