Quality control for cardiac surgery in the Veterans Administration

The volume of cardiac surgical procedures and the 30-day mortality associated with them were reviewed for the total experience of 72 Veterans Administration medical centers over a 10-year period (1975 to 1984). The total number of cardiopulmonary bypass operations increased from 3,074 in 1975 to 6,455 in 1984, whereas operative mortality declined from 8.3 to 4.7%. Operative mortality associated with isolated valve replacement operations declined from 10.9 to 5.9%. Aortocoronary vein bypass operations, which increased in number from 1,679 to 4,988 over the 10-year period, were associated with an operative mortality of 4.7% in 1975 and 3.6% in 1984. The extent of the patient's disease accounted for most of the operative mortality, but problems related to the adequacy of myocardial protection and the surgical technique were also important factors. These data were compared with similar comprehensive statistics compiled by the New York State Department of Health over a five-year period (1979-1983). Operative mortality rates were quite similar for aortocoronary bypass procedures, mitral valve replacements, and total cardiac operations. However, operative mortality for aortic valve procedures was higher among the Veterans Administration hospitals. In the future, if operative risk factors are clearly defined, a more meaningful comparison of operative mortality among ongoing reviews, such as those being carried out by the Veterans Administration and by New York State, could be used to establish standards of performance for cardiac surgery.