Ann Thorac Surg 1998;66:1263
© 1998 The Society of Thoracic Surgeons
Original articles: cardiovascular
Invited commentary
William C. Nugent, MDa
a Section of Cardiothoracic Surgery, Dartmouth-Hitchock Medical Center, One Medical Center Dr, Lebanon, NH 03756-0001, USA
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Invited commentary
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Mozes and coauthors have used existing methodology to create a national risk model for coronary artery bypass grafting mortality at the 14 centers performing coronary bypass operations in Israel. Nurses trained as chart abstractors gathered data on all patients over a 1-year period. Univariate and multivariate logistic regression were used to identify variables that were predictors of operative mortality and to develop a model with excellent predictive and discriminative capabilities. Mozes and coauthors found that performance varied between centers. Operative mortality was higher than would have been predicted at two of the centers and lower at one center.
Although I applaud Mozes and coauthors’ efforts, no new information is added to what has already been published. O’Connor and associates published two articles in 1991 describing variation in crude and adjusted mortality after coronary artery bypass grafting in five centers in Northern New England [1] and their risk model [2]. Similar studies have been published from The Society of Thoracic Surgeons’ National Cardiac Surgical Database, the New York State Cardiac Surgical Reporting System, and the Veterans Administration Cardiac Surgery Database.
Nevertheless, this information is important for those practicing cardiac surgery in Israel. Although it is tempting to concentrate on improving the outcomes for patients having operations at the two "outlier" hospitals, it would be much more effective to share this information with all surgeons so that outcomes could be improved for all coronary artery bypass grafting patients [3]. The variation in outcomes described in this article reflect differences in the process of care which, once understood, can lead to practice changes for all surgeons, not just the outliers. By involving all the surgeons, Mozes and coauthors now have a great opportunity to improve outcomes for all coronary artery bypass grafting patients throughout Israel.
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References
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- O’Connor G.T., Plume S.K., Olmstead E.M., et al. A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting: The Northern New England Cardiovascular Disease Study Group. JAMA 1991;266:803-809.[Abstract]
- O’Connor G.T., Plume S.K., Olmstead E.M., et al. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery: The Northern New England Cardiovascular Disease Study Group. Circulation 1992;85:2110-2118.[Abstract/Free Full Text]
- O’Connor G.T., Plume S.K., Olmstead E.M., et al. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. JAMA 1996;275:841-846.[Abstract]
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Invited commentary
References