Abstract 15728: Combining Risk-Adjusted Complications and Mortalities Avoided as a Single Measure of Ranking Hospital Performance Among Hospitals Performing Both PCI and CABG Procedures on Medicare Beneficiaries During Fiscal Year 2008: Is Performance Consistent Across Modalities?
Objectives:This analysis reports risk-adjusted mortality (RAMR) and complication (RACR) rates by performance tier, ranked on the total number of adverse events avoided (EA), during all PCI and CABG procedures on Medicare beneficiaries to determine if revascularization outcomes are consistent between the two procedures.
Methods:This retrospective study examined Fiscal Year 2008 MedPar File and identified 737 hospitals that performed at least 52 CABG surgeries and 52 PCIs on Medicare Beneficiaries (MB). ICD-9-CM codes and discharge status were used to identify adverse events for PCI (in-hospital mortality, new onset hemodialysis, and any vascular complication) and CABG (in-hospital mortality, new onset hemodialysis, post-operative stroke, post-operative infection, and post-operative ARDS) hospitalizations. Separate multivariate logistic regression models were used to estimate the probability that each MB would experience an adverse event during a PCI or CABG hospitalization. Total events avoided (EA) for each hospital was calculated as the differences between the expected number of events across the two procedures and the observed number. Hospitals were then tiered into quartiles based on the total number of EA.
Findings: Overall the (RACR) was 6.43% for PCI hospitalizations and 15.57% for CABG hospitalizations. The second row of the table indicates that hospitals in the top tier had 17 fewer hospitalizations with an adverse event than expected while bottom tier hospitals had nearly 22 more hospitalizations with an adverse event than expected. The remainder of the table reports the average EA for PCI and CABG, RACR rate for PCI and CABG, and RAMR for PCI and CABG by performance tier.
Conclusions:Tiering hospitals performance on EA rewards hospitals that both reduce mortality and complications for both types of coronary revascularization and not just a single procedure.
- © 2010 by American Heart Association, Inc.