HOSPITAL DEATH ON A CARDIAC SURGICAL SERVICE - NEGATIVE INFLUENCE OF CHANGING PRACTICE PATTERNS

From January 1982 through December 1985, 3,772 patients underwent a cardiac surgical procedure for coronary or acquired heart disease. Operative mortality increased from 4% in 1982 to 7% in 1985 (p < 0.001 by χ2 analysis). There was an increase over time of patients older than 70 years (p < 0.001). Female patients increased from 31% in 1982 to 35% in 1985 (p < 0.001). The percentage of patients having isolated coronary artery bypass grafting decreased from 69% in 1983 to 60% in 1985 (p < 0.001), and hospital mortality after this procedure increased (p = 0.058). Patients requiring more complex procedures including multiple-valve operations or combined valve replacement or repair plus bypass grafting increased from 1982 through 1985 (p = 0.005). Reoperations for multiple-valve procedures or combined valve repair or replacement plus coronary artery bypass grafting also increased (p = 0.02), particularly for patients more than 70 years of age (p < 0.001). Changing practice patterns have had 2 negative impact on surgical results. This evolution in cardiac surgical practice has important implications related to peer review and quality-assurance screening, diagnosis-related group reimbursement, and reporting of surgical outcomes to governmental agencies. © 1990.