When It's Surgery on Your Heart, 
Ask Lots of Questions First

There have been many advances in treatment options for patients with heart problems.  Drugs and lifestyle changes may help to relieve symptoms, but some patients may require open heart surgery.  This is an extremely invasive procedure with a small but significant mortality risk.  To be sure that open heart surgery is appropriate for you, review all treatment alternatives with your doctor.

In choosing the best treatment option with your doctor, be sure to ask these important questions:

1. What are your options, both surgical and non-surgical?
2. What are the benefits versus the risks of the recommended treatment?
3. Is open heart surgery the best treatment for your particular condition?

If you decide on open heart surgery, quality, not convenience, should be your major concern.  Your choice of hospital and doctor is important since there may be significant quality and mortality differences among hospitals and surgeons.

Published research studies discuss the quality differences among open heart surgery programs.  These studies show that open heart surgery patients tend to have better survival rates at hospitals doing more of these operations.  Low-volume programs (typically new ones) often have lower survival rates, although some low volume hospitals have good results, and some high-volume hospitals have poor results.  

The old adage, "Practice makes Perfect," is correct!

Medical researchers interested in reducing mortality and promoting quality outcomes have developed minimum volume recommendations for various surgical procedures, including open heart surgery. Their work indicates that patients generally fare better when treated at hospitals that care for lots of patients with the same problem.  Based on that research, in 1993, the State of Michigan increased its annual minimum volume requirements for new open heart surgery programs. New programs must perform at least 300 adult surgeries by the third year of operation;  surgeons must perform at least 50.

More recently, a March 2000 article in the Journal of the American Medical Association indicated that even higher volumes (at least 500 cases annually) correlate with lower mortality.  The article reported "Evidence exists that high-volume hospitals have lower mortality rates than low-volume hospitals" for coronary arty bypass graft surgeries (CABGs), which comprise almost all open heart surgeries.  

In addition, hospitals in Medicare's Centers of Excellence cardiovascular demonstration project must perform at least 500 CABGs/valve replacements annually.  Surgeons must do at least 125 cases.

Ask these questions before selecting the hospital and surgeon:

1. How many procedures does the hospital and surgeon perform annually?  How does that compare with other hospitals and surgeons??
2. What are mortality and complication rates for the hospital and surgeon, allowing for severity of patients' conditions?  How doe those compare with other hospitals and surgeons?
3. Does the hospital have a full range of serves for diagnosis and treatment of heart and related problems?
4. What is the surgical team's experience, including nurses and technicians;  how often does the team work together?
5. Insurance plans vary.  Ask your company or union health plan administrator about your health benefit coverage.

Selecting a hospital and surgeon for open heart surgery should be based on standardized, severity-adjusted, publicly-available, hospital-specific and surgeon-specific comparative outcome data.  However, until that information is available in Michigan, as it is in some states, patients should look at "total number of heart surgeries" as an important indicator of potentially greater safety and higher quality.

Michigan has 14 open heart programs (out of 27) with 3-year averages above 500 cases annually.  The programs are well-distributed around the state.

Published data on open heart surgery volumes are available.  The following charts list all Michigan hospitals with open heart surgery programs and their annual number of surgeries.  To encourage questions about consistency, hospital volumes for each of the last three years are shown, along with the average for those years.

Remember, pick a high volume hospital and surgeon, unless you and your doctor are given strong evidence that another choice will assure you of the best quality outcome with the lowest risk.

For the following hospitals, the 3-year average volume is at or ABOVE state minimum:

For the following hospitals, the 3-year average volume is at or BELOW state minimum:

+ Starting 2/13/93, for new adult programs to receive Michigan Department of Community Health approval, Certificate of Need (CON) Standards require annual minimum of 300 surgeries from the third year of operation onward.  For new pediatric programs (patients under age 15) CON minimum requirements since 1988 has been 100 cases by the third year of program.  Most older programs, (adult and pediatric) however, are not required to meet these higher 1993 minimums and in some cases not even lower minimums. because these programs were initiated before effective date of the applicable COM Standards or prior to any CON requirements being in effect.
* Data reported by all non-VA hospitals to Michigan Department of Community Health.  Each hospital determines its own 12-month program year.
# Sinai's open heart program suspended on 3/31/99 prior to merger of Sinai and Grace Hospitals.  1999 data is mostly for six months ending the prior December.

The above information has been compiled by The Economic Alliance for Michigan, the statewide business/labor coalition, December, 2000.  

Sponsors of the printed brochure are:  Alliance for Health, Besser, Budd Co, DaimlerChrysler, Delphi, Detroit Building Trades Council, Detroit Edison, Federal Mogul, Ford Motor, General Motors, Greater Detroit Area Health Council, JSJ, Kroger of MI, Kushner & Co, Lear, MEA, MESSA, Michigan Building Trades Council, Michigan Conference of Teamsters Welfare Fund, Michigan Farm Bureay, Michigan State AFL-CIO, Michigan State Utility Workers Council, Michigan Teamsters Join Council #43, SEIU Michigan State Council, Southwest Michigan Health Care Coalition, Steelworkers District 2, UAW International Union, UFCW Local 951 & Visteon.