Health Care Quality Assessment

Heart disease is the leading cause of death among both men and women in the United States. The most common form of heart disease is coronary artery disease.

Coronary artery disease occurs when the arteries that carry blood and oxygen to the heart muscle become clogged, partially blocked or narrowed by the buildup of fatty deposits (cholesterol and plaque) on the artery walls. This can lead to chest pain (angina), which is a warning sign for a heart attack. A heart attack occurs when a coronary artery is totally blocked. Over time, coronary artery disease can also weaken the heart muscle and contribute to heart failure and arrhythmias.

Treatment for coronary artery disease will vary for different patients. If lifestyle changes and other alternatives are not enough, your doctor may recommend that you have coronary artery bypass (CABG) surgery.

CABG surgery is a type of surgery performed by heart surgeons. It involves taking a vein from another body part and transplanting it into the patient’s heart so that the blood can go around (or bypass) the blockage. Because CABG surgery is a licensed service, not all New Jersey hospitals perform this type of surgery.

To receive this license, hospitals must undergo a rigorous review and certification process from the New Jersey Department of Health (NJDOH). Eighteen New Jersey hospitals are licensed to perform CABG surgery.

Check with your doctor to see if there are other surgery and non-surgery options available to treat your condition.

The measures listed below show how well hospitals are providing care for patients undergoing CABG surgery. One way to measure the quality of CABG surgery is to look at the patient outcome after the surgery, in this case the mortality or death rate.

Every CABG surgery patient admitted to a hospital has a different risk of death based on their health, age and other characteristics. Some hospitals treat sicker patients than other hospitals. In order to account for these differences and allow for hospitals to be fairly compared, the mortality rates are “risk adjusted”, a statistical method that allows hospitals to be compared fairly. This means that the data is adjusted, or standardized, to account for differences in a patient’s health before surgery. It also accounts for differences in the patient’s age, race, sex and patient’s history of previous operations.

A 95% Confidence Interval indicates that we are 95% confident that the hospital’s true mortality rate falls within the range displayed. There is, however, a 5% chance that the hospital’s true mortality rate can fall outside the range displayed.

For instance, imagine that Morristown Memorial Hospital’s mortality rate is 1.29 percent, and that they performed 542 CABG surgeries with a 95% confidence interval of 0.47 to 2.81 percent. In statistical terms, this means that we are 95% confident that the hospital’s true mortality rate will not fall below 0.47 percent nor go above 2.81 percent (deaths per 100 surgeries). 

For more details, visit the most recent Cardiac Surgery Report.

The measures also include the number of CABG surgery cases performed by each NJ hospital. Many national and local studies have shown that, in general, hospitals that perform bypass surgery more often have better outcomes. This measure is also considered an outcome.

All CABG surgery measures are based on all New Jersey cardiac surgery patients 18 years or older for 2011. Lower rates are better and mean fewer deaths.

CABG Surgery Mortality

THIS RATE TELLS YOU the percent of cardiac surgery patients who died while in the hospital following CABG surgery or died within 30 days from the date of their CABG surgery. These patients did not undergo any other major procedure. Lower percentage indicates fewer deaths.

THIS INFORMATION IS IMPORTANT because it tells you how well the hospitals take care of their cardiac patients who undergo CABG surgery. Lower mortality scores are better, mean fewer deaths and show better quality care.

Number of Cases by Hospital

THIS NUMBER TELLS YOU how many CABG surgery operations the hospital had performed during the year.

THIS INFORMATION IS IMPORTANT because research supports that, in general, treating a higher number of patients means more experience and is related to better outcomes. However, there are many hospitals that do not treat a lot of patients but have good outcomes, and other hospitals that treat a high number of patients and do not have good outcomes.