Study cites readmission rates after heart surgery

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About one in every six heart patients who underwent coronary artery bypass or heart valve surgery in Pennsylvania hospitals had to be readmitted within 30 days, a new study has found.

Those readmissions resulted in more than $81 million in additional hospital charges and more than 11,000 additional hospital days, according to the Pennsylvania Health Care Cost Containment Council's report released today on cardiac surgeries performed in 2007 and 2008. The report also includes cost data and outcomes data for individual surgeons.

Although four- and 30-day readmission rates for valve surgery decreased from 2007 to 2008, seven- and 30-day readmission rates for coronary artery bypass surgery without valve repair or replacement went up.

The full report is available today on the PHC4 website, http://www.phc4.org/reports/cabg/.

Statewide, death rates following cardiac surgery rose slightly, from 1.75 percent in 2007 to 1.9 percent in 2008, but the rate dropped 45.8 percent between 1994 and 2007.

"I think we've pretty much plateaued" when it comes to reducing deaths among cardiac surgical patients, said Joe Martin, executive director of PHC4, an independent state agency that collects and analyzes quality and cost data on health care in Pennsylvania.

But he sees medical centers putting more emphasis on reducing readmission rates, particularly with plans afoot on the federal level to reduce Medicare payments to hospitals with higher readmission rates. Traditionally, infections or heart failure are the most common reasons for a readmission following cardiac surgery.

Among major local heart centers, the combined program at UPMC Presbyterian and UPMC Shadyside had a higher than expected number of deaths among heart patients, for patients undergoing bypass both with and without valve replacement in 1,644 procedures done during 2007 and 2008. UPMC Mercy's mortality and readmission numbers were within the expected range.

Allegheny General Hospital had higher than expected mortality after 30 days among patients who had bypass only, but lower than expected readmissions after seven days. West Penn Hospital and West Penn-Forbes Regional Campus' mortality and readmission rates fell in the expected range for the two years.

Excela Health Westmoreland showed higher than expected deaths among patients undergoing coronary artery bypass without valve replacement.

Mr. Martin cautioned about making hasty judgments based on the numbers in one report.

"There could be reasons [for deaths] that are not related to poor performance. Sometimes a doctor does everything right and the patient still dies," he said. "This information is designed to say that something is occurring here that is different than what occurred at other hospitals, and people should use that information as a way to ask for additional information about their caregiver.

"It's not designed to put a bull's eye on someone's back."

At the same time, he added, "If I were a patient, I would certainly be asking my cardiologist about it and certainly trying to get as much information as I could."

Among other local centers, Washington Hospital had higher than expected readmission rates for valve surgery patients, although only 135 procedures were done in 2007-08. Butler Memorial fell in the expected range for deaths, and lower than expected 30-day readmissions. St. Clair Hospital in Mt. Lebanon and Jefferson Regional in Jefferson Hills had an expected number of deaths and readmissions in 2007-08.

The report also includes cost data. In 2008, hospital charges for cardiac surgery procedures at Allegheny General ranged from $97,161 to $131,020, compared with $226,227 to $348,917 for UPMC Shadyside and UPMC Presbyterian together.


Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


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