Out-of-Hospital 30-day Deaths Following Cardiac Surgery Are Often Under-reported.

Background. Operative mortality (in-hospital during the index admission or within 30 days of the procedure after discharge) is commonly used as a quality of care measure for public reporting of cardiac surgery outcomes, but the ability to capture out-of-hospital deaths accu- rately remains undetermined. The objective of the study was to estimate the impact of incomplete reporting of out- of-hospital deaths on hospital risk-adjusted mortality and outlier status. Methods. New York State's 2014 to 2016 cardiac regis- try data were used to compare the capture of 30-day postprocedure deaths after discharge with and without the use of national and state-level vital statistics data for all 54,442 patients undergoing isolated coronary artery bypass graft, cardiac valve surgery, or both. Hospital risk- adjusted operative mortality rates and mortality outliers were compared based on statistical models that were developed with and without the use of vital statistics data. Results. Thirty-day deaths postprocedure after discharge ranged from 10% to 39% of all operative deaths among cardiac surgical procedures. More than 30% of these deaths were missing without vital statistics con firmation for 7 of the 10 cardiac procedures exam- ined, and more than 40% were missing for 5 of the procedures examined. When vital statistics data were used to con firm 30-day postprocedure deaths after discharge, an additional high outlier for valve surgery was identi fied. Conclusions. Operative mortality after cardiac surgery is often underreported owing to a considerable percent- age of out-of-hospital cardiac surgery deaths that are missed by reporting centers. This can adversely affect the assessment of hospital risk-adjusted mortality in public reports. (Ann Thorac Surg 2020;110:183-8) (C) 2020 by The Society of Thoracic Surgeons