Death rates associated with heart bypass operations, gallbladder removals and three other common surgeries varied tremendously among California hospitals in 1985, according to a Times analysis of data covering nearly all patients hospitalized in the state.
At seven hospitals, more than 1 in 10 bypass surgery patients died after the operation, compared to the statewide average of fewer than one in 20. These hospitals included Hollywood-Presbyterian Medical Center, Daniel Freeman Memorial Hospital in Inglewood and UC Medical Center San Francisco. Five others, including two in San Diego, had significantly low bypass surgery death rates.
For gallbladder surgery, six hospitals had death rates more than four times the state average death rate of 1.6%. By comparison, 22 hospitals that performed large numbers of the operation, including County-USC Medical Center and three Kaiser Foundation hospitals, had death rates of less than 0.6%.
These are among the conclusions from a computerized hospital-by-hospital analysis of surgical death rate data by the Los Angeles Times Poll in collaboration with expert consultants from the Institute for Health Policy Studies at UC San Francisco.
Guide to Quality of Care
"These kinds of data are useful markers for the quality of care provided in hospitals," said Jonathan A. Showstack, one of the three UCSF experts retained by The Times. "Hospitals should be expected to provide additional information to explain their high mortality rates."
The data may help patients discuss with their physicians where to undergo specific surgical procedures. The federal Medicare program and private insurance carriers have said they are studying the use of such statistics to help identify the hospitals that will qualify for reimbursement for certain complex procedures, such as heart bypass surgery.
Some hospitals with above-average death rates vehemently denied that their statistics pointed to potential deficiencies in their quality of care. But some facilities acknowledged that they had been motivated to improve their performance.
"We are not happy with these numbers, looking at them, either," said Sandi Chester, a Hollywood-Presbyterian vice president, of the hospital's 14.6% death rate for heart-bypass surgery in 1985, more than three times the state average of 4.6%. Chester said the 395-bed facility is in the process of substantially retooling its cardiology and cardiac surgery programs.
Some Lessons Seen
"There is clearly in this some self-education," said Dr. George Stefanik, a cardiac surgeon at Daniel Freeman. Hospital statistics show that the bypass surgery mortality rate decreased from 12.2% in 1985 and 13.0% in 1986 to 5.6% in 1987.
Bypass surgery death rates also decreased by about 50% between 1985 and 1987 at UCLA Medical Center and Pacific Presbyterian Medical Center in San Francisco--two hospitals that have heart transplant programs and reputations for operating on high-risk patients turned down by surgeons at other hospitals.
The Times analysis covers about 106,000 patients who underwent five common surgeries--heart bypass, gallbladder removal, prostate resection, total hip replacement and carotid endarterectomy--in 1985, the most recent year for which complete information is available.
It is based on computer tapes compiled by the Office of Statewide Health Planning and Development. The data is supplied and verified by individual hospitals and is "among the most accurate data of this type," Showstack said.
The Times compared the mortality rates for individual hospitals to the statewide average, after correcting for variations between hospitals in the age, sex and race of patients. The death rates indicate the percentage of patients receiving a particular surgery who die in the hospital out of all such patients who are admitted.
This analysis attempts to improve upon other widely publicized hospital death-rate disclosures in recent years by such groups as the federal Health Care Financing Administration and California Medical Review. This is because it includes all adult patients, not just the elderly and disabled, and because it focuses on specific procedures, not broad heterogenous categories of illnesses.
For heart bypass and gallbladder surgeries, the analysis also corrected for some of the factors that may cause some patients to be sicker than others before an operation, such as the percentage of patients with acute heart attacks or the percentage with cancer.
Despite such improvements, the UCSF consultants and hospital officials caution that other factors are also important in judging the quality of surgical care. Among these are more complete data about the pre-operative condition of patients and post-operative complications, such as that contained in confidential medical records. A high death rate at a hospital does not necessarily indicate bad performance, nor a low death rate good performance.