California Cardiac Surgery Intervention Project

California Cardiac Surgery and Intervention Project (CCSIP)

The California Cardiac Surgery and Intervention Project (CCSIP), an initiative of the California Society of Thoracic Surgeons (CASTS), has been dedicated to data collection, study of best practices, and performance improvement since 2003. Reporting of regional outcomes of cardiovascular procedures has been a recent focus of the project.

The CCSIP has been supported by unrestricted grants from several non-profit foundations and is currently funded by hospitals participating in the project. The data reported in the CCSIP reports is intended to provide hospitals, physicians and heart team members with comparative data on heart hospitals within their regional area as well as within California. The information can provide a background for regional discussion and collaboration for performance improvement.

This website includes statewide and hospital-specific reports obtained from the patient discharge (PDD), emergency department (ED) and ambulatory surgery (AS) databases of the California Office of Statewide Health Planning and Development (OSHPD). Reports are posted on all adult coronary artery bypass graft (CABG), aortic valve, mitral valve, percutaneous coronary intervention (angioplasty or PCI), and certain other invasive heart procedures performed in California from 1999 through 2015.

The surgery groups for which data are presented are following the approach adopted for public reporting in New York and Pennsylvania. These states combine isolated valve and CABG/valve groups for outcome reporting, which allows more complete reporting by increasing volume numbers for lower volume hospitals.

While legislation was introduced in the California Senate (SB 830) which was going to allow OSHPD the reporting of outcomes after percutaneous coronary intervention (PCI) and valve procedures as well as CABG, the California Senate did not appropriate funds. Until such legislation is successful, CCSIP reports might give hospitals a heads-up on their relative performance status for interventional cardiovascular care in advance of public reporting.

Our methods and this website were revised extensively to accommodate feedback received from users of our previous reports. Several reviewers noticed that PCI volumes listed here understated their facility's clinical data. In investigating this issue, we found it to be likely related to the underreporting of outpatient procedures. Please review Why do the PCI volumes reported for a facility differ from volumes reported by other data sources? for a more detailed discussion.

The Summary section provides a brief summary of California-wide trends in cardiac surgeries and interventions from 1999 to 2015.

The Surgery Volume section provides detailed hospital-level data on the volume of isolated CABG, isolated Valve, CABG/Valve and other cardiac surgeries as well as Percutaneous Coronary Interventions with and without ACS. Also provided is more detail on the type of valve procedures performed with and without CABG.

The Mortality section provides detailed hospital-level data on mortality outcomes after isolated CABG surgery, isolated valve surgery, CABG/Valve surgery, PCI with ACS and PCI without ACS. Mortality is based on deaths that occurred during the surgery admission or acute care admissions following transfer after the index surgery/intervention that were connected to the index admission and in-hospital / emergency room deaths that occurred after a discharge home and within 30 days of the procedure. Note that this measure is very similar to the STS operative mortality measure (see Which outcomes after cardiac surgery / intervention are shown?).

The MACCE section provides detailed hospital-level data on Multiple Adverse Cardiac and Cerebrovascular Events (MACCE) after isolated CABG surgery, isolated valve surgery, CABG/Valve surgery, PCI with ACS and PCI without ACS. The MACCE outcome is based on death, post-operative stroke, post-operative acute myocardial infarction or non-elective re-intervention during the index admission or during acute care admissions following transfer after the index surgery/intervention that were connected to the index admission.

The MACCE-90 section provides detailed hospital-level data on Multiple Adverse Cardiac and Cerebrovascular Events (MACCE) within 90 Days of isolated CABG surgery, isolated valve surgery, CABG/Valve surgery, PCI with ACS and PCI without ACS. The MACCE outcome includes the same events as the MACCE outcome; in addition, acute care re-admissions within 90 days are also included in outcome identification.

The Methods section provides a rich source of background information, definitions applicable for this project, details on the risk-adjustment process and details on all risk-adjustment models used.

Please use the contact information in the Contacts to direct any further questions to CCSIP support.

09-23-2015 update: We have added volume of and unadjusted outcomes after transcatheter AVR to the CCSIP website.

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