TY  - BOOK
AU  - Mittel,Aaron M.
AU  - Kim,Dae Hyun
AU  - Cooper,Zara R.
AU  - Argenziano,Michael
AU  - Hua,May
TI  - Use of 90-day mortality does not change assessment of hospital quality after CABG in New York State
PY  - 2022///-02
KW  - Text
KW  - local
N1  - /pmc/articles/PMC7554081; /pubmed/32414596
N2  - OBJECTIVES: Publicly reported postoperative 30-day mortality rates are commonly used to compare hospital quality after coronary artery bypass graft (CABG) surgery. We sought to determine whether 90-day mortality rates, which are not publicly reported but better capture post-discharge mortality, are a better determinant of hospital performance. METHODS: Retrospective cohort analysis of 30 versus 90-day risk-standardized mortality rates (RSMR) at adult cardiac surgical centers in NYS from 2008 - 2014. Hospitals were classified as good or poor-performing outliers at each time point based on the bounds of the 95% confidence interval around each hospital's predicted RSMR, determined via hierarchical models. The primary outcome was change in institutional performance via outlier classification from 30 to 90 days. RESULTS: During the study period, 72,398 adults underwent a CABG procedure at one of 42 institutions. The RSMR increased from 30 to 90 days at all institutions, with a median 30-day RSMR of 2.16% (IQR 0.69%) and median 90-day RSMR of 3.69% (IQR 1.00%). In using a 90 instead of 30-day metric, 3 hospitals changed outlier status. One hospital improved to a good from as expected performer; 2 worsened to as expected from good performers. CONCLUSIONS: In a cohort of patients who underwent CABG surgery from 2008 - 2014 in NYS, use of a 90-day mortality metric resulted in a change in hospital quality assessment for a minority of hospitals. The use of 90-day mortality may not provide additional value when evaluating institutional performance for this population
UR  - http://dx.doi.org/10.1016/j.jtcvs.2020.03.072
ER  -