How To Get The Data You Need
Shahian says that if the hospital you’re considering doesn’t share its data with Consumer Reports or STS, try to get that information on your own.
But calling the hospital directly isn’t the best bet: When we tried that at several hospitals, the staff wasn’t able to connect us with the right person to answer our questions.
Instead, Shahian recommends asking your surgeon these questions:
- Does the hospital where you perform surgery participate in the Society of Thoracic Surgeons database?
- If so, how does it perform in the STS ratings, and would you be willing to go over their most recent report with me?
If the surgeon won’t have that discussion or says the hospital doesn’t collect the data, Shahian says to consider another doctor and medical center.
Editor’s Note: This article also appeared in the May 2017 issue of Consumer Reports magazine.
Overall Mortality Rates And Survival
In total data on 33 094 interventions were extracted from the NVT national database. The study population is described in Table . The total follow-up time after intervention was 90 386.6 years and the mean follow-up time was 996.9 days. Early mortality rates using the different measures are presented in Fig. . Mortality after discharge from the primary hospital was doubled after 1 year: from 972 deaths to 2052 deaths . In-hospital and 30-day mortalities were nearly identical. However, in Table the difference between these outcome measures is shown. Approximately 20% of all deaths during admission occur after 30 days. The other way around holds true as well: 20% of all deaths within 30 days occur at home or at another care facility.
KaplanMeier survival curve with 95% CI after cardiac surgery. The green line represents the survival rate of the age-matched general population in The Netherlands. The survival rate of the cardiac surgery population equals that of the general population from approximately 120 days after surgery onwards. The hazard after cardiac continues to decline well after 30 days postoperatively. The constant phase of the hazard seems to start after 120 days.
You May Experience Sleep Issues
Many people complain of having trouble sleeping for some time after heart surgery. You may experience insomnia because of:
Effects of anesthesia
Changes in your daily routine
Stress from personal concerns
Normal sleeping patterns typically return in two to three weeks. Until then, try these tips:
Take enough rest breaks in between your normal daily activities but avoid a daytime nap longer than 20 minutes.
If you have pain, take your pain medication about 30 minutes before bedtime.
Arrange the pillows so you can maintain a comfortable position and decrease muscle strain.
If you feel anxious or nervous, talk to your spouse, partner or a trusted friend. Get your troubles off your mind.
Avoid caffeine in the evenings.
Listen to relaxing music or a guided imagery audio program.
Ask your partner to give you a back rub.
Take a relaxing shower.
Follow a bedtime routine to let your body know its time to relax and get to sleep.
Its OK to sleep on your back, side or stomach. You will not hurt your incisions.
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He considers it telling that off-pump coronary bypass surgeries in the U.S. dropped from 23 percent in 2002 to 17 percent in 2012.
The vast majority of cardiac surgeons dont want to hurt their patients, and while they want to be innovative, I think when they stop doing this operation, you know that theres got to be a problem, he said.
What Are The Four Types Of Heart Valves
The heart is made up of four pumping chambers:
- Two atria: Upper chambers of the heart
- Two ventricles: Lower chambers of the heart
There are valves between each of the heart’s pumping chambers that open and close in coordination with each other. Their action keeps blood flowing forward through the heart. There are four valves in the heart:
- Tricuspid valve: Between the right atrium and the right ventricle
- Pulmonary valve: Between the right ventricle and the pulmonary artery
- Aortic valve: Between the left ventricle and the aorta
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Newborn Cardiac Surgery Survival
Performing heart surgery on newborn babies is more challenging due to the young age and small size of the patients. By comparing newborn survival rates along with STAT category, parents can get an idea of how well the surgeons perform in the most challenging cases.
What we measure:
We compare our survival rates for newborn patients with national averages by the complexity of the surgery.
What it means:
At Childrens Colorado, our surgeons have extensive experience correcting heart defects in even the youngest patients some just a few hours old. Our survival rates for STAT 1, STAT 2 and STAT 5 cases are higher than the national averages.
How Many Heart Surgeries Take Place Each Year
The number of heart surgeries can vary by year. In 2018, nearly half a million people in the U.S. had heart surgery.
But the COVID-19 pandemic affected how many people are having heart surgery. The monthly average dropped by 50% in April 2020. The number continued to be lower than normal through the rest of 2020. Partly, this is because hospitals needed to postpone non-elective care. But it seems many people also chose to delay care even if they had symptoms.
If youve been putting off your appointments because youre concerned about COVID-19 exposure, youre not alone. But its important that you call your healthcare provider and make an appointment. Ask your provider what their office is doing to help keep you safe. And keep in mind that untreated heart problems can get worse and lead to more serious issues down the road.
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How Long Can You Live After Heart Surgery
You can live for many years or decades after heart surgery. Many factors affect how long you live, including other health conditions and risk factors. Heart surgery can make you healthier and stronger. But its important to keep doing whatever you can to lower your risks for future problems. Things you can do include:
- Make lifestyle changes recommended by your healthcare provider.
- Take your medications as prescribed.
- Keep all your medical appointments and follow-ups.
Heart surgery is like a bicycle that can carry you down a long road when youre tired of walking, but you still have to push the pedals.
What Is Recovery Like After Open
Recovery time varies depending on the surgery type, complications and your overall health before surgery. It can take 6 to 12 weeks to recover from an open-heart procedure.
Your surgeon will let you know when you can return to work and other activities. Typically, you shouldnt drive or lift anything heavy for the first six weeks.
Some people need to take blood thinners after heart surgery to prevent blood clots. Your healthcare provider may also recommend cardiac rehabilitation. This medically supervised program can help you regain strength and stamina and improve overall heart health.
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Cardiac Resynchronisation Therapy And Cardiac Resynchronisation Therapy Defibrillator Device
If you have heart failure, you may need a special type of device called cardiac resynchronisation therapy device. As well as treating heart arrhythmias, this device also synchronises your hearts chambers to contract and relax in a regular way, which improves the pumping action of your heart.
There is also a type of CRT that can be used as above and in addition can deliver a “shock” to treat dangerous heart arrhythmias and then synchronise your hearts chambers to normal rhythm once more. This is CRT-D .
What Are Pediatric Cardiac Surgery Outcomes
In the medical world, the term outcomes means success rates. Many but not all pediatric cardiology centers measure and report their surgical outcomes to help parents make the best decision about where to take their child for heart surgery.
Here, we evaluate our success by monitoring and comparing our cardiac surgery statistics with other top pediatric hospitals. We also routinely check and publish other quality and patient safety metrics and heart transplant outcomes to ensure that families have the latest information when deciding who should care for their child.
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Measuring Congenital Cardiac Surgery Survival
Open heart surgeries can be risky, and some deaths and complications are inevitable. Unfortunately, no program has a 100% survival rate. When researching a pediatric heart surgery center, its also important to compare the survival rate by patient age, type of operation and STAT category . This is because these rates can be much different than the programs overall survival rate.
Why Transparency Matters
We believe that families have the right to know every heart surgery programs outcomes. Our Heart Institute is the only pediatric heart surgery program in Colorado and one of the few in our region to publicly report our cardiac surgery outcomes data. This transparency is one of the keys to our success as one of the best hospitals for congenital heart surgery in the country.
When researching heart surgery programs, parents should look for multiple outcome measures, such as total survival, survival by surgical complexity and length of stay, and consider these statistics together. No single metric should stand alone.
View some of the many things we measure and see our latest outcomes data below.
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What Happens During Open
Heart surgery is complex. Some surgeries may take six hours or longer. You will receive anesthesia and be asleep during the procedure.
Surgery steps vary depending on the heart condition and procedure. In general, your surgeon:
- Makes a 6- to 8-inch long incision down the middle of your chest.
- Cuts the breastbone and spreads your ribcage apart to reach your heart.
- Connects the heart to a heart-lung bypass machine, if youll have an on-pump surgery. An anesthesiologist gives IV medication to stop your heart from beating and monitors you during the surgery.
- Repairs your heart.
- Restores blood flow to your heart. Usually, your heart starts beating on its own. Sometimes, the heart needs a mild electrical shock to restart it.
- Disconnects the heart-lung bypass machine.
- Closes the breastbone or other incision with wires or sutures that remain in your body.
- Uses stitches to close the skin incision.
What Happens During Heart Surgery
What happens during your surgery depends on the type youre having. It also depends on the method your surgeon uses to perform the operation.
Surgeons use different methods for operating on your heart. These include open-heart surgery, off-pump bypass surgery and minimally invasive heart surgery. Your care team will discuss which method is best for you, and why.
Open-heart surgery is what most people think of when they hear someone say heart surgery. Your surgeon makes a 6-to 8-inch long incision in the middle of your chest and spreads your ribcage to reach your heart. Youll be connected to a heart-lung bypass machine, so your heart wont be beating during the surgery.
The length of traditional open-heart surgery varies based on whats being fixed. CABG surgery takes about three to six hours.
Off-pump bypass surgery
Off-pump bypass surgery is also called beating heart surgery. Its similar to traditional open-heart surgery, but you wont be on a heart-lung bypass machine. This method can only be used for CABG surgery. And its most suitable when only one or two coronary arteries need to be bypassed.
Minimally invasive surgery
Minimally invasive heart surgery is also called a keyhole surgery. This means your surgeon makes smaller incisions to access your heart.
A partial sternotomy involves a 3- to 4-inch incision through part of your sternum . A mini-thoracotomy avoids your breastbone and instead uses small cuts between your ribs.
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What Are The Risks Of Heart Ablation
Side effects of heart ablation are more common after surgical ablation than after catheter ablation. Possible risks of heart ablation include:
- Damage to the vein from the sheath and catheter.
- Damage to your heart, like a puncture or damaged valves or conduction.
- Narrowing of the veins that carry blood between your lungs and heart .
- Exposure to radiation during catheter ablation.
- Infection or bleeding.
About Coronary Artery Bypass Surgery
An estimated 170,000 Americans undergo coronary artery bypass surgery each year. This operation, once considered a difficult achievement, is now almost routine in many medical centers.
Studies have conclusively demonstrated that the operation prolongs life in patients who have severe blockages in the three major coronary arteries, in severe disease, in patients with low ejection fraction, and in patients with diabetes. There is less agreement about when it is appropriate for other patients. In general, it is recommended for people with disabling angina that cannot be controlled by conventional therapy and who are also good candidates for surgery.
The operation itself is relatively simple. For “on-pump” procedures, circulation is maintained by a heart-lung machine. In an “off-pump” operation, the surgeon operates directly on the beating heart. Most people who undergo the operation report feeling vastly better afterward. Very often, the patient may have suffered from disabling angina or other cardiac limitations before the operation. With an increased blood supply to the heart muscle, these problems should be eliminated or minimized.
The skill and experience of the surgical and recovery teams also are important considerations. Patients considering coronary bypass surgery always should determine whether the surgeon performs this particular operation regularly and whether there is a skilled recovery team and a special recovery unit.
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What Happens After Heart Surgery
After your heart surgery is done, youll be moved to the intensive care unit . Youll recover in the ICU for at least one day. Youll then move to a regular hospital room for continued rest and care.
How long you stay in the hospital depends on the surgery you had and how your body responds to it. Each persons recovery is different. Your hospital team will keep a close eye on you and make sure youre healing as you should. Theyre also prepared to notice and respond to any problems that come up.
Benchmarking Using Different Outcome Measures
The effect of using different outcome measures on the benchmarking procedure is shown in Fig. . When in-hospital mortality is used as outcome, one low mortality outlier and two high mortality outliers are found . However, by using 30-day mortality as outcome measure, two other centres are identified as outliers as well: Centre B as a low mortality outlier and Centre E as a high mortality outlier. Prolonging follow-up from 30 days to 1 year leads to changes in outlier status in four hospitals . When the same is done for a subset of isolated CABG procedures, benchmarking results remain unchanged with the different follow-up periods. This is shown in Fig. .
Benchmarking of isolated CABG in 10 hospitals using different mortality measures. Interventions from 2007 until 2010 were included. Benchmarking results are unaffected by the choice of the follow-up period.
Pediatric Heart Surgery Volumes
Finally, when it comes to congenital heart surgery, volume matters. Studies show that kids who need heart surgery do better when they are treated by medical teams that perform a high number of surgeries. This is because surgeons in high-volume centers get more experience and see a wider range of heart defects than surgeons who perform only a handful of surgeries per year.
Performing hundreds of surgeries each year indicates that the hospital is a high-volume center and is likely to have better patient outcomes. This is particularly true for patients with complex heart defects.
Average Length Of Stay
What we measure:
The chart below shows the average number of days that children stay in the hospital for heart surgery by benchmark procedure.
|Cl 12.2 – 18.8|
What it means:
Our postoperative length of stay is less than expected when considering the complexity of conditions we treat at Childrens Colorado. When comparing our data to other large pediatric surgery programs, we have one of the lowest postoperative hospital lengths-of-stay. The majority of cardiac surgery patients at Childrens Colorado spend less time in the hospital than the national average, indicating that they receive high-quality care before, during and after surgery, which helps them go home sooner.
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How Should I Prepare For Open
To prepare for open-heart surgery, you should follow your healthcare providers recommendations about:
- Medications: You may need to stop taking certain medicines a week or two before surgery. People often stop blood thinners and nonsteroidal anti-inflammatory drugs . These medicines can increase bleeding risk.
- Food and drink: Your healthcare team will ask you to fast before your surgery. Anesthesia is safer on an empty stomach.
- Smoking and alcohol: Cut back on alcohol and quit smoking. Both can slow postsurgical healing and increase the risk of complications.
What Conditions Does Cardiac Ablation Treat
Cardiac ablation treats heart arrhythmias that cant be controlled with medication. Heart ablation procedures can treat all types of irregular or abnormal heart rhythms, including:
- Atrial fibrillation : Afib is the most common reason for heart ablation. When you have Afib, the upper chambers of your heart beat irregularly. The atria quiver instead of contracting. Without strong contractions, your heart cant pump blood. When your blood doesnt move through your heart properly, it increases your risk of forming blood clots within your heart and the risk of stroke if the clot travels to your brain.
- Atrial flutter: With this condition, the atria contract to pump blood, but they do it too quickly. Atrial flutter results in a heartbeat thats faster than normal and like Afib, increases your risk for blood clots and stroke.
- Supraventricular tachycardia : If you have SVT, your heart still pumps blood normally. But youll experience episodes of racing heartbeats . If SVT occurs frequently or for long periods, the arrhythmia can lead to heart damage and severe symptoms.
- Ventricular tachycardia : The ventricles are the two lower chambers of your heart. An arrhythmia in those chambers causes your heart to beat too quickly, not allowing enough time for blood to fill and pump to your body, leading to a dangerous drop in blood pressure.
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