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Evaluation of complication rates after coronary artery bypass surgery using administrative data
1Health Care Research Unit, Evans Department of Medicine, Boston Medical Center, MA, USA. wghali@acs.ucalgary.ca
Insights
Studying complications after coronary artery bypass graft (CABG) surgery offers insights into hospital quality beyond mortality rates. Administrative data, like ICD-9-CM, are valuable for assessing CABG outcomes.
Area of Science:
- Health Services Research
- Cardiovascular Surgery Outcomes
- Quality of Care Assessment
Background:
- Hospital quality assessment often relies on mortality rates.
- Coronary Artery Bypass Graft (CABG) surgery outcomes require robust evaluation methods.
- The utility of administrative data for surgical outcomes research is an ongoing area of investigation.
Purpose of the Study:
- To determine if hospital complication rates after CABG provide unique quality insights beyond mortality data.
- To re-evaluate the usefulness of ICD-9-CM administrative data for assessing CABG surgical outcomes.
Main Methods:
- Development and validation of multivariate risk adjustment models using Massachusetts CABG cohorts from 1990 and 1992.
- Prediction of in-hospital mortality and complication rates.
- Statistical analysis of hospital-level complication and mortality data.
Main Results:
- Risk adjustment models demonstrated good discrimination and calibration.
- Wide variation in adjusted hospital complication rates (13.0%–57.6%) and mortality rates (1.4%–6.1%) in 1992.
- A significant correlation between high complication and mortality rates (r = 0.74, p = 0.006), with two hospitals showing divergent rankings based on complications versus mortality.
Conclusions:
- Complications following CABG surgery are frequent and offer valuable information on hospital quality not fully captured by mortality rates alone.
- ICD-9-CM administrative data remain a promising and effective resource for conducting outcomes research in cardiovascular surgery.
Abstract:
Our objectives were (1) to determine if studying hospital complication rates after coronary artery bypass graft (CABG) surgery provides information not available when only mortality is studied, and (2) to reexplore the utility of ICD-9-CM administrative data for CABG outcomes assessment. Using data from Massachusetts, we identified CABG cohorts from 1990 and 1992 to respectively develop and validate multivariate risk adjustment models predicting in-hospital mortality and complications. The resulting models had good discrimination and calibration. In 1992, adjusted hospital complication rates ranged widely from 13.0% to 57.6%, while mortality rates ranged from 1.4% to 6.1%. Hospitals with high complication rates tended to have high mortality (r = 0.74, p = 0.006), but 2 of the 12 hospitals studied ranked quite differently when judged by complications rather than mortality. We conclude that (1) complications after CABG occur frequently and may provide information about hospital quality beyond that obtained from hospital mortality rates, and that (2) administrative data continue to be a promising resource for outcomes research.