[HSF] RE: risk adjusted mortality

[Tea Acuff]

Cute, Ani. 
Cute and tragic.
Yes it is hard to pick all the variables that one wants to emphasize in the Descartian universe.

tea



----- Original Message ----
From: Ani Anyanwu <anianyanwu at hotmail.com>
To: openheart-l at lists.hsforum.com
Sent: Saturday, April 12, 2008 9:38:17 PM
Subject: RE: [HSF] RE: risk adjusted mortality

> Actually I would prefer to have my operation in the center with the lowest risk-adjusted mortality with reasonable volume. 
>
>John

Interesting comment - if we physicians believe in risk adjusted mortality statistics then what hope for the patients. 

Reminds me of recent case we had - a patient whose daughter works for the state reporting system so has access to mortality data on all surgeons and hospitals in the state. Mum needs a valve operation and she looks up her statistics. Picks the best surgeon - the only one with zero mortality (of cause she of all people should know you cannot risk adjust a zero mortality) for mum's valve operation. Surgeon does operation - patient survives (as data says she would). All good? No. Why? She was focusing on wrong outcome. Patient has paravalvar leak and severe regurgitation and in 6 months needs another operation. What does she do? Selects her 'best' surgeon again - all his patients live don't they? What happened? Sure she lived again - afterall that was the focus a zero mortality. Surgeons does a repeat valve replacement for paravalvar leak with a clamp time of 38 minutes and 50 minute bypass. As Dr Flege says it is very difficult to kill a human being,
 especially with such a swift operation. Well poor lady - she survives surgery her valve still leaks and leaks a lot. Severe regurgitation after a second operation by the best zero mortality surgeon in the state, in and out of hospital in heart failure, now cachectic octogenerian, liver and kidney failing etc four months after second operation is hospital bound NYHA IV on IV infusions - another zero mortality success. What does she do this time? No longer looking for a zero mortality center she comes to our hospital - says she is looking for an 'expert' in valve surgery. Of course we do not have a zero mortality - we cannot for the cases we do. Now her Eurocore predicted mortality for this third surgery is 70 percent. Daughter now admits she was after the wrong outcome - survival of surgery rather than success and expertise in achieving outcome of surgery (curing the valve dysfunction with acceptable operative risk and restoring long-term quality of
 life). Of course you have to survive surgery to have a good result but you need to have a good surgical result to survive beyond surviving surgery. We operate on frail lady, third valve operation she dies - another valve mortality for us and the zero mortality surgeon remains with zero mortality, untouched and still the best.

Ani




> Date: Sat, 12 Apr 2008 12:11:41 -0500> From: jdpigott at tulane.edu> To: openheart-l at lists.hsforum.com> Subject: [HSF] RE: OpenHeart-L Digest, Vol 46, Issue 22> > Dear Tea Ani and Hal,> Actually I would prefer to have my operation in the center with the lowest risk-adjusted mortality with reasonable volume. If the mortality is higher, all the intensivists, PA's etc aren't much help. This goes back to Hal's comment about the intra-operative conduct of surgery, which is the single most important facet of the care (IMHO).> > John> > > -----Original Message-----> From: openheart-l-bounces at lists.hsforum.com on behalf of openheart-l-request at lists.hsforum.com> Sent: Sat 4/12/2008 7:29 AM> To: openheart-l at lists.hsforum.com> Subject: OpenHeart-L Digest, Vol 46, Issue 22> > Send OpenHeart-L mailing list submissions to> openheart-l at lists.hsforum.com> > To subscribe or unsubscribe via the World Wide Web, visit> http://mmp.cjp.com/mailman/listinfo/openheart-l> or, via
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