Summary of California-wide Trends in Cardiac Procedures - Mortality after Cardiac Surgery / Intervention
Mortality is based on deaths that occurred during the surgery admission or acute care admissions following transfer after the index surgery/intervention that were connected to the index admission and in-hospital / emergency room deaths that occurred after a discharge home and within 30 days of the procedure.
Mortality after Cardiac Procedures, California, 2020-2021
| Cardiac Procedure | Number of Procedures | Number of Events | % Mortality |
|---|---|---|---|
| Isolated CABG | 21,455 | 562 | 2.62 |
| Isolated SAV-Replacement, SMV-Replacement, SMV-Repair | 6,922 | 216 | 3.12 |
| TAVR | 14,534 | 202 | 1.39 |
| Isolated SAV-Replacement, SMV-Replacement, SMV-Repair with CABG | 3,108 | 188 | 6.06 |
| PCI with ACS | 52,157 | 2,986 | 5.72 |
| PCI without ACS | 38,352 | 742 | 1.93 |
CABG: Coronary Artery Bypass Graft
SAV: Surgical Aortic Valve SMV: Surgical Mitral Valve TAVR: Transcatheter Aortic Valve Replacement PCI: Percutaneous Coronary Intervention ACS: Acute Coronary Syndrome | |||
Mortality after isolated CABG decreased from 1999 to 2006 with little variation in mortality rates through 2019. Mortality after isolated CABG surgery went up in 2020 which might be a result that due to COVID-19, some less urgent CABG procedures might have been postponed. In 2021, mortality isolated CABG decreased slightly.
Mortality after isolated Surgical AV-Replacement, MV-Replacement or MV-Repair mostly decreased from 1999 to 2019. In 2020 and 2021, mortality increased reaching a level in 2021 not seen since 2013.
Mortality after CABG with Surgical AV-Replacement, MV-Replacement or MV-Repair mostly decreased from 1999 to 2019. As for isolated CABG and isolated isolated Surgical AV-Replacement, MV-Replacement or MV-Repair procedures, an increase in mortality after CABG with Surgical AV-Replacement, MV-Replacement or MV-Repair occurred in 2020, followed by a slight decrease in 2021.
For Transcatheter AV-Replacement, after an initially very high level of mortality in 2011, the decrease in mortality is striking and possibly related to a new procedure being refined by California surgeons.
Mortality after PCI with or without ACS increased from 1999 to 2021, from 4.0% to 5.88% for PCI with ACS, and from 1% to 1.96% for PCI without ACS.
At the same time, looking at a case mix (case complexity) indicator - the expected mortality rates implied by the model for mortality - the average California heart procedure patient has steadily become sicker for most cardiac procedure groups. This trend is particularly pronounced for patients undergoing PCI with ACS. Decreased mortality after cardiac surgery is therefore unlikely a result of procedures being performed on healthier patients, rather management of the cardiac patient has improved. The increased mortality after PCI coupled with increasingly sicker patients undergoing the procedure needs to be explored further.
Using the mortality level in 2020-2021 as a standard, casemix-adjusted mortality after isolated CABG surgery, and isolated Surgical AV-Replacement, MV-Replacement or MV-Repair with or without CABG decreased significantly from 1999 to 2019. For isolated Surgical AV-Replacement, MV-Replacement or MV-Repair with or without CABG, risk-adjusted mortality increased in 2020 and 2021. In 2019, casemix-adjusted mortality after isolated CABG surgery was statistically significantly higher compared to the average mortality in 2020 and 2021 combined.
casemix-adjusted mortality after Transcatheter AV-Replacement has not changed statistically significantly since 2019.
For PCI without ACS, a significant decrease in casemix-adjusted mortality occurred from 1999 to 2010, and from then on, mortality has increased back to 2001 levels. For PCI with ACS, after decreasing casemix-adjusted mortality through 2019, mortality went up in 2020 and 2021.