Reporting systems for cardiac surgery

BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7463.413 (Published 19 August 2004) Cite this as: BMJ 2004;329:413
  1. Vipin Zamvar, consultant cardiothoracic surgeon (zamvarv@hotmail.com)
  1. Royal Infirmary of Edinburgh, Edinburgh EH16 4SU

    Existing systems assure safety but do not indicate quality

    The outcomes of medical treatment arouse political and public interest around the world. In the United States the departments of health in New York, New Jersey, and Pennsylvania publish cardiac surgical results that are specific to surgeons and hospitals. The New York initiative, which broke new ground, provides robust risk stratified data, and identifies surgeons and hospitals with better or worse outcomes than the state average.1 However, it lumps all coronary artery bypass graft operations together, uses only mortality as an outcome measure, and takes three years to produce by which time the results are not of much use to patients to make a choice.

    Is mortality a good indicator of outcome? Mortality is defined by the Society of Cardiothoracic Surgeons in the United Kingdom as death in the hospital where surgery is done, during the same admission.2 This excludes deaths in patients who have been discharged to peripheral hospitals or rehabilitation facilities. The definition of mortality could be improved to include these deaths as is done in New York, but systems in the United Kingdom are unable to capture …

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