California has recently become the first state to report hospital data on rate of stroke in patients after coronary artery bypass graft (CABG) surgery, and the results show a wide variation among 121 hospitals.
The new measure comes in the state's regular hospital data report for 2007 on CABG mortality, which has been issued eight times since 2001 when the first report covered hospital performance for 1998-99.
Joe Parker, director of healthcare outcomes for the California Office of Statewide Health Planning and Development, which issued the report, says that stroke was included this time in the CABG data because better hospital practices can reduce the number of patients who develop the complication, a known risk factor in these procedures.
"We want to be selecting something over which there is a possibility of control and improvement by a hospital," he says. "Stroke was selected because it is an important negative outcome of CABG surgery, and one that has a huge impact on families of those who care for stroke victims, as well as on the patients."
Of the 121 hospitals in the state that perform bypass graft surgery, one hospital had the lowest rate of stroke complications, Alta Bates Summit Medical Center, Summit Campus, a 337-bed hospital in Oakland.
Parker says that he visited with Russell Stanten, MD, cardiothoracic surgeon at Alta Bates, to learn what the hospital does to prevent stroke in these patients. He says Stanten replied that the hospital screens each patient for carotid disease, "and if they find it they deal with it prior to the CABG surgery." Additionally, Alta Bates surgeons also make sure the patients have transesophageal echocardiograms performed intraoperatively.
Additionally, Junaid Khan, MD director of cardiovascular services at Alta Bates, says a crucial reason for the hospital's success is in making sure that every anesthesiologist on a CABG case is board certified in echocardiography. The hospital, which does about 800 open heart procedures a year—many of them CABG—also limits the number of anesthesiologists and others who are allowed to work on these patients only "to those who do a lot of them."