Public reporting of surgical mortality: A survey of New York State cardiothoracic surgeons

Background. Public disclosure of individual surgeons mortality following co ronary artery bypass (CAB) is part of the New York State Department of Heal th Cardiac Surgery Reporting System (CSRS). The effects on the practice of cardiac surgery, as perceived by surgeons, remain unknown. Methods. All 150 New York State cardiac surgeons were sent an anonymous mai l survey in 1997. Data was analyzed to determine the dominant opinion regar ding the CSRS. Results. One hundred and four surgeons (69.3%) responded. The majority (70% ) did not experience a change in practice. Data reporting was performed by the surgeon or an employee (58%). Many picked the incorrect definition of c hronic obstructive pulmonary disease (COPD) (45%) or statistical method (60 %). The aspect of CSRS most in need of improvement was gaming with risk fac tors (40%). Most surgeons (62%) refused to operate on at least one high-ris k CAB patient over the prior year, primarily because of public reporting. R efusal was more common in surgeons in practice less than 10 years, those wi th less than 100 cases per year, and those with a mixed cardiothoracic prac tice (p < 0.05, Pearson's chi(2) test). A significantly higher percentage o f high-risk CAB patients were treated non-operatively, when compared with a scending aortic dissection patients (not disclosed) (p < 0.001, Wilcoxon si gned ranks test). Conclusions. The public disclosure of surgical results may be based on impe rfect data and appears to have resulted in denial of surgical treatment to high-risk patients. (C) 1999 by The Society of Thoracic Surgeons.