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 …