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Mortality rate higher in hospitals without cardiac surgery programs

Quality Improvement Monitor, October 29, 2004

Patients who undergo an increasingly popular non-surgical heart procedure in hospitals that do not have onsite cardiac surgery programs have a higher mortality rate than those in hospitals with a cardiac surgery program, according to a study led by Dartmouth Medical School (DMS).

The study, which appears in the October 27 Journal of the American Medical Association, investigates the outcomes of over 600,000 Medicare enrollees who underwent a cardiac procedure called a percutaneous coronary intervention (PCI) at a U.S. acute-care facility between 1999 and 2001.

It concluded that patients who underwent PCI at a hospital without a cardiac surgeon onsite had a 29% overall increased risk of mortality compared to those who had the procedure in a hospital with surgical backup.

PCI is a non-surgical procedure that unblocks narrowed coronary arteries, often using a balloon to open a constricted artery and a wire stent to keep the artery clear. Although it is a non-surgical procedure, complications that require emergency cardiac surgery, may arise.

U.S. hospitals with catheterization laboratories but without cardiac surgery on location are rapidly developing PCI programs in hopes of improving patient care and remaining competitive.

PCIs in hospitals without cardiac surgery backup are often performed for reasons other than immediate treatment of a myocardial infarction and are associated with a higher risk of adverse outcomes, the study found.

"The findings that these non-AMI populations are at higher risk of death--36% higher--when they have their procedures in hospitals without onsite surgery programs is concerning," says David Wennberg, MD, MPH, adjunct associate professor of community and family medicine and of medicine at DMS.

-- Wendy Johnson
wjohnson@hcpro.com

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