The California Cardiac Surgery and Intervention Project: evolution of a public reporting program

Mandatory public reporting of cardiac surgery outcomes in California was instituted in 2003. To study the impact of the program, the outcomes of coronary artery bypass graft (CABG), valve, and percutaneous coronary intervention (PCI) procedures performed after January 1, 2003 were compared with previous years using the Patient Discharge Database (PDD) of the Office of Statewide Health Planning and Development. Risk-adjusted in-hospital mortality for CABG, CABG plus valve or aneurysm, and valve procedures decreased during 2003 and 2004 compared with 1998 through 2002, and PCI mortality remained unchanged. The average annual procedural volume per hospital decreased 25 per cent (232% +/- 205% to 173% +/- 157%) for CABG and 18 per cent (310% +/- 278% to 253% +/- 235%) for all cardiac surgeries, whereas PCI increased 12 per cent (433% +/- 277% to 492% +/- 356%). During 2003 and 2004, less than one-half of the 120 hospitals performed 200 or more cardiac surgeries per year, and only 25 performed 300 or more. Higher CABG mortality was observed primarily in low-volume programs, but the relationship of volume to risk-adjusted mortality was not significant for any surgical group or for PCI. Identification of outlier status was facilitated by use of 30-day posthospital outcomes (death or reoperation) in addition to in-hospital mortality. This study suggests that the introduction of a mandatory cardiac surgery reporting program in California was associated with improved outcomes.