With lightning speed, cardiac care has undergone a dramatic evolution in the last decade. From angioplasty and stents to keep coronary arteries open, to pacemakers and defibrillators, to beta blockers, blood thinners, and statins, patients face a dazzling array of less-invasive options to care for their hearts, extend their lives, and promote their quality of life.
Although angioplasty and stents are often chosen as an alternative to surgery for plaque-clogged arteries, there is increasing discussion in the medical community and in the lay press that bypass surgery should also be considered in complex cases where patients have multiple blockages in two or more arteries. A few years ago, most patients would not hear about the option for surgery in these complex cases. As more long-term data on stent usage is available, there is a renewed discussion regarding the benefit of restoring blood flow surgically by bypassing the section of the diseased artery.
When surgery is necessary whether it is a bypass or a valve replacement, or a combination of both consumers need to be aware of important considerations for a successful operation and recovery. The cardiac business has changed, and as hospitals have retooled to capture the new ways of doing “heart business” not every center performing cardiac surgery is equal.
The cardiac team at Deborah Heart and Lung Center urges patients to shop around and compare when they are considering open-heart surgery options.
What is the Hospital’s Experience?
It can not be stressed enough that experience matters. The more open-heart procedures a doctor and hospital have performed, the better they will be. It is true practice makes perfect. Surgeons and surgery teams that have worked together for years with high volume case loads have the experience to anticipate potential problems in the OR before the problems manifest. Each team member is clear regarding expectations for performance during routine, urgent, and emergent situations. Each surgical team, under the direction of a qualified Attending Cardiothoracic Surgeon has the depth and expertise that comes from working together over years and the shared experience to change courses or alter a procedure at a moment’s notice. It is this experience that keeps patients healthy.
In fact, experience is so important that the State of New Jersey licenses both hospitals and doctors according to the number of procedures they perform. A cardiac program must perform at least 350 open heart surgeries a year (558 were performed at Deborah in 2006) to remain open and each operating doctor must log in at least 100 surgeries a year. Anything below that, the State reasons, does not support patient safety.
Deborah Heart and Lung Center urges patients to question their surgeons, and ask “How many open heart procedures did you perform last year?” “What type of procedures were they?” and “How many did the hospital do overall?” If you’re not satisfied with what you hear, don’t be afraid to shop around.
Dr. Lynn McGrath, Deborah’s Vice President of Medical Affairs, Chair of Cardiothoracic Surgery at Deborah, recognizes its critical relationship between cardiac surgery volume and quality. With more than 10,000 open-heart surgery procedures under his belt, he is one of the most experienced heart surgeons in the world. He also recognizes that respect and collaboration between cardiologists, interventionalists, and cardiac surgeons are paramount to crafting the most appropriate treatment strategy for patients.
“There is no doubt that more and more hospitals are shifting their resources into cath-lab procedures like angioplasty. Reimbursement is good and it’s less risky,” he said. “The problem these cardiac hospitals run into is that they continue to do open-heart surgery without a full commitment to the program. Their numbers start to slip, their experience erodes, both as individual cardiac surgeons and within their team, and the quality of surgery may not be as high.”
McGrath adds that patients should also ask how many years a surgeon has been at a hospital, what type of capital improvements the hospital has made in the OR, and the extent to which the facility is involved in research. Cardiac surgery volume, participation in cardiovascular research, and facility improvements in equipment, personnel, and structure often indicate a hospital’s commitment to its surgery program.
What is the Hospital’s Overall Performance Record?
Cardiac hospitals throughout the state are ranked by many different organizations. These include New Jersey’s Department of Health, the American Heart Association, survey and research groups like the Jackson Organization, and private consumer groups like Leapfrog.
These organizations look at various quality indicators throughout the hospital in their reports. Some look at infection rates, others scrutinize adherence to established guidelines for care, some categorize overall program quality, and others look at consumer satisfaction rates. All of these are critical when considering a hospital for open-heart surgery.
“Patients should strongly consider good surgery outcomes when selecting a hospital, but there are additional factors to consider as well,” points out Dr. Augustine Agocha, Chairman of Deborah’s Cardiology Department. “Infection rates are important as well. Even if your heart repair is perfect, you could pick up an infection while you’re recovering. While this can happen anywhere, even under the best circumstances, a hospital that has known high infection rates should send up a warning flag to a consumer.”
Dr. Agocha encourages patients to ask and question your doctor. Don’t be afraid to ask them about hospital infection rates. Ask them what former patients and employees have to say about the hospital. Ask them how the state has ranked them. And find out, does the American Heart Association recognize their program as an outstanding quality program in both the state and the country? This type of information is readily available. Before you agree to a heart program, compare what’s available.”
Look at the Big Picture
Dr. McGrath notes, “Any time a patient undergoes a surgical procedure, there are risks. An educated consumer should do everything possible to find the best facility. But it’s even more than that. The whole family, not just the patient, is affected by surgery. If all things are equal, look at what amenities the hospital can offer. Is the staff known for its dedication to service? Is the hospital close by, or are family members going to have to drive to a big city, pay parking, tolls, and fight traffic? All this puts additional stress and expense on a family. We want all patients to be educated consumers. Don’t be afraid to ask.