Out-of-Hospital 30-day Deaths After Cardiac Surgery Are Often Underreported

Edward L. Hannan, Zaza Samadashvili, Kimberly Cozzens, Joanna Chikwe, David H. Adams, Thoralf M. Sundt, Leonard Girardi, Craig R. Smith, Stephen J. Lahey, Jeffrey P. Gold, Andrew Wechsler, Desmond Jordan, Mohammed H. Ashraf, Paul A. Kurlansky

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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 accurately 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 registry 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 confirmation for 7 of the 10 cardiac procedures examined, and more than 40% were missing for 5 of the procedures examined. When vital statistics data were used to confirm 30-day postprocedure deaths after discharge, an additional high outlier for valve surgery was identified. Conclusions: Operative mortality after cardiac surgery is often underreported owing to a considerable percentage 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.

Original languageEnglish (US)
Pages (from-to)183-188
Number of pages6
JournalAnnals of Thoracic Surgery
Issue number1
StatePublished - Jul 2020

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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