Bypass Results Vary by Hospital

Checking up on hospitals and surgeons before bypass surgery may pay off.

A quarter of a million Americans have bypass surgery each year. Most of these operations are elective procedures, scheduled in advance to ease chest pain or other symptoms of cholesterol-clogged coronary arteries. Even though it's a big operation, the vast majority of people who undergo bypass surgery survive it, recover, and live better lives because of it. The sad fact is, though, that between 2% and 3% of people die during or soon after having bypass surgery, according to numbers from the federal Agency for Health Care Quality. As you might expect, that nationwide number hides a huge range, with very low death rates in some hospitals and high rates in others. A study underscores the gap in quality from hospital to hospital.

Researchers reviewed the results of more than 250,000 bypass surgeries performed in 800 hospitals in 2003 and 2004 (the latest years with full statistics). After adjusting for age, general and cardiovascular health, and other factors that affect the outcome of bypass surgery, they determined the bypass-related death rate for each hospital and ranked them from best to worst. In the top 200 hospitals, 1.4% of people died during or soon after bypass surgery, while in the bottom 200 the rate was 6.5% (Archives of Internal Medicine, Nov. 24, 2008). Across the board, women fared a bit worse than men. Their in-hospital death rates were much closer to men's in the top-tier hospitals than they were in the bottom-tier hospitals. The researchers estimate that three-quarters of post-bypass deaths could be avoided if bottom-tier hospitals did the operation as well as top-tier hospitals.

This study adds fuel to the already heated debate about making public the results of bypass surgery. Some states, including New York, Massachusetts, and California, create and publish "report cards" for cardiac surgeons and hospitals based on how well their patients fare during and immediately after the operation. The reports don't stop with bypass surgery, but also cover aneurysm repair, valve replacement, and other operations.

This information can be helpful to people who need to have heart surgery. But it is extremely difficult to make these ratings fair. A terrific surgeon who operates on extremely sick people can end up with a poorer grade than a mediocre one who only takes on routine cases. Likewise, ratings can also be skewed against tertiary care hospitals that get the most complicated cases.

Creative thinkers, stellar statisticians, and other experts have been devoting a lot of brainpower to finding good ways to create report cards that offer accurate and fair snapshots of how good cardiac surgeons and hospitals are when it comes to bypass surgery and other cardiac procedures.

In the meantime, "it pays to compare by asking questions," says Dr. Matthew R. Reynolds, an assistant professor of medicine at Harvard Medical School and a coauthor of the Archives study. "How many?" is the question to start with, for your hospital and surgeon. Hospitals in which 200 or more bypass surgeries are performed a year have lower death rates than those in which fewer are done. For surgeons, the benchmark is at least 100 bypass operations a year. The most direct way to get this information is to ask your surgeon. You can also ask what his or her success rates are. Not long ago, such questions would have been considered pushy. Today, they should be standard. If a doctor balks at giving you this information or gets miffed at your asking, think twice about whether you want him or her operating on you.