Patient deaths after heart bypass surgeries at California hospitals plummeted 34 percent between 2003 and 2009, newly released statistics show - a drop that may reflect the power of publicly reporting medical results as well as improvements in cardiac care.
Experts believe that having to report the results pushed hospitals to work harder to improve their success numbers in bypass operations, and that one major technique has been turning toward alternatives to the surgery.
That contention seems to be supported in the new statistics, which show that the number of bypass operations declined while alternative procedures - such as less invasive angioplasties and the insertion of stents - were on the rise, along with the use of cholesterol-lowering drugs and other medications.
'Procedure has advanced'
"We hope public reporting has contributed to that decline, but there are a lot of other things going on," said Joseph Parker, manager of the health care outcomes center at the Office of Statewide Health Planning and Development, which released the annual report. "The procedure has advanced. It's now a well-studied and well-performed procedure."
The state report on coronary artery bypass graft surgery, which is being made available to the public Tuesday, is now in its sixth year and is still the most detailed measure of any medical procedure in the state. The report relies on 2009 data, the most recent hospital and cause-of-death information available.
In 2009, the report says, the statewide risk-adjusted death rate within 30 days of isolated bypass surgery - not with another procedure like a valve repair - was 1.9 percent. That was a sharp reduction from the 2.9 percent rate in 2003, the first year the state required hospitals to report their results.
"Patients are undergoing this procedure less frequently, and when they do undergo it, they have better survival rates," said Maribeth Shannon, director of the market and policy monitor project at the California HealthCare Foundation, a health philanthropy based in Oakland.
How hospitals rated
California is also one of a handful of states, including Pennsylvania and New York, that require public reporting of the procedure.
"There's been a huge focus on improving hospital quality and safety and transparency about the health care system in general," Shannon said.
The California bypass report rated the 119 hospitals that perform the procedure as "better," "average" or "worse" than the state average on several factors, including death rates and strokes resulting from the surgery. It also rated them, for the first time, on whether patients have to be readmitted because of complications.
While the hospitals generally received average ratings on most of the measures, a few local hospitals stood out.
Alta Bates Summit Medical Center's Oakland hospital received a "better" performance rating for the third year in a row for postoperative strokes, while Good Samaritan Hospital in San Jose performed "worse" on that measure.
Napa's Queen of the Valley Medical Center was the only hospital in the state to get rated as "better" when it came to whether patients had to be readmitted within 30 days of surgery. San Joaquin Community Hospital got dinged on readmissions, while St. Joseph's Medical Center in Stockton did better than average on strokes.
"We have patients who come to us because they've seen this data," said Dr. Junaid Khan, director of cardiovascular services at Alta Bates.
Standardization of care
Khan attributes much of the hospital's success to a standardization of care that involves the entire team of caregivers, including those who make sure the patient is receiving proper care at home.
But he said the power of public reporting has improved bypass surgery outcomes across the board over the six-year period.
"The hospitals that were underperforming have either stopped doing surgery or they were forced to adopt better practices," Khan said.
Heart bypass surgery in state's hospitals
The California Report on Coronary Artery Bypass Surgery, which relied on 2009 data, found:
-- California hospitals performed 13,260 isolated bypass surgeries in 2009 that did not also involve other surgeries, with 252 deaths.
-- For the first time, the death rate for isolated bypass surgery in 2009 was actually slightly lower than the in-hospital mortality rate for angioplasties and stenting, which are known as a percutaneous coronary intervention. The procedure involves putting tiny tubes called stents into arteries.
To view the report: To see "California Report on Coronary Artery Bypass Graft Surgery, 2009," go to links.sfgate.com/ZLJJ .
Source: Office of Statewide Health Planning and Development
Victoria Colliver is a San Francisco Chronicle staff writer. firstname.lastname@example.org
This article appeared on page A - 1 of the San Francisco Chronicle
Patient deaths after heart bypass surgeries at California hospitals plummeted 34 percent between 2003 and 2009, newly released statistics show - a drop that may reflect the power of publicly reporting medical results as...
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Heart bypass deaths fall as care, reporting improve