This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tu, J. V. Articles by Naylor, C. D. Search for Related Content PubMed PubMed Citation Articles by Tu, J. V. Articles by Naylor, C. D.

(Circulation. 1996;94:2429-2433.)
© 1996 American Heart Association, Inc.

Articles

Coronary Artery Bypass Mortality Rates in Ontario

A Canadian Approach to Quality Assurance in Cardiac Surgery

Jack V. Tu, MD, PhD, FRCPC; C. David Naylor, MD, DPhil, FRCPC; and the Steering Committee of the Provincial Adult Cardiac Care Network of Ontario*

the Institute for Clinical Evaluative Sciences in Ontario (J.V.T., C.D.N.); Department of Medicine (General Internal Medicine Division) and Clinical Epidemiology Unit, Sunnybrook Health Science Centre (J.V.T, C.D.N.), University of Toronto, Ontario; and the Department of Health Care Policy, Harvard Medical School, Boston, Mass (J.V.T.).

Background This study was conducted to assess the overall mortality rate and the amount of interhospital variation in risk-adjusted mortality rates after coronary artery bypass graft (CABG) surgery in Ontario, Canada. CABG outcomes data are not publicly disseminated in Ontario.

Methods and Results Clinical risk factors and surgical outcomes were collected on 15 608 patients undergoing isolated CABG surgery between April 1, 1991, and March 31, 1994, at the nine hospitals performing adult cardiac surgery in Ontario. The data were analyzed on the basis of a fiscal year. The overall mortality rate was 3.01%, and the risk-adjusted mortality rate declined from 3.17% in 1991 to 2.93% in 1993. In 1991, one of the nine hospitals had a risk-adjusted mortality rate significantly lower than the provincial average. Otherwise, the hospitals all had risk-adjusted mortality rates within the expected range during the time period of the study. All hospitals performed >300 CABG procedures in 1992 and 1993, and only 2 of 42 cardiac surgeons performed <50 CABG procedures in 1993.

Conclusions The in-hospital mortality rate after CABG surgery in Ontario is low, and the amount of interhospital variation in risk-adjusted mortality rates is no greater than that expected by chance alone. These outcomes are probably attributable to regionalization of CABG surgery and a very low prevalence of low-volume cardiac surgeons in Ontario.

Key Words: bypass • mortality • surgery • coronary disease

This article has been cited by other articles:

				V. Guru, J. V. Tu, E. Etchells, G. M. Anderson, C. D. Naylor, R. J. Novick, C. M. Feindel, F. D. Rubens, K. Teoh, A. Mathur, et al. Relationship Between Preventability of Death After Coronary Artery Bypass Graft Surgery and All-Cause Risk-Adjusted Mortality Rates Circulation, June 10, 2008; 117(23): 2969 - 2976. [Abstract] [Full Text] [PDF]

				V. A. Ferraris, F. H. Edwards, D. M. Shahian, and S. P. Ferraris Risk Stratification and Comorbidity Card. Surg. Adult, January 1, 2008; 3(2008): 199 - 246. [Full Text]

				F. Seccareccia, C. A. Perucci, P. D'Errigo, M. Arca, D. Fusco, S. Rosato, D. Greco, and on behalf of the research group of the Italian CAB The Italian CABG Outcome Study: short-term outcomes in patients with coronary artery bypass graft surgery Eur. J. Cardiothorac. Surg., January 1, 2006; 29(1): 56 - 62. [Abstract] [Full Text] [PDF]

				B. K. Nallamothu, K. A. Eagle, V. A. Ferraris, and R. M. Sade Should Coronary Artery Bypass Grafting Be Regionalized? Ann. Thorac. Surg., November 1, 2005; 80(5): 1572 - 1581. [Full Text] [PDF]

				L Nobilio, D Fortuna, M Vizioli, E Berti, P Guastaroba, F Taroni, and R Grilli Impact of regionalisation of cardiac surgery in Emilia-Romagna, Italy J Epidemiol Community Health, February 1, 2004; 58(2): 97 - 102. [Abstract] [Full Text] [PDF]

				J. V. Tu, H. Wang, B. Bowyer, L. Green, J. Fang, and D. Kucey Risk Factors for Death or Stroke After Carotid Endarterectomy: Observations From the Ontario Carotid Endarterectomy Registry Stroke, November 1, 2003; 34(11): 2568 - 2573. [Abstract] [Full Text] [PDF]

				E. L. Hannan, C. Wu, T. J. Ryan, E. Bennett, A. T. Culliford, J. P. Gold, A. Hartman, O. W. Isom, R. H. Jones, B. McNeil, et al. Do Hospitals and Surgeons With Higher Coronary Artery Bypass Graft Surgery Volumes Still Have Lower Risk-Adjusted Mortality Rates? Circulation, August 19, 2003; 108(7): 795 - 801. [Abstract] [Full Text] [PDF]

				D. M. Shahian and S.-L. T. Normand The volume-outcome relationship: from Luft to Leapfrog Ann. Thorac. Surg., March 1, 2003; 75(3): 1048 - 1058. [Abstract] [Full Text] [PDF]

				V. A. Ferraris and S. P. Ferraris Risk Stratification and Comorbidity Card. Surg. Adult, January 1, 2003; 2(2003): 187 - 224. [Full Text]

				P J Bradshaw, K Jamrozik, M Le, I Gilfillan, and P L Thompson Mortality and recurrent cardiac events after coronary artery bypass graft: long term outcomes in a population study Heart, December 1, 2002; 88(5): 488 - 494. [Abstract] [Full Text] [PDF]

				C. D. Naylor Public Profiling of Clinical Performance JAMA, March 13, 2002; 287(10): 1323 - 1325. [Full Text] [PDF]

				J. Hoey, A. M. Todkill, and K. Flegel What's in a name? Reporting data from public institutions Can. Med. Assoc. J., January 1, 2002; 166(2): 193 - 194. [Full Text]

				B. K. Nallamothu, S. Saint, S. D. Ramsey, T. P. Hofer, S. Vijan, and K. A. Eagle The role of hospital volume in coronary artery bypass grafting: is more always better? J. Am. Coll. Cardiol., December 1, 2001; 38(7): 1923 - 1930. [Abstract] [Full Text] [PDF]

				J. V. Tu, M. J. Schull, L. E. Ferris, J. E. Hux, and D. A. Redelmeier Problems for clinical judgement: 4. Surviving in the report card era Can. Med. Assoc. J., June 1, 2001; 164(12): 1709 - 1712. [Abstract] [Full Text] [PDF]

				E. D. Peterson, E. R. DeLong, L. H. Muhlbaier, A. B. Rosen, H. E. Buell, C. I. Kiefe, and T. F. Kresowik Challenges in comparing risk-adjusted bypass surgery mortality results: Results from the Cooperative Cardiovascular Project J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2174 - 2184. [Abstract] [Full Text] [PDF]

				C. D. Naylor, J. P. Szalai, and M. Katic Benchmarking the vital risk of waiting for coronary artery bypass surgery in Ontario Can. Med. Assoc. J., March 1, 2000; 162(6): 775 - 779. [Abstract] [Full Text] [PDF]

				K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]

				M. Carrier, L. C. Pelletier, R. Martineau, M. Pellerin, and B. C. Solymoss In elective coronary artery bypass grafting, preoperative troponin T level predicts the risk of myocardial infarction J. Thorac. Cardiovasc. Surg., June 1, 1998; 115(6): 1328 - 1334. [Abstract] [Full Text] [PDF]

				J. Ivanov, R. D. Weisel, T. E. David, and C. D. Naylor Fifteen-Year Trends in Risk Severity and Operative Mortality in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery Circulation, February 24, 1998; 97(7): 673 - 680. [Abstract] [Full Text] [PDF]