Are high-quality cardiac surgeons less likely to operate on high-risk patients compared to low-quality surgeons? Evidence from New York State.

摘要

CONTEXT: It is unknown whether high-risk cardiac surgical patients have less access to high-quality surgeons compared with lower-risk patients. OBJECTIVE: To determine whether high-quality surgeons are less likely to perform coronary artery bypass graft (CABG) surgery on high-risk patients compared with low-quality surgeons. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study using the New York State (NYS) CABG Surgery Reporting System (CSRS) of all patients undergoing CABG surgery in NYS who were discharged between 1997 and 1999 (51,750 patients; 2.20 percent mortality). Regression modeling was used to estimate the association between surgeon quality and patient risk of death. Surgeon quality was quantified using the observed-to-expected mortality ratio (O-to-E ratio). RESULTS: Higher-risk patients are more likely to receive CABG surgery from higher-quality surgeons. For every 10 percentage point increase in patient risk of death (e.g., from 5 to 15 percent), there is an absolute reduction of 0.034 in the surgeon O-to-E ratio (p < .001). CONCLUSION: This study suggests that high-risk CABG patients are significantly more likely to receive care from high-quality surgeons compared with lower risk patients.