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Public reporting of CABG results associated with better outcomes

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Compared with the United States as a whole, Massachusetts, which mandates public reporting of CABG results, had better patient outcomes after CABG, according to findings presented at the American Association for Thoracic Surgery Annual Meeting.

The researchers obtained data from CABG procedures submitted to the Massachusetts Data Analysis Center by 14 centers between 2002 and 2014 and compared outcomes with Massachusetts cases submitted to national registry data from the Society of Thoracic Surgeons (STS), and to national cases from the registry not from Massachusetts.

Outcomes of interest included observed mortality, expected mortality and risk factor prevalence.

Compared with patients from the national cohort, patients from Massachusetts had lower odds of shock (OR = 0.66; 99% CI 0.53-0.83) and having an emergent or emergency-salvage procedure (OR = 0.57; 99% CI 0.52-0.61), according to the researchers. However, they wrote, patients from Massachusetts were older and more likely to have diabetes, peripheral vascular disease or reduced left ventricular ejection fraction.

From 2003 to 2007, expected mortality was higher in patients from Massachusetts vs. patients from the national cohort (P = .000), but there was no difference between 2008 and 2014 (P = .135), presenter David M. Shahian, MD, professor of surgery at Harvard Medical School and vice president of the Center for Quality and Safety at Massachusetts General Hospital, and colleagues found.

After adjustment for STS Predicted Risk of Mortality score, the Massachusetts patients from the STS registry had lower operative mortality (OR = 0.82; 99% CI, 0.69-0.98) and 30-day mortality (OR = 0.79; 99% CI 0.66-0.96) than patients from other states in the STS registry, according to the researchers.

Volume of CABG procedures decreased less in Massachusetts than in other states between 2002 and 2014, Shahian and colleagues found.

"The bottom line is that mandatory public reporting was consistently associated with better outcomes, although a causal relationship cannot be proven, and there was conflicting and inconclusive evidence for risk aversion,” Shahian said in a press release. – by Erik Swain

Reference:

Shahian D, et al. Abstract 27. Presented at: American Association for Thoracic Surgery Annual Meeting; April 28-May 1, 2018; San Diego.

Disclosure: Shahian reports no relevant financial disclosures.