Nearly one-sixth of California hospitals with heart surgery programs had significantly high death rates for heart bypass patients in 1986, according to a Times analysis of data covering nearly all such operations in the state.
At 10 of these hospitals, the percentage of bypass surgery patients who died before leaving the hospital was at least double the statewide average death rate of 5.3%. The facilities included Valley Presbyterian Hospital in Van Nuys, Daniel Freeman Memorial Hospital in Inglewood, Hollywood Presbyterian Medical Center, and two hospitals in Long Beach.
Most of the hospitals with the highest death rates had relatively few bypass operations, suggesting, according to some experts, that patients might be better off at busier heart surgery hospitals.
Some Had Low Death Rates
Eight other institutions, including three in Los Angeles and one in San Diego, had significantly low bypass surgery death rates.
The Times analysis also revealed tremendous variations in typical hospital charges for bypass patients--from a high of nearly $59,000 a case at Hollywood Presbyterian to a low of about $16,000 a case at nearby St. Vincent Medical Center in Los Angeles, the busiest bypass surgery hospital in the state. The statewide median charge was $27,700.
The Times prepared the computerized hospital-by-hospital study of heart bypass surgery in collaboration with expert consultants from the Institute for Health Policy Studies at UC San Francisco.
"These data can help to point out hospitals with possible problems with quality of care," said Jonathan A. Showstack, a UCSF associate professor of health policy and one of three experts retained by The Times. "Patients and physicians have a right to know these data. Hospitals with high mortality rates should be asked to provide explanations."
Almost all of the hospitals with high death rates said that their statistics reflected a high number of difficult cases, not quality-of-care problems. But Dr. John W. Kirklin, who is considered an expert on the subject, said bypass surgery patients at most hospitals are "more alike than different" and explanations of high death rates based on sicker patients are "usually not easy to support."
With a typical mix of patients, a hospital's mortality rate for bypass surgery ought to be about 3.5% to 4% in 1988, said Kirklin, a professor of cardiac surgery at the University of Alabama at Birmingham, who has reviewed the performance of a number of institutions. "Some people will object that this mortality rate is not realistic. But for programs of undoubted merit, that figure is probably pretty reasonable."
Among The Times' most significant findings are the lower death rates at hospitals that had many bypass surgeries compared to facilities that performed fewer surgeries.
The average death rate varied from 4.3% for hospitals with more than 350 surgeries during 1986 to 7.4% for those with fewer than 100 surgeries. The state's 23 lowest-volume hospitals included 13 in Los Angeles County.
More Cases, Lower Rate
The average death rate was 5.2% for facilities with between 200 and 350 surgeries and 6.8% for those with between 100 and 200 cases.
Because of the relationship between high volume and low mortality, a significant number of deaths might be prevented by concentrating heart surgery in a smaller number of busier hospitals, Showstack said. "The data imply that low volume hospitals probably should not be doing heart surgery," he said.
The Times analysis covers 18,315 adults who underwent heart bypass surgery in 1986, the most recent year for which complete information is available. (The Times published a similar analysis of 1985 data on heart bypass and four other common surgeries in March.)
This expensive, technically complex and frequently performed operation is considered one of the most important to study in assessing the quality of hospital care. Surgeons restore an adequate blood supply to heart tissue by grafting blood vessels from elsewhere in the body around blockages in the arteries supplying blood to the heart.
The analysis 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 considered highly accurate; in addition, the data were reconfirmed with all the hospitals with high death rates.
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 bypass patients who died in the hospital out of all such patients who were admitted.