Abstract 6229: The California Coronary Artery Bypass Graft Outcomes Reporting Program: Comparative Surgical Volume and Operative Mortality in Over 35,000 Patients in 2003 and 2006
By legislative mandate, California launched its coronary artery bypass graft surgery (CABG) outcomes reporting program (CCORP) in 2003 for all hospitals performing this procedure. The program has provided annual public reports by hospital/surgeon. However, the impact of this program on operative mortality and access to surgery for high-risk patients has not been clarified. We extracted all isolated CABG cases from the CCORP database for 2003 and 2006 and applied a multivariable logistic pre-operative risk adjustment model to compute predicted operative mortality for isolated CABG for each of these years. We also classified patients into quintiles based on the predicted risk and compared predicted and observed operative mortality for 2003 and 2006. Although the total volume of isolated CABG decreased by 26.5% from 2003 (N=21,276) to 2006 (N=15,647), the predicted operative mortality rate remained stable (2003: 3.06%, 95%CI 2.98–3.13; 2006: 3.05%, 95%CI 2.97–3.14). There were no significant differences in the predicted mortality between 2003 and 2006 for each quintile of risk (95% CI of the predicted morality rates overlapped between years for all quintiles). However, the overall observed mortality rate declined from 2.90% in 2003 to 2.22% in 2006. Overall, the empirical odds ratio (OR) of operative death for 2006 patients was 24% lower than for 2003 patients. Further, 2006 patients with the highest predicted risk (quintiles 4 and 5) had 26–35% lower observed likelihood of operative mortality compared to patients in 2003 (empirical OR for quintile 4: 0.65; for quintile 5: 0.74). 1) Total CABG volume decreased from 2003 to 2006. 2) However, operative mortality for all CABG patients and for the highest risk groups was lower in 2006. These data demonstrate no evidence of decreased access to CABG for high risk patients.