2017 Articles

Impact of public reporting of 30-day mortality on timing of death after coronary artery bypass graft surgery

Hua, May; Scales, Damon C.; Cooper, Zara; Pinto, Ruxandra; Moitra, Vivek Kumar; Wunsch, Hannah

Background: Recent reports have raised concerns that public reporting of 30-day mortality after cardiac surgery may delay decisions to withdraw life-sustaining therapies for some patients. We sought to examine whether timing of mortality after coronary artery bypass graft (CABG) surgery significantly increases after day 30 in Massachusetts (MA), a state that reports 30-day mortality. We used New York (NY) as a comparator state, which reports combined 30-day and all in-hospital mortality, irrespective of time since surgery.
Methods: We conducted a retrospective cohort study of patients who underwent CABG surgery in hospitals in MA and NY, 2008-2013. We calculated the empiric daily hazard of in-hospital death, without censoring on hospital discharge and used joinpoint regression to identify significant changes in the daily hazard over time.
Results: In MA and NY, 24,310 and 61,925 patients underwent CABG respectively. In-hospital mortality was low, with 524 deaths (2.2%) in MA and 1,398 (2.3%) in NY. Joinpoint regression did not identify a change in the daily hazard of in-hospital death at day 30 or 31 in either state; significant joinpoints were identified on day 10 (95% confidence interval 7-15) for MA and days 2 (2-3) and 12 (8-15) for NY.
Conclusion: In MA, a state with a long history of publicly reporting cardiac surgery outcomes at day 30, we found no evidence of increased mortality occurring immediately after day 30 for CABG patients. These findings suggest that delays in withdrawal of life-sustaining therapy do not routinely occur as an unintended consequence of public reporting.