Bypass study boosts small hospitals

Patients who undergo heart bypass surgery are just as likely to survive whether the operation is performed at a smaller community hospital or a major teaching medical center in Massachusetts, according to a report card released yesterday by state public-health authorities.

Statewide, nearly 98 of every 100 patients who had bypass surgery were still alive a month after the operation, and there was no statistically relevant difference in survival rates among the 13 hospitals performing bypasses in 2002, the year covered by the report. Compared with three other Northeastern states that collect data in a similar fashion, Massachusetts had slightly better survival rates.

The study, which reviewed 4,603 bypass surgeries, marked the first time that the Department of Public Health had attempted to measure how well hospitals perform the procedure, among the most common surgeries in the United States and the same operation that Bill Clinton underwent last month at a New York hospital.

Public-health authorities cautioned yesterday that the report card, which will be released annually, provides just an initial snapshot of how the community hospitals fared. Because the report reflects only their early months of operation and relatively few cases, more data will be needed to make sweeping conclusions.

The report card was mandated in 2000 by the state Legislature when it directed the public-health agency to oversee the creation of open-heart surgery programs at three smaller hospitals, ending a protracted battle to win the right to perform procedures considered among the more profitable in healthcare. Legislators wanted assurance that patients opting for surgery at smaller hospitals in Hyannis, Salem, and Charlton would fare as well as patients undergoing bypass at the iconic Boston teaching hospitals.

"We didn't see anything that was a source of concern," said Sharon-Lise T. Normand, a Harvard Medical School researcher who conducted the review for the state. "Basically, we're saying there were not statistically significant differences among the hospitals. That's the bottom line."

The public-health agency commissioned the Harvard researchers to examine data submitted by hospitals on deaths among patients who had recently undergone coronary artery bypass surgery. In an effort to provide apple to apple comparisons, the researchers took into account in their calculations the severity of patients' medical condition.

After making those adjustments, the Harvard team reported that the 13 hospitals performing the procedure in 2002 had roughly comparable death rates, ranging from 2.08 percent at Tufts-New England Medical Center in Boston to 2.58 percent at UMass Memorial Medical Center in Worcester.

"For consumers, I would strongly stress that the numbers are so small that it's very hard to even interpret what they mean in terms of differences," said Dr. Walter H. Ettinger, president of UMass Memorial.

Cape Cod Hospital in Hyannis began performing bypasses in August 2002 while the Southcoast Hospitals system in Charlton started in spring of that year, according to state officials. Those hospitals performed relatively few of the operations -- Cape Cod, for instance, had just 26 cases -- but reported mortality rates nearly identical to the state average.

Heart surgeons at both Cape Cod and Southcoast -- as well as at North Shore Medical Center in Salem, which began performing bypasses last year and, thus, is not included in the current report card -- collaborate closely with specialists from major teaching hospitals. The chief of cardiology at Cape Cod, for instance, came from Brigham and Women's Hospital, and patients with especially complex conditions have been referred for treatment to the Boston hospital.

"Particularly in the early months of the program, Cape Cod and the Brigham carefully reviewed each case and made decisions about where the case was going to be done," Cape Cod chief operating officer Margy Hanson said.

Government agencies as well as insurers and large employers in recent years have become more aggressive in attempting to measure the quality of healthcare services they purchase. A pivotal component of such assessments, said one specialist in the field, is attempting to make fair comparisons among hospitals so that institutions aren't penalized for taking on complicated cases.

"We have to take account of how sick their patients are and other characteristics that will impact their likelihood of surviving," said Suzanne Delbanco, chief executive officer of the Leapfrog Group, a coalition of more than 160 large healthcare purchasers working to improve health quality. "So it's very important that we account for the cases each hospital sees so that our comparisons are meaningful to a patient who's trying to choose a hospital."

Because the differences in mortality rates among hospitals were so slight, cardiac specialists said it would be inappropriate for patients to use the data to compile a best and worst list.

"Looking at it as a top 10 list on a yearly basis is not a useful exercise," said Dr. David F. Torchiana, a heart surgeon at Massachusetts General Hospital.

Delbanco said that while the mortality figures should prove useful for consumers, they don't provide a complete portrait. The state report card does not tell consumers about the quality of life enjoyed by patients who survive. Rating initiatives such as Leapfrog endeavor to take a wider array of issues into account. The state does not have plans to expand its review of bypass beyond mortality rates.

"I would want to know more than just that factoid about mortality," Delbanco said. "I would want to know: What's my likelihood of suffering a complication? What's the average length of stay? What's the patient experience like?"

Stephen Smith can be reached at stsmith@globe.com.