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Assessing quality in cardiac surgery: why this is necessary in the twenty-first century

Gill Heart Institute, University of Kentucky College of Medicine, Lexington, Kentucky, jswain{at}hq.nasa.gov

Renee S Hartz

Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana

The cost and high-profile nature of coronary surgery means that this is an area of close public scrutiny. As much pioneering work in data collection and risk analyses has been carried out by cardiac surgeons, substantial information exists and the correct interpretation of that data is identified as an important issue. This paper considers the background and history of risk-adjustment in cardiac surgery, the uses of quality data, examines the observed/expected mortality ratio and looks at issues such as cost and reactions to outliers. The conclusion of the study is that the continuation of accurate data collection by the whole operative team and a strong commitment to constantly improving quality is crucial to its meaningful application.

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