Original Article

How to Do It: Utilizing Risk Stratification to Evaluate Outcomes in Adult Open-Heart Operations

Desert Springs Hospital, Las Vegas, Nevada

^* Address correspondence to: Timothy A. Dickinson, CCP, MHA Department of Perfusion Services Desert Springs Hospital 2075 East Flamingo Road Las Vegas, NV 89119

Abstract

The purpose of this study is to demonstrate that by using a proven method of stratifying open-heart operations into levels of predicted mortality, hospitals can closely monitor trends of their open-heart programs and possibly improve the health planning decisions for their institution. A proven method of uniform risk stratification utilizing objective and readily available preoperative patient data was implemented at our institution for a 12 month period (September I, 1991 through August 31, 1992). A total of 367 patients were included in this study. The patients were categorized into four risk ranges (0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and ≥ 15% high risk) indicating a predictive percent probability of operative mortality. The number patients categorized as either 0 to 4% good risk, 5 to 9% fair risk, 10 to 14% poor risk, and ≥ 15% high risk were46, 74, 84and 163, respectively. The patient's average post -operative length of stay in each risk tegory was 7.6 days, 8.2 days, 10 days and 12 days, respectively.

The patient's average total hospital charges in each risk category were $48,241,$53,531,$60,416 and $75,555, respectively. This information has helped our hospital administration make relevant and objective decisions concerning our open-heart program. Uniform risk stratification( outcomes research) should be incorporated into all adult open-heart surgery programs because it is simple, inexpensive, and can evaluate the outcomes and cost of open-heart surgery.