[HSF] RE: risk adjusted mortality

[Nasser F. Abou'Seada]

Very sad - better said sarcastic  !! - to observe that out of "knowledgeable
arrogance", some colleagues tend to "overlook" the different variables
involved in risk weighing, when comparing the non-risk adjusted Mortality
index,  just to show that some "privileged" surgeons have ZERO mortality, in
contradistinction to other "rival" surgeons ... having a high mortality
index .... not taking into account - whereas they KNOW- the high risk
population - substrate- the "high risk-surgeons" are accepting and the
nature and kind of operations they are involved in.

Not astonishing, that THERE ARE ALWAYS some - may be many - KNOWLEDGEABLE
ARROGANT PEER COLLEAGUES - who would persistently and enthusiastically
compare the mortality outcome of surgeons dealing with high risk procedures
- their mortality by default is > 70-80%"- like triple re/replacement double
valve with tricuspid reapir and eMaze in a haemodynamically compromized
patient, to the mortality outcome of some other surgeon who is SELECTIVELY
performing - exclusively -  near zero risk, straight forward Mitral valve
replacement for Mitral regurge annular size 29-31.  ..... no mentioning of
course -as Hal will say it now- that the mitral could - in fact SHOULD- have
been repaired by an expert, or that the ventriculo-annular continuity should
have been preserved in case of failed reconstruction and mitral replacement,
not to mention any residual paravalvular leak .....  end point is that
patient lives ..... no matter what will happen in next 3-4 months period ...
!!!! ... announcement of mortality is always being deferred for the "later"
surgeon who will deal with the "stinky apple" .... !!!

For an observer .... it can be labelled a drama ? a tragedy ?? or in fact a
Comedy ?????

Dear Ani ... it is a small price you have to pay ...... having to explain
and withstand the "scientific" comments by the "knowledgeable arrogants"
commenting on results ....... ignoring - on purpose - the appropriate
statistical proper evaluating methods ...!!


NFA


On 4/12/08, Ani Anyanwu <anianyanwu at hotmail.com> wrote:
>
> > 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>
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