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Hospital Level Reports
VOLUME & MORTALITY INDICATORS FOR INPATIENT PROCEDURES (bar charts and tables)
Medical articles and journals have suggested that, for some complex medical and surgical procedures, outcomes for patients may be better in hospitals where doctors perform such procedures regularly, rather than occasionally. Better quality may be associated with greater volume, however, low-volume providers may have excellent outcomes. Since volume alone is not an outcome (result) measure, where possible, volume indicators should be evaluated along with mortality indicators (outcome measures) for the same procedure. The volume measures report the number of times the procedure is performed in the hospital.
The mortality indicators report the percentage of patients who died at a hospital after undergoing a specific type of surgery. Patients transferred to another hospital or with incomplete discharge information are not included in the mortality charts. Better quality may be associated with lower mortality rates. Less frequently performed procedures have less comparative performance to report. (PDF format)
The esophagus is the tube that carries food from the mouth to the stomach. It sometimes has to be removed, usually due to cancer. Surgery on the esophagus is difficult, and requires an experienced surgeon and surgical team. The removal of the esophagus involves manipulation of vital organs in both the chest and the abdomen, together with reconstruction of a way to replace the function of the esophagus. This procedure is rarely done and few hospitals do even one such operation in a year. Patients transferred to another short-term hospital or with incomplete discharge information are excluded. Because this surgery is not done often, caution should be used in comparing hospital performance based on these rates.
The pancreas is an organ that lies deep in the abdomen and produces digestive enzymes and important hormones such as insulin. If cancer develops in the pancreas, removing the organ by surgery may be life saving. Surgical removal of the pancreas is a demanding operation in which complications and death occur even in the most experienced of hands. This may be the only treatment option for those with cancer of the pancreas. This procedure is rarely done and few hospitals do even one such operation in a year. Patients transferred to another short-term hospital or with incomplete discharge information are excluded. Caution should be used in comparing hospital performance based on these rates.
Abdominal Aortic Aneurysm (AAA) Repair
An aneurysm is a defect or swelling in the wall of a weak or damaged artery. The abdominal aorta is the major blood vessel from the heart that supplies blood to most of the major organs and the legs. Aneurysms can form in the aorta, the main artery carrying blood from the heart. Aneurysms that occur in the part of the aorta within the abdomen are called abdominal aortic aneurysms. When the vessel swells to a certain size, it is likely to rupture, often causing death. This may be prevented by repair of the swelling before it bursts. In some cases, once the aneurysm has burst, the patient may be saved by emergency surgery to repair the vessel. Patients requiring this procedure may have disease of other major vessels as well, which may lead to stroke or heart attack during or after the major surgery required to repair the abdominal aorta. This surgery usually is performed by surgeons who specialize in repair of blood vessels, and at hospitals where other specialists are available to deal with the expected complications. The type of aneurysm and other patient-related factors greatly affect the mortality rate for this procedure. Patients transferred to another hospital or with incomplete discharge information are not included.
Coronary Artery Bypass Graft (CABG)
A coronary artery bypass graft (CABG) is a surgical procedure to reroute or “bypass” blockages in the arteries that carry blood to the heart. A CABG may be done to reduce chest pain, prevent heart attack or to treat other heart problems caused by blockages in the coronary arteries. Studies have shown that higher volumes may be associated with better patient outcomes. Thousands of bypass surgeries are performed each year and the death rate is relatively low. However, this relatively common procedure requires skill in the use of complex equipment. Patients transferred to another hospital or with incomplete discharge information are not included.
Percutaneous Transluminal Coronary Angioplasty (PTCA)
This procedure is a minimally invasive procedure done to open blockages in the arteries that carry blood to the heart muscle. A thin tube is threaded through a major blood vessel in the leg up to the heart, and a small balloon or other device on the tip of the tube is used to reduce or eliminate the blockage. The procedure may be done to reduce chest pain, prevent or treat heart attacks, or to treat other heart problems caused by blockages in the coronary arteries. It requires proficiency with the use of complex equipment, and technical errors may lead to clinically significant complications. The procedure is frequently done on an outpatient basis and this report is limited to the number of times the procedure was performed on hospitalized patients only.
The carotid arteries are the major arteries in the neck, which carry blood from the heart to the brain. If blockages develop in these arteries, stroke or other brain problems can result. Carotid endarterectomy is a surgery to remove blockages from these arteries and reduce the chance of stroke. It is a fairly common procedure that requires proficiency with the use of complex equipment. Complications can result in stroke, heart attack or death. Patients transferred to another hospital or with incomplete discharge information are not included.
Craniotomy is the surgical opening of part of the cranium, or skull, to gain access to the underlying structures, the brain, the meninges (protective membranes covering the brain), and the blood vessels. This surgery is performed to remove a brain tumor, repair an aneurysm (ballooning of blood vessels), inspect the brain, perform a biopsy (removal of tissue for microscopic examination to establish a diagnosis), or relieve pressure inside the skull. It is a demanding operation that is sometimes associated with high risk of disability or death. The mortality rate for this operation may be high even in the hands of an extremely experienced neurosurgeon and neurosurgical team. The adjustments used in this report to equalize "risk" may not fully reflect the many types of risk associated with this complex surgery, which often is performed on an emergency basis.
Hip Replacement Mortality
Planned replacement of a diseased hip joint with an artificial joint is a common procedure to treat disabling pain or improve hip function. The mortality rate is low for this procedure, as would be expected in a procedure designed to improve function rather than extend life. The patients are often elderly, and many have multiple medical conditions. The cases for this indicator are undercounted, resulting in a higher than actual mortality rate. The results should not be compared with earlier years.
MORTALITY INDICATORS FOR INPATIENT CONDITIONS (bar charts and tables)
This section reports the percentage of patients who died at a hospital while being treated for each condition. Better quality may be associated with lower mortality rates. (PDF format)
Acute Myocardial Infarction (AMI) Mortality
A heart attack is called a myocardial infarction. Myocardial means heart muscle, and infarction means an area of tissue death due to lack of blood supply. Heart attacks occur when an artery to the heart (a coronary artery) becomes blocked. A heart attack is a life-and-death emergency. According to the American Heart Association, if a heart attack victim gets to an emergency room fast enough, prompt care dramatically reduces heart damage. Detailed practice guidelines covering all phases of heart attack management have resulted from research. This report does not consider how quickly the patient began receiving medical treatment. Patients transferred to or from another hospital are not included.
Congestive Heart Failure (CHF) Mortality
CHF is one of the most common and severe heart diseases affecting Americans, and one of the most common reasons for hospitalization. Congestion is the presence of an abnormal amount of fluid in the tissues, usually because of limitations in the body’s ability to return the flow of blood from the arms or legs to the heart and lungs. Though CHF has many possible underlying causes, the end result is an inability of the heart muscle to function well enough to meet the demands of the rest of the body. CHF mortality is influenced greatly by other medical problems, including lung disease, high blood pressure, cancer and liver disease.
Acute Stroke Mortality
A stroke is a disruption in the blood supply to the brain. A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts, or is clogged by a blood clot or some other particle. Because of this rupture or blockage, part of the brain doesn’t get the flow of blood it needs, and the nerve cells in the affected area of the brain cannot function. When nerve cells cannot function, neither can the part of the body they control. The effects of stroke often are permanent because dead brain cells are not replaced. Mortality rates will vary based on the cause of the stroke, the severity of the stroke, other patient illnesses and speed of arrival at the hospital. Some advanced treatments may be helpful only in the first few minutes or hours following the onset of the stroke, and this report does not consider that information.
Gastrointestinal (GI) Hemorrhage Mortality
GI hemorrhage is the loss of blood from the gastrointestinal tract: the esophagus, stomach, small intestine or colon. While many cases are relatively minor, some are life threatening or fatal. The risk of death is primarily related to the reason why the bleeding began, along with patient factors, such as age and other illnesses. The evidence for substantial variance in mortality rates due to provider performance is weak. This indicator should be interpreted with caution.
Hip Fracture Mortality
Hip fractures are a common cause of morbidity and functional decline among elderly persons. Complications of hip fracture and other medical conditions can lead to a relatively high mortality rate, and evidence suggests that some of these complications are preventable. Elderly patients often have other medical conditions and pre-fracture functional impairments. As a result, they are at significant risk of postoperative complications, which—if not recognized and effectively treated—can lead to life-threatening problems.
Pneumonia is a medical condition involving an infection in the lungs. An irritation to the lining of the lungs causes fluid to collect, often making breathing difficult. Pneumonia typically is treated with antibiotics, sometimes in an outpatient setting. However, death may occur even when the patient is in the hospital, especially in patients with weakened respiratory systems or other chronic health problems. There is a significant impact from patient factors and admitting practices (whether your doctor thinks you need to be in the hospital or not).
UTILIZATION INDICATORS (bar charts and tables)
This section of indicators reflects the use of certain procedures about which questions have been raised about overuse or underuse. While there is no "correct" frequency for performing procedures included in this section of the report, high or low rates may raise questions that should be discussed with your doctor and hospital. (PDF format)
Primary Cesarean Section Delivery Rate
Cesarean section (C-section) is the surgical removal of the baby through the mother's abdomen. Whether or not the procedure is necessary and appropriate depends largely on each individual's clinical characteristics. The decision is usually a joint one between the patient and her doctor. Babies in the breech (buttocks first) position, prior C-section(s), the number of previous births, placental or umbilical cord complications, infections and high or low birth weight are factors that may cause a woman to have a C-section, according to the American College of Obstetrics and Gynecology, but women with abnormal presentation, preterm delivery, fetal death, more than one baby, or previous C-section are not included in this calculation. Hospitals that serve as referral centers for high risk pregnancies, those with intensive care units for very sick babies, and those serving mothers who have not had the benefit of prenatal care can be expected to have higher C-section rates.
Vaginal Birth After Cesarean (VBAC), Uncomplicated Rate
Just because a woman has had one Cesarean section (C-section) delivery does not necessarily mean she must deliver future babies by C-section. Many women have normal deliveries even though they had a C-section in the past. This report provides information on the proportion of vaginal births that occurred to mothers who had delivered previously by C-section. Mothers with abnormal presentation, pre-term delivery, fetal death, or more than one baby are not included in this calculation. This indicator must be viewed with caution, as there is some evidence that standards of care are changing in this complex area.
Laparoscopic Cholecystectomy Rate
Cholecystectomy (surgical removal of the gall bladder) is now performed with a laparoscope in most uncomplicated cases. The majority of these procedures are done on an outpatient basis. In less severe cases, the laparoscopic technique is associated with fewer complications than the traditional open method. However, the laparoscopic technique might not be possible due to patient condition or anatomy. Since this report includes only those cases that are performed on hospital inpatients, it does not present a complete picture of the occurrence of this procedure. The rate provides useful information on hospital practice patterns on cholecystectomies, but high or low rates are not in themselves indicators of good or poor quality. Rather, low rates might reflect the share of procedures performed on an outpatient basis, and high rates might in some cases reflect the removal of gall bladders from patients with marginal clinical indications to undergo cholecystectomy.
- The data for this indicator are not included in this report. You may request a copy of the results. The rates should be used with caution.
Incidental Appendectomy in the Elderly Rate
Removal of the appendix (appendectomy) at the same time other necessary abdominal surgery is being done (incidental) is intended to eliminate the risk of future appendicitis. Appendicitis is a severe inflammation of a small bulging pouch at the beginning of the large intestine. Because it is thought to be an unnecessary organ past age two, it often is removed when an adult patient is having other needed abdominal surgery simply to remove the possibility of developing appendicitis, which can be difficult to diagnose, later in life. However, incidental appendectomy is not recommended in the elderly because they have both a lower risk for developing appendicitis and a higher risk of complications after surgery. This indicator reports the number of incidental appendectomies performed on patients age 65 or older.
Bilateral Cardiac Catheterization Rate
Cardiac catheterization is a diagnostic test that can show if blood vessels to the heart are narrowed or blocked. Most people only need it done on the left side of their heart. A liquid dye is injected into the arteries of the heart through a catheter, a long narrow tube that is fed through an artery, usually in the thigh, to arteries in the heart. As the dye fills the arteries, they become visible on X-ray and reveal any areas of blockage. To identify coronary artery disease, the test is performed on the main arteries feeding muscles on the left side of the heart, which is the major pumping chamber. It is not routinely performed on the right side without specific clinical indications. Administrative data used to develop this report may not contain adequate information to indicate the clinical need for this procedure. This indicator reports the proportion of patients who received heart catheterization on both sides of the heart.
Developed by THCIC using Inpatient Quality Indicators software, Version 4.1, released December 2009 by the Agency for Healthcare Research and Quality.
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