VA’s Chief Surgeon in Long Beach Raps ‘Distorted’ Report

A government report this week indicating an excessive number of deaths among open-heart surgery patients at the Long Beach Veterans Administration Hospital gives a “distorted” impression of the facility’s long-term mortality rate, the hospital’s chief of surgery said Thursday.

The statistics for the Long Beach hospital, which were part of an internal VA audit of its 172 hospitals, showed the mortality rate for open-heart surgery at the Long Beach facility to be 18.2% during a six-month period that ended in April, 1985. It was the highest mortality rate for any hospital in the study, conducted by the VA’s inspector general.

A report published last month in a surgical journal stated that the comparable rate for VA hospitals nationwide ranged between 5% and 8%.

But according to Dr. Edward Stemmer, the Long Beach VA Hospital’s chief surgeon, his facility’s mortality rate appeared excessive because the six-month period for which the statistics applied happened to be a period during which only 33 open-heart surgeries were performed.

“When you take six months out of a 19-year history, you get a distorted idea of the overall program,” he said. “The 18.2 rate was a red flag for us, too, but it doesn’t mean a thing except that a small number of patients” were operated on during that period.

The Long Beach statistics, except for the study period, are essentially the same as most of the VA’s other 51 hospitals that perform open-heart surgery, the surgeon said.

According to the audit, 7.1% of the 183 heart patients operated on at Wadsworth VA Hospital in West Los Angeles died. At the San Diego VA Hospital, where 175 heart operations were performed during the study period, the death rate was 4%.

During the 4 1/2-year period ending in April, 1985, Stemmer said, the Long Beach hospital’s open-heart surgery mortality rate was 7.9%, or 37 deaths out of a total of 470 cases. The majority of open-heart surgeries are coronary bypass operations, intended to increase blood flow to the heart muscle. The mortality rate for that procedure alone was 5.2%

Last December, the VA issued a guideline asking that each facility doing open-heart surgery perform at least 150 procedures each year. The purpose of the guideline is to help ensure quality by making certain that each surgeon’s skills are sharpened by frequent practice.

Although the number of cases done at the Long Beach hospital during the study period fell below that level, Stemmer said that typically over the last five years between 140 and 145 annual procedures have been performed.

The mortality rate at community hospitals generally is lower than that at VA hospitals. Stemmer said a major reason is that VA patients typically are sicker when they seek care, partly because they often belong to lower socioeconomic groups.

Earlier this week, Rep. Ted Weiss (D-N.Y.) said in Washington that the inspector general’s report found that more than half of the 134 deaths following heart surgery in VA hospitals during the study period were “preventable.” But a senior VA official said such mortality rates alone are not accurate indicators of overall health-care quality.

The VA has announced its intention to reduce the number of its hospitals that do heart surgery. But Stemmer said that to date he has not been informed whether Long Beach will be one of the facilities affected.

VA HOSPITAL OPEN HEART SURGERY DEATHS

Data from five Veterans Administration hospitals in Southern California reflect the six months between October, 1984, and April, 1985. Open heart surgeries consist primarily of coronary bypass procedures and artificial valve implants

HOSPITALS ALL SURGERIES % DIED OPEN HEART % DIED Long Beach 1,906 6.0 33 18.2 Wadsworth 1,728 5.0 183 7.1 San Diego 1,382 3.2 175 4.0 Loma Linda 1,113 6.0 -- -- Sepulveda 674 4.5 -- --