Ninety-Day Risk-Standardized Home Time as a Performance Metric for Cardiac Surgery Hospitals in the United States

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Quality Improvement

Background:

• Assessing hospital performance in cardiac surgery requires valid quality metrics.
• The association between hospital-level risk-standardized home time and other performance indicators like mortality, readmission, and surgical volume was previously unevaluated.

Purpose of the Study:

• To evaluate the association of hospital-level risk-standardized home time with mortality rates, readmission rates, and annual surgical volume in cardiac surgery.
• To assess the utility of 90-day home time as a performance metric for cardiac surgery hospitals.

Main Methods:

• Included Medicare beneficiaries undergoing major cardiac surgeries (CABG, Aortic/Mitral Valve) from 2013-2019.
• Estimated hospital-level metrics: annual surgical volume, 90-day risk-standardized mortality, readmission, and home time using generalized linear mixed models.
• Correlations assessed via Pearson correlation coefficient; patient outcomes compared across home time quartiles; temporal stability analyzed.

Main Results:

• Included 919,698 patients from 1179 hospitals. Median 90-day home time was 71.2 days.
• 90-day home time correlated positively with surgical volume (r=0.31) and inversely with readmission (r=-0.40) and mortality (r=-0.60) (all P<0.001).
• Using 90-day home time reclassified hospital performance rankings significantly (11.6%-22.8%) and demonstrated the most temporal stability.

Conclusions:

• Ninety-day risk-standardized home time is a feasible and comprehensive metric for cardiac surgery.
• It offers a patient-centered approach to hospital performance assessment.
• This metric exhibits superior temporal stability compared to traditional measures of mortality and readmission.