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Risk Aversion in Cardiac Surgery: 15-Year Trends in a Statewide Analysis
- Source :
- The Annals of Thoracic Surgery. 109:1401-1407
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- With a rising emphasis on public reporting, we hypothesized that select hospitals are becoming increasingly risk-averse by avoiding high-risk operations. Further, we evaluated the association between risk-averse practices, outcomes, and publicly reported quality measures.Clinical data from 78,417 patients undergoing cardiac surgery (2002-2016) from a regional consortium was paired with publicly available reimbursement and quality data. High-risk surgery was defined as predicted risk of mortality ≥5%. Hospital risk aversion was defined as a significant decrease in both high-risk volume and proportion, with cases stratified by hospital risk aversion status for univariate analysis.The rate of high-risk cases decreased from 17.9% in 2002 to 12.6% in 2016. Significant risk aversion was seen in 39% of hospitals, which had a 59% decrease in high-risk volume vs a 16% decrease at non-risk-averse hospitals. In the last 5 years, declining high-risk cases at risk-averse hospitals were driven by fewer cases from transfers (19.2% vs 28.1%, P.001) and the emergency department (17.6% vs 19.2%, P = .001). Only non-risk-averse hospitals had mortality rates lower than expected (risk-averse: 0.97 [95% confidence interval, 0.91-1.03], P = .30; non-risk-averse: 0.88 [95% confidence interval, 0.83-0.94], P = .001). There were no differences by risk aversion status in reported ratings or financial incentives (all P.05).Over 60% of hospitals continue to operate on high-risk patients, with concentration of care driven by transfer patterns. These non-risk-averse hospitals are high-performing with better-than-expected outcomes, particularly in high-risk cases. Transparency and objectivity in reporting are essential to ensure continued access for these high-risk patients.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
030204 cardiovascular system & hematology
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
Public reporting
Risk of mortality
medicine
Humans
Hospital Mortality
Significant risk
Cardiac Surgical Procedures
Reimbursement
Aged
Retrospective Studies
Univariate analysis
business.industry
Incidence
Middle Aged
United States
Cardiac surgery
030228 respiratory system
Data quality
Emergency medicine
Female
Surgery
Cardiology and Cardiovascular Medicine
business
Hospitals, High-Volume
Follow-Up Studies
Forecasting
Subjects
Details
- ISSN :
- 00034975
- Volume :
- 109
- Database :
- OpenAIRE
- Journal :
- The Annals of Thoracic Surgery
- Accession number :
- edsair.doi.dedup.....9e1a6ed0f7b2ee487ef90dc214cafa44