In today’s healthcare environment, we hear a lot about risk factors. Here at Cleveland Clinic, we want all our patients—and you—to clearly understand the risk factors for heart disease. We know that the more risk factors you have, the more likely it is that you’ll develop heart disease. Because there’s so much you can do to reduce your risk factors, we’ll never stop reminding you to stop smoking, eat healthier, control blood pressure and cholesterol, and get your fair share of physical activity.
However, there are also risk factors when you are having heart surgery. These include the things that increase the risk of needing surgery as well as co-existing medical conditions you may have when you go to surgery.
Understanding outcomes and what they mean to you
We also talk about outcomes, including mortality, which is the number of people who die during a procedure and morbidity, the number of people who have complications after a procedure.
You might ask yourself, “So what does this have to do with me?” Outcomes or results matter to you, your doctor and your hospital. The Society of Thoracic Surgeons knows this. I’m a member of this professional group, and we’ve been collecting the outcomes, both mortality and morbidity, of cardiac surgery programs for a long time. We collect this data so we can help create benchmarks and improve quality for cardiac surgery programs across the country.
To improve quality, it’s necessary to risk adjust knowing that different surgery programs operate on different patients who all have different co-existing conditions at that time. Those conditions impact their outcomes. No two patients are the same and so they don’t have the same outcomes.
The society defines risk adjustment as “basically a corrective tool used to level the playing field regarding the reporting of patient outcomes, adjusting for the differences in risk among specific patients. Risk adjustment also makes it possible to compare performance fairly. Comparing unadjusted event rates for different hospitals would unfairly penalize those performing operations on higher risk patients.”
Taking into account the type of surgery a patient has and co-existing medical conditions, the society developed its own online risk calculator for surgeons to use when discussing risk with a patient. The development of the risk calculator was based on groups of patients. I caution people that the calculator helps determine “not actual risk but if a patient is a low, medium, or high risk”. It can help in discussions with patients and their family when looking at the benefits and risks of surgery.