Harvard Heart Letter

Bypass results vary by hospital

Checking up on hospitals and surgeons before bypass surgery may pay off.

A quarter of a million Americans have bypass surgery each year. Most of these operations are elective procedures, scheduled in advance to ease chest pain or other symptoms of cholesterol-clogged coronary arteries. Even though it's a big operation, the vast majority of people who undergo bypass surgery survive it, recover, and live better lives because of it. The sad fact is, though, that between 2% and 3% of people die during or soon after having bypass surgery, according to numbers from the federal Agency for Health Care Quality. As you might expect, that nationwide number hides a huge range, with very low death rates in some hospitals and high rates in others. A study underscores the gap in quality from hospital to hospital.

Researchers reviewed the results of more than 250,000 bypass surgeries performed in 800 hospitals in 2003 and 2004 (the latest years with full statistics). After adjusting for age, general and cardiovascular health, and other factors that affect the outcome of bypass surgery, they determined the bypass-related death rate for each hospital and ranked them from best to worst. In the top 200 hospitals, 1.4% of people died during or soon after bypass surgery, while in the bottom 200 the rate was 6.5% (Archives of Internal Medicine, Nov. 24, 2008). Across the board, women fared a bit worse than men. Their in-hospital death rates were much closer to men's in the top-tier hospitals than they were in the bottom-tier hospitals. The researchers estimate that three-quarters of post-bypass deaths could be avoided if bottom-tier hospitals did the operation as well as top-tier hospitals.

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