Ninety-Day Risk-Standardized Home Time as a Performance Metric for Cardiac Surgery Hospitals in the United States. Issue 17 (26th September 2022)

• Record Type: Journal Article
• Authors: Mentias, Amgad; Desai, Milind Y.; Keshvani, Neil; Gillinov, A. Marc; Johnston, Douglas; Kumbhani, Dharam J.; Hirji, Sameer A.; Sarrazin, Mary-Vaughan; Saad, Marwan; Peterson, Eric D.; Mack, Michael J.; Cram, Peter; Girotra, Saket; Kapadia, Samir; Svensson, Lars; Pandey, Ambarish
• Is Part Of: Circulation. Volume 146:Issue 17(2022)
• Page Start: 1297
• Page End: 1309
• Publication Date: 2022-09-26
• Subjects: cardiac surgery -- health metrics -- mortality -- patient readmission -- quality indicators; Blood -- Circulation -- Periodicals; Cardiovascular system -- Periodicals; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Blood Circulation; Cardiovascular System; Vascular Diseases; 616.1
• DOI: 10.1161/CIRCULATIONAHA.122.059496
• Languages: English
• ISSNs: 0009-7322

Abstract

Abstract : Background: Assessing hospital performance for cardiac surgery necessitates consistent and valid care quality metrics. The association of hospital-level risk-standardized home time for cardiac surgeries with other performance metrics such as mortality rate, readmission rate, and annual surgical volume has not been evaluated previously. Methods: The study included Medicare beneficiaries who underwent isolated or concomitant coronary artery bypass graft, aortic valve, or mitral valve surgery from January 1, 2013, to October 1, 2019. Hospital-level performance metrics of annual surgical volume, 90-day risk-standardized mortality rate, 90-day risk-standardized readmission rate, and 90-day risk-standardized home time were estimated starting from the day of surgery using generalized linear mixed models with a random intercept for the hospital. Correlations between the performance metrics were assessed using the Pearson correlation coefficient. Patient-level clinical outcomes were also compared across hospital quartiles by 90-day risk-standardized home time. Last, the temporal stability of performance metrics for each hospital during the study years was also assessed. Results: Overall, 919 698 patients (age 74.2±5.8 years, 32% women) were included from 1179 hospitals. Median 90-day risk-standardized home time was 71.2 days (25th–75th percentile, 66.5–75.6), 90-day risk-standardized readmission rate was 26.0% (19.5%–35.7%), and 90-day risk-standardized mortality rate was 6.0% (4.0%–8.8%). Across 90-day home time quartiles, a graded decline was observed in the rates of in-hospital, 90-day, and 1-year mortality, and 90-day and 1-year readmission. Ninety-day home time had a significant positive correlation with annual surgical volume ( r =0.31; P <0.001) and inverse correlation with 90-day risk-standardized readmission rate ( r =–0.40; P <0.001) and 90-day risk-standardized mortality rate ( r =–0.60; P <0.001). Use of 90-day home time as a performance metric resulted in a meaningful reclassification in performance ranking of 22.8% hospitals compared with annual surgical volume, 11.6% compared with 90-day risk-standardized mortality rate, and 19.9% compared with 90-day risk-standardized readmission rate. Across the 7 years of the study period, 90-day home time demonstrated the most temporal stability of the hospital performance metrics. Conclusions: Ninety-day risk-standardized home time is a feasible, comprehensive, patient-centered metric to assess hospital-level performance in cardiac surgery with greater temporal stability than mortality and readmission measures.