California Cardiac Surgery and Intervention Project
A quality improvement initiative and hospital outcomes reporting program supported by the
California Society of Thoracic Surgeons and the University of California, Irivine
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California's Best Heart Hospitals?

See the reports...

The rankings produced in this section are grouped in standardized procedure categories as established by the STS and ACC national databases, using mandatory discharge data submitted by hospitals to OSHPD, with risk modeling as described in the documentation page. No attempt is made to attach statistical significance to the findings, which are for quality improvement purposes only. While the risk modeling is subject to limitations as described, the data on repeat hospitalizations and reinterventions is accurate and precise. For this reason we now include both in-hospital mortality and the adverse event rate at 90 days (Mortality, Acute MI, Stroke or Reintervention-MARS-90) as primary outcomes. Reports are displayed in terciles (high, intermediate and low volume groups) according to annual procedure volume.


Strategy and Limitations

These reports are produced from the Office of Statewide Health Planning and Development (OSHPD) Patient Discharge Database (PDD). The database is available to University of California researchers through a protocol approved by the OSHPD Committee for the Protection of Human Subjects. The protocol approved for the California Society of Thoracic Surgeons (CASTS) provides data on all hospital discharges for the period 1997-2010. The CASTS, through its CCSIP project, uses the data for quality improvement initiatives and various research studies.

The reports address variation in procedure volume, in-hospital mortality (IHM) and post hospital adverse vent rate for California Heart Hospitals. A "Heart Hospital" is defined as a facility that offers full services in cardiovascular medicine and surgery, including coronary artery bypass graft (CABG), heart valve and percutaneous coronary intervention (PCI) procedures. These reports are more comprehensive and complete than any other available reports on cardiac interventions, including the OSHPD "California CABG Outcomes Reporting Program (CCORP)", which includes data on CABG only, and the Society of Thoracic Surgeons and American College of Cardiology reports, which collect data on the initial hospitalization only, and do not provide individual hospital comparisons. The OSHPD PDD includes data on all hospital discharges in California, so procedures and outcomes for the initial hospitalization as well as outcomes during re-admissions are counted.

The PDD has two important limitations: 1) out-of-hospital outcomes are not included and 2) adjustment for individual hospital variation in risk factors does not allow for clinical levels of severity in some co-morbidities. These limitations will be managed by linking the database to OSHPD vital statistics files and to STS and ACC clinical data in future iterations of these reports.

The current reports include all 117 hospitals that offered PCI, CABG and heart valve interventions during 2008-2009. CCSIP protocol limits reporting of outcomes to hospitals with 25 or more events. As discussed in the reports, we have combined procedure groups to limit the inpact of low volume at many hospitals. For example, combining all valve procedures reduced the number of hospitals with less than 25 events to 14 sites; combining isolated CABG with all valve procedures reduced the number with less than 25 to one site.


Can We Identify California's Best Heart Hospitals?

This report does not attempt to answer the question about "best" heart hospitals. Instead, we have produced volume and outcome reports in terciles according to procedure volume, in order to compare institutions with similar size programs. We have also attempted to improve comparative discrimination by using procedure-specific formats and including both in-hospital and post-hospital outcomes.

In-hospital Mortality (IHM) Report on all Risk-Adjusted CABG and Valve procedures CA 2010  * New *

The CASTS has begun analysis of the 2010 OSHPD patient discharge data. The first report includes Observed/Expected Ratios for in-hospital mortality (IHM) for all California heart hospitals. In-hospital mortality is corrected for patients dying after connected transfer to another institution, but not for patients dying out-of-hospital. Hospitals are identified by OSHPD ID numbers only. Participants in the California Cardiac Surgery and Intervention Project (CCSIP) may login to see hospitals identified by name in this report.

Adult Heart Surgery Procedure Volumes for California Heart Hospitals 2008-2009

Adult cardiac surgery procedures performed by California Heart Hospitals during 2008-2009 are shown in the figures below. Total case volume and total number of risk adjusted CABG and Valve procedures are indicated. Most CABG and Valve procedures can be risk adjusted to account for differences in case mix. Other procedures such as aortic aneurysms, ventricular resections, transplants and certain complicated CABG or Valve cases can not be adjusted. University programs tend to have more of these complicated cases.

Percutaneous Coronary Intervention (PCI) Procedure Volumes for California Heart Hospitals 2008-2009

Percutaneous coronary intervention (PCI) procedures performed by California Heart Hospitals during 2008-2009 are shown in the figures below. Total number of PCIs, PCI with acute coronary syndrome (PCI-ACS) and PCI without ACS (PCI-noACS) procedures are indicated. PCI-ACS (procedures performed with an admitting diagnosis of acute MI ICD-9-CM codes 410.xx) represented 43% of PCI cases statewide during 2008-2009. There was considerable variation across hospitals in the percentage of PCI-ACS cases among the total number of PCI procedures performed.

Regional Adult Heart Surgery and PCI Procedure Volumes CA 2008-2009

These reports are separated into regions as established by the CCORP reports. Cardiac surgery numbers are presented as total CABG (isolated + "other"), total Valve (isolated Valve, Valve-CABG, + "other" valve), and all other procedures (adult congenital, aneurysms, transplants, etc.). PCI and Isolated CABG procedures are shown together to indicate the total number of coronary revascularizations performed, and the ratio of PCI to CABG procedures at each hospital.

In-hospital Mortality (IHM) Report on all Risk-Adjusted CABG and Valve procedures CA 2008-2009 (login required)

These reports combine all isolated CABG, isolated valve, and valve-CABG procedures. They are presented in volume terciles in order to compare programs of similar size. Highest volume sites perform 4 or more cardiac surgery procedures per week, intermediate sites 2-4 per week, and low volume sites 2 or less per week.

In-hospital Mortality (IHM) Report on all Risk-Adjusted PCI procedures CA 2008-2009 (login required)

These reports combine all PCI-ACS and PCI-noACS, and are presented in volume terciles. Highest volume sites perform 10 or more procedures per week, intermediate sites 5-10 per week, and lowest volume sites 5 or less per week

Adverse Event Rate at 90 days (MARS-90: Mortality, Acute MI, Stroke or Reintervention at 90 Days) Report on California Heart Hospitals 2008-2009 (login required)


© 2011 California Society of Thoracic Surgeons