Perioperative Medicine  |   December 2017
Impact of Public Reporting of 30-day Mortality on Timing of Death after Coronary Artery Bypass Graft Surgery
Author Notes
  • From the Department of Anesthesiology, Columbia University College of Physicians and Surgeons (M.H., V.M., H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (D.C.S., H.W.); Department of Medicine, Interdepartmental Division of Critical Care (D.C.S.), Department of Anesthesia (H.W.), and Interdisciplinary Department of Critical Care Medicine (H.W.), University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts (Z.C.); and Department of Critical Care Medicine, Sunnybrook Research Institute, Toronto, Ontario, Canada (R.P., H.W.).
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Submitted for publication February 21, 2017. Accepted for publication August 16, 2017.
    Submitted for publication February 21, 2017. Accepted for publication August 16, 2017.×
  • Address correspondence to Dr. Hua: Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street PH5, Room 527D, New York, New York 10032. mh2633@cumc.columbia.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Cardiovascular Anesthesia
Perioperative Medicine   |   December 2017
Impact of Public Reporting of 30-day Mortality on Timing of Death after Coronary Artery Bypass Graft Surgery
Anesthesiology 12 2017, Vol.127, 953-960. doi:10.1097/ALN.0000000000001884
Anesthesiology 12 2017, Vol.127, 953-960. doi:10.1097/ALN.0000000000001884
Abstract

Background: Recent reports have raised concerns that public reporting of 30-day mortality after cardiac surgery may delay decisions to withdraw life-sustaining therapies for some patients. The authors sought to examine whether timing of mortality after coronary artery bypass graft surgery significantly increases after day 30 in Massachusetts, a state that reports 30-day mortality. The authors used New York as a comparator state, which reports combined 30-day and all in-hospital mortality, irrespective of time since surgery.

Methods: The authors conducted a retrospective cohort study of patients who underwent coronary artery bypass graft surgery in hospitals in Massachusetts and New York between 2008 and 2013. The authors calculated the empiric daily hazard of in-hospital death without censoring on hospital discharge, and they used joinpoint regression to identify significant changes in the daily hazard over time.

Results: In Massachusetts and New York, 24,864 and 63,323 patients underwent coronary artery bypass graft surgery, respectively. In-hospital mortality was low, with 524 deaths (2.1%) in Massachusetts and 1,398 (2.2%) in New York. Joinpoint regression did not identify a change in the daily hazard of in-hospital death at day 30 or 31 in either state; significant joinpoints were identified on day 10 (95% CI, 7 to 15) for Massachusetts and days 2 (95% CI, 2 to 3) and 12 (95% CI, 8 to 15) for New York.

Conclusions: : In Massachusetts, a state with a long history of publicly reporting cardiac surgery outcomes at day 30, the authors found no evidence of increased mortality occurring immediately after day 30 for patients who underwent coronary artery bypass graft surgery. These findings suggest that delays in withdrawal of life-sustaining therapy do not routinely occur as an unintended consequence of this type of public reporting.