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Equalization Of Risk-adjusted In-hospital Mortality For PCI And CABG In California
J. S. Carey*1, B. Danielsen2, B. E. Stabile1. 1Harbor-UCLA Medical Center, Torrance, CA, 2Health Information Solutions, Sacramento, CA,
BACKGROUND:
PCI is increasingly used to treat multivessel coronary artery disease. CABG procedures have decreased, and PCI increased, as a result. The overall impact of this treatment shift is uncertain. We examined the operative mortality (OM) rates for these procedures in Cailfornia using a combined risk model.
METHODS:
The confidential data set of the Office of Statewide Health Planning and Development Patient Discharge Database (PDD) was queried for 1997-2006. A risk model was developed using ICD-9-CM procedure and diagnostic codes from the combined pool of isolated CABG and PCI procedures performed during 2005-2006. OM was defined as in-hospital mortality, corrected for "same day" transfers to another healthcare facility to include 30 day deaths.
RESULTS:
CABG volume decreased from 28,249 (1997) to 14,782 (2006) while PCI volume increased from 37,964 to 52,769. OM for CABG decreased from 3.70% (1997) to 2.05% (2006) while OM for PCI remained stable at 1.6%. Expected mortality, predicted from the 2005-2006 risk model, increased 50% from 1997 to 2006 for both PCI and CABG. Risk adjusted mortality rate (RAMR) decreased markedly for CABG and slightly for PCI.
CONCLUSIONS:
This study shows that as volume shifted from CABG to PCI, expected mortality increased for both procedures. However, operative mortality decreased, nearly equalizing for the two interventions. Overall, RAMR decreased for patients undergoing coronary revascularization procedures in California during 1997-2006.
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