Leading expert in cardiac surgery, Dr. Lawrence Cohn, MD, explains how patients can find the best heart surgeon by analyzing risk-adjusted mortality data and clinical outcomes reported by state agencies and professional societies like the Society of Thoracic Surgeons. He details the importance of comparing a surgeon's actual results against expected outcomes, especially for complex procedures like coronary artery bypass graft (CABG) surgery, and underscores the critical role of a second opinion in confirming a heart disease diagnosis and treatment plan.
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How to Find the Best Cardiac Surgeon Using Risk-Adjusted Outcomes Data
Jump To Section
- What is Risk-Adjusted Mortality?
- How to Compare a Surgeon's Results
- State Reporting Requirements for Cardiac Surgery
- Society of Thoracic Surgeons Database
- Evidence-Based Medicine in Cardiac Surgery
- Importance of a Second Opinion
- Choosing Between CABG and Stents
What is Risk-Adjusted Mortality?
Risk-adjusted mortality is a crucial concept for finding the best cardiac surgeon. Dr. Lawrence Cohn, MD, explains that this metric accounts for how sick a surgeon's patients are before an operation. A patient arriving in shock after a major heart attack has a much higher expected mortality rate than a stable patient having elective surgery. This data allows for a fair comparison of surgical skill by showing how a surgeon's actual results measure up against statistically predicted outcomes.
How to Compare a Surgeon's Results
Comparing the quality of cardiac surgeons requires objective analysis of their clinical outcomes. Dr. Lawrence Cohn, MD, advises patients to look at how a surgeon's performance compares to the expected results. A top-tier surgeon will often have actual mortality rates that are lower than the risk-adjusted predictions. This objective data provides a powerful tool for patients seeking the best possible care for complex heart surgeries like coronary artery bypass grafting.
State Reporting Requirements for Cardiac Surgery
Many US states mandate public reporting of cardiac surgery outcomes, which helps patients find the right surgeon. Dr. Lawrence Cohn, MD, notes that state government agencies collect data on procedures like CABG and cardiac catheterization. This transparency forces hospitals and individual surgeons to be accountable for their results. Patients can access these reports to make an informed decision when selecting a cardiac surgeon for their treatment.
Society of Thoracic Surgeons Database
The Society of Thoracic Surgeons maintains a massive database tracking all types of heart surgery outcomes. Dr. Lawrence Cohn, MD, highlights this repository as a key resource for assessing surgical quality. This national database collects detailed information on patient risk factors and clinical results, providing a benchmark for surgeons and institutions to measure their performance against national averages and strive for excellence.
Evidence-Based Medicine in Cardiac Surgery
Cardiac surgery is a highly data-driven field where evidence-based medicine directly impacts patient care. In his discussion with Dr. Anton Titov, MD, Dr. Cohn points to coronary artery bypass graft surgery as a prime example. Rigorous analysis of treatment methods, such as comparing drug-eluting stents to bare-metal stents, sometimes yields unexpected results that challenge common practices. This continuous scientific scrutiny ensures that surgical techniques evolve to provide the best possible outcomes for heart disease patients.
Importance of a Second Opinion
Obtaining a second opinion is a critical step for any patient facing heart surgery. Dr. Lawrence Cohn, MD, emphasizes that this process confirms the initial diagnosis of valvular heart disease or coronary artery disease is correct and complete. Furthermore, a second opinion helps ensure that the recommended surgical treatment is indeed the best option available. This step builds patient confidence before moving forward with a major procedure.
Choosing Between CABG and Stents
The choice between coronary artery bypass graft surgery and stent placement is a key area where evidence-based analysis guides treatment. Dr. Cohn references studies showing that drug-eluting coronary stents are not always significantly superior to bare-metal stents. This kind of data is essential for cardiologists and cardiac surgeons to make the best recommendation for each individual patient, balancing the risks and benefits of each intervention for coronary artery disease.
Full Transcript
Dr. Anton Titov, MD: How do you determine the skill of a surgeon? How do you find the correct best surgeon? What does evidence-based medicine tell us about how to find the best surgeon?
A leading cardiac surgeon shares his experience on how to find the right surgeon. Here is advice from an eminent cardiac surgeon. He explains how to find the right doctor and how to compare the quality of cardiac surgeons.
Dr. Lawrence Cohn, MD: An important factor is the risk-adjusted mortality concept.
Dr. Anton Titov, MD: How sick are the patients that the surgeon treats? What is their expected rate of death after surgery? How do you find the best heart surgeon? This is how to find the right surgeon.
How do the surgeon's actual results compare with the expected results? Many US states report risk-adjusted mortality data on cardiac surgery.
Dr. Lawrence Cohn, MD: A second opinion confirms that the heart disease diagnosis is correct and complete. Second opinion helps to choose the best surgical treatment for heart disease and coronary artery disease.
You have to know how to find the right surgeon. Get a second opinion on valvular heart disease and coronary artery disease and be confident that your treatment is the best.
How to find the right surgeon. How to pick a good surgeon.
Objective analysis of data that compares clinical outcomes for different treatments is called the practice of evidence-based medicine. It sometimes brings unexpected results.
Some commonly accepted methods of treatment are subjected to rigorous scientific analysis. For example, in cardiology, analysis of the efficacy of drug-eluting coronary stents versus bare-metal coronary stents has brought some unexpected results.
Studies showed that drug-eluting coronary artery stents are not significantly better than bare metal stents.
Dr. Anton Titov, MD: What are the areas in cardiac surgery where evidence-based analysis of common practices could be beneficial? Maybe there are examples of evidence-based clinical trials that have already challenged commonly held medical practice methods?
Dr. Lawrence Cohn, MD: Coronary artery bypass graft (CABG) surgery is clearly very data-driven. In many states of this country, you have to report all your patients' clinical outcomes data to a government agency.
Patient outcome data is risk-adjusted, of course. Because sometimes a patient comes in shock or has a big heart attack. Then the patient has an emergency coronary artery bypass graft (CABG) operation.
This patient's risk profile is higher than when somebody comes on an elective basis for a planned CABG operation. That patient could be doing well recovering at home.
Many states record clinical outcomes data of coronary artery bypass graft operations. As you pointed out, it is true.
The cardiac catheterization and cardiac coronary intervention procedures have clinical outcomes recorded in many states in the US. The Society of Thoracic Surgeons has a big database on all kinds of heart surgery.
Many states require a doctor to submit data on clinical outcomes for his or her patients and report this data to the public. But there are these repositories of clinical outcomes data for individual surgeons and hospitals.
Dr. Anton Titov, MD: This information is very helpful to assess the quality of surgeons and hospitals. How to find the right surgeon? How to compare results of surgical treatment? How to choose the best surgeon? What is risk-adjusted mortality? Cardiac surgery.