"You may have people who are doing 10 cardiac surgeries a year. Ours are doing 100 cardiac cases a year," Khan says. "We also work with the perfusionists to make sure they maintain adequate pressure,"
The state's report says that risk adjusted post-operative stroke rates for five hospitals were worse than average:
In a letter to the state agency, Robert Adamson, MD, medical director of the cardiac transplant program at Sharp, says that in 2006, "we noted an unusual cluster of six strokes. Each case was individually reviewed and no trends or common causes could be identified," but "strongly influenced our results for the two-year period."
He says that in 2007, the incidence of stroke in this population was half that in 2006 and zero in 2008. "In view of this, we feel that the rating, while accurate in number, does not reflect our current performance in this area."
For Harbor-UCLA, Bassam Omari, MD, chief of the division of cardiothoracic Surgery, wrote the agency explaining that the hospital has discovered discrepancies in risk factors reported for its CABG patients, which "adversely affected our expected mortality and morbidity."
Other reasons for Harbor-UCLA's high rates, he wrote, dealt with the high number of Jehovah's Witnesses "whose beliefs preclude our ability to provide life-saving blood transfusions" and said the hospital failed to adequately count those patients who had a prior stroke, which put them at greater risk.