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.
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