CASTS update on public reporting: Comments Requested!

Cardiothoracic surgeons in California are at a crossroads with regard to public reporting in cardiac surgery.   The Clinical Advisory Panel of the California CABG Outcomes Reporting Program (CCORP) recommended in 2013 that no additional surgical procedures be added to the report without including percutaneous interventions, such as PCI.  However, the new panel voted last year to include CABG-valve procedures as part of the mandate to report on “all” CABG surgery.  A risk model was approved at the February CCORP meeting.

Reporting CABG-valve without reporting other valve procedures will be problematic for several reasons.  Risk adjustment will be less reliable in view of the lower case volumes combined with wide variation in patient risk factors.  Statistical significance will be rare because most hospitals have low volume.  Unintended consequences might include a tendency to omit adding CABG to a valve procedure to avoid inclusion in the report, or avoiding high risk cases and recommending PCI or medical treatment instead of surgery.

The CASTS successfully lobbied for assistant fees last year, but attempts to expand public reporting to PCI failed in the legislature due to budget concerns.  We have updated the CASTS reporting program, the California Cardiac Surgery and Intervention Project (CCSIP), through 2013.  A 2014 update is scheduled this summer.  The website (www.californiacardiacsurgery.com/CCSIP2013) shows hospital procedure volumes for CABG, PCI and all cardiac surgical procedures.   A participation fee is required to access outcome data for isolated CABG, PCI, CABG-valve and isolated valve procedures.  We strongly recommend that cardiac surgical programs make use of this important resource to follow their comparative outcomes and see how a future report might look.

We need your input.  Please click on the comment balloon above and post your comments.  We will carry your responses to the CCORP Clinical Advisory Panel, to OSHPD and any other appropriate stakeholders.

 

2 thoughts on “CASTS update on public reporting: Comments Requested!

  1. We had a discussion today about a case of PCI going down 3 days post procedure, with subsequent AMI and ruptured papillary muscle requiring emergency surgery. The patient was in extremis and did not survive. This may be counted as a surgical death but is really a consequence of PCI as intent-to-treat. This is just one example of the problems that reporting CABG-valve procedures will create when PCI goes unreported.

  2. As a patient advocate in the community and spouse to someone who had a mitral valve replacement in California at 43 years old I am disheartened by our state’s decision not to expand its public reporting to include PCI and stand alone heart valve surgeries. With an aging population and more heart valve surgeries being performed it is imperative that the public is able to make informed decisions about their care. This decision leaves patients in California requiring a heart valve surgery or PCI procedure vulnerable to current best practices.

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