How to do it: utilizing risk stratification to evaluate outcomes in adult open-heart operations

The purpose of this study is to demonstrate that by using a proven method of stratifying open-heart operations into levels of predicted mortality, hospitals can closely monitor trends of their open-heart programs and possibly improve the health planning decisions for their institution. A proven method of uniform risk stratification utilizing objective and readily available preoperative patient data was implemented at our institution for a 12 month period (September 1, 1991 through August 31, 1992). A total of 367 patients were included in this study. The patients were categorized into four risk ranges (0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and greater than or equal to 15% high risk) indicating a predictive percent probability of operative mortality. The number of patients categorized as either 0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and greater than or equal to 15% high risk were 46, 74, 84 and 163, respectively. The patient's average post-operative length of stay in each risk category was 7.6 days, 8.2 days, 10 days, and 12 days, respectively. The patient's average total hospital charges in each risk category were $48,241, $53,531, $60,416 and $75,555, respectively. This information has helped our hospital administration make relevant and objective decisions concerning our open-heart program. Uniform risk stratification (outcomes research) should be incorporated into all adult open-heart surgery programs because it is simple, inexpensive, and can evaluate the outcomes and cost of open-heart surgery.