Heart Surgeons' Death Rates Published Online

Undergoing heart surgery? Now you may be able to check your surgeon's death rates before you reach the operating table.

Three states already offer patients an online peek at their heart surgeons' mortality data. Beginning Dec. 18, Massachusetts will become the fourth state to publish procedure-related death rates for individual heart surgeons.

In 1991, New York became the first state to report this data. Since then, New Jersey and Pennsylvania have followed suit. California and Florida are expected to make the information available next year.

With Massachusetts joining a growing number of states that make doctors' grades publicly available, experts say that there is a national trend towards publicizing doctors' performance records.

"An effective and accurate registry will greatly help patients and surgeons by helping us understand risks and outcomes," said Dr. John Byrne, chairman of the department of cardiac surgery at Vanderbilt University Medical Center in Nashville, Tenn.

But some experts debate the effectiveness of the system, even warning that it may cause surgeons to shy away from patients who are already severely ill.

"I think that surgeons will initially not take on high-risk cases," said Dr. Bruce Leavitt, professor of surgery at the University of Vermont and Fletcher Allen Health Care in Burlington, Vt.

"Even though the statisticians tell surgeons that taking on a high-risk patient will be compensated by the risk model, all of us know that when a high-risk patient dies, it affects our [record]."

Patients May Doctor-Shop for Heart Surgeons

Experts say patients may use this information to shop around for the best heart surgeons.

"It will tell [patients] where to go or not to go," said Dr. Lawrence Cohn, professor of cardiac surgery at Brigham and Women's Hospital in Boston.

"Some patients come to my office with lots of papers and information printed from the Internet," Leavitt said. "Technologically savvy patients and family will obtain information from the Internet."

But, he said, many patients may not have the opportunity to check the Internet when they are admitted to the hospital after a sudden event, such as a heart attack. In these cases, he said, "it is a bit difficult for them to get onto the Internet to check out a surgeon's statistics."

And checking a surgeon's background may work. A study that examined the New York heart surgeon report card system found that patients who picked a top-performing surgeon had half the chance of dying as did those who picked a surgeon from the bottom quartile.

However, researchers also found that the surgeons with the best records aren't getting more patients than those whose statistics are not as good. And doctors said the system may not yet offer the clearest picture to patients.

"Sometimes the slickest ad campaign gets the referral," said Dr. Abe Deanda, director of aortic surgery at Montefiore Medical Park in New York. "The public cannot be expected to make decisions based on poorly understood statistics, nor should they.

"There is too much room for misinterpreting results."

Doctors Debate Report Card Accuracy

Thirty-seven states and the District of Columbia have mandatory health care reporting systems for inaptient hospital data. Another 10 states have voluntary reporting systems.

A primary concern over setting up the report card system was ensuring that mortality data were adjusted to reflect riskier surgeries.

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