Coronary artery bypass graft: contemporary heart surgery center performance in China

The use of coronary artery bypass grafting (CABG) surgery in China is growing, but little is known about hospital-level performance. We sought to characterize the variation in performance across hospitals participating in a national registry in China.

The study sample was drawn from the Chinese Cardiac Surgery Registry, a national multicenter database that includes 43 hospitals across 13 provinces and 4 direct-controlled municipalities in China. We assessed consecutive patients undergoing isolated CABG surgery during the period of January 1, 2007, through December 31, 2008. Hierarchical generalized linear models were used to estimate hospital-level risk-standardized in-hospital all-cause mortality rates (RSMR) and major complication rates (RSMCR), which included death, myocardial infarction, reoperation for bleeding, mediastinal infection, stroke, reintubation, and renal failure. Among 8739 patients who underwent isolated CABG surgery, the mean age was 62.2 years (SD=9.2), and 78% were male. Observed in-hospital mortality and complication rates were 2.2% (95% confidence interval [CI], 1.9-2.5%) and 6.6% (95% CI, 6.1-7.1%), respectively. The mean RSMR was 1.9% (SD=1.1), with a range of 0.7-5.8%, and the mean RSMCR was 6.4% (SD=1.5), with a range of 3.8-10.1%. The odds of dying and the odds of having a complication after CABG surgery at a hospital 1 SD below the average relative to a hospital 1 SD above the average were 2.06 (95% CI, 1.40-3.04) and 1.53 (95% CI, 1.31-1.79), respectively. The Eastern region had the lowest RSMR and RSMCR (1.6% and 5.8%, respectively), whereas the Central region had the highest RSMR (2.5%) and the Southern region had the highest RSMCR (7.7%).

Mortality and complication rates after CABG surgery in the Chinese Cardiac Surgery Registry are generally low but vary by hospital and region within China. These results suggest that there are opportunities to improve outcomes in some CABG facilities.