ASSESSMENT OF CORONARY-ARTERY BYPASS GRAFT-SURGERY PERFORMANCE IN NEW-YORK - IS THERE A BIAS AGAINST TAKING HIGH-RISK PATIENTS

OBJECTIVES. The purpose of this study was to determine whether perform ing coronary artery bypass surgery on high-risk patients adversely aff ects the risk-adjusted mortality rates for patients of surgeons and ho spitals in New York State compared with the impact of performing surge ry on more routine patients. METHODS. Risk-adjusted mortality rates we re calculated for 31 hospitals and 87 surgeons for high-risk (a predic ted mortality rate of at least 7.5%) and low-risk patients during the time period 1990 to 1992. RESULTS. The risk-adjusted mortality for all high-risk patients was lower (2.94%) than the risk-adjusted mortality for other patients (3.02%). Fifteen of the 31 hospitals had a lower r isk-adjusted mortality for all patients than they did for low-risk pat ients only, and no differences in either direction were statistically significant. Forty-one of 87 surgeons (47%) had risk-adjusted mortalit y for all patients that was at least as low as the risk-adjusted morta lity for low-risk patients. In general, hospitals and surgeons with th e lowest risk-adjusted mortality for all cases also had the lowest ris k-adjusted mortality for high-risk cases. CONCLUSIONS. The authors con clude that there is no systematic bias against operating on high-risk coronary artery bypass graft patients in the risk-adjusted performance system in New York.