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<tr><td>Name</td><td>

30-Day In-Hospital Mortality After Coronary Artery Bypass Graft (CABG) and Aortic Valve Replacement (AVR)

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<tr><td>Short/Other Names</td><td>

CABG and AVR Mortality

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<tr><td>Description</td><td>

Risk-adjusted rate of all-cause in-hospital deaths occurring within 30 days for patients undergoing coronary artery bypass graft (CABG) and aortic valve replacement (AVR) surgery. For further details, please see the Cardiac Care Quality Indicators (CCQI) General Methodology Notes (PDF).

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<tr><td>Interpretation</td><td>

Lower rates are desirable.

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<tr><td>HSP Framework Dimension</td><td>

Health System Outputs: Appropriate and effective

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<tr><td>Areas of Need</td><td>

Getting Better

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<tr><td>Geographic Coverage</td><td>

All provinces/territories

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<tr><td>Reporting Level/Disaggregation</td><td>

National, Province/Territory, Facility

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<tr><td>Indicator Results</td><td>

https://www.cihi.ca/en/cardiac-care

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<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>

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<tr><td>Name</td><td>

30-Day In-Hospital Mortality After Coronary Artery Bypass Graft (CABG) and Aortic Valve Replacement (AVR)

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<tr><td>Short/Other Names</td><td>

CABG and AVR Mortality

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<div role="button" class="expandableTitle" aria-controls="descAndCalRegion">Indicator Description and Calculation</div>

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<tr><td>Description</td><td>

Risk-adjusted rate of all-cause in-hospital deaths occurring within 30 days for patients undergoing coronary artery bypass graft (CABG) and aortic valve replacement (AVR) surgery. For further details, please see the Cardiac Care Quality Indicators (CCQI) General Methodology Notes (PDF).

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<tr><td>Calculation: Description</td><td>

The risk-adjusted rate for a facility is calculated by dividing the observed number of in-hospital deaths for each facility by the expected number of in-hospital deaths for the facility and multiplying by the Canadian average in-hospital death rate.

Unit of analysis: Episode of care

An episode of care refers to all contiguous inpatient hospitalizations and same-day surgery visits. For episodes with transfers within or between facilities, transactions were linked regardless of diagnoses. For further details, please see the CCQI General Methodology Notes (PDF).

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<tr><td>Calculation: Geographic Assignment</td><td>

Place of service

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<tr><td>Calculation: Type of Measurement</td><td>

Rate - Rate - per 100

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<tr><td>Calculation:  Adjustment Applied</td><td>

The following covariates are used in risk adjustment:
Age, sex, urgent admission, shock, NSTEMI, previous acute myocardial infarction, previous cardiac surgery, cardiac dysrhythmias, multiple cardiac interventions, acute renal failure, Charlson Index

For detailed definitions of covariates and the risk-adjustment methodology, please refer to the CCQI General Methodology Notes (PDF).

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<tr><td>Calculation:  Method of Adjustment</td><td>

Logistic regression

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<tr><td>Denominator</td><td>

Description:
Number of hospitalization episodes for patients age 18 and older who underwent a CABG and AVR surgery

Inclusions:

  1. Episodes that had a CABG (CCI code 1.IJ.76.^^) and AVR (CCI code 1.HV.90.LA-^^) during the same operating episode, where the interventions were not coded as out of hospital or abandoned (Out-of-Hospital Indicator not equal to Y and Intervention Status Attribute not equal to A)
  2. Discharge date at the end of the episode between April 1 and March 31 of the fiscal year
  3. CABG and AVR surgery date on or before March 1 of the fiscal year (to allow for a 30-day follow-up to capture deaths occurring in the same fiscal year). CABG and AVR surgeries performed prior to the fiscal year may be included if the discharge date at the end of the episode of care was in the following fiscal year.
  4. First CABG and AVR within 30 days (i.e., repeat CABG and AVR surgeries within 30 days are excluded)

Exclusions:

  1. Episodes with other valve procedures (CCI codes 1.HS.^^ Therapeutic Interventions on the Tricuspid Valve, 1.HT.^^ Therapeutic Interventions on the Pulmonary Valve, 1.HU.^^ Therapeutic Interventions on the Mitral Valve, 1.HW.^^ Therapeutic Interventions on the Annulus not elsewhere classified and other aortic valve procedures not in the inclusion list: 1.HV.80.^^, 1.HV.90.ST-^^, 1.HV.90.GQ-XX-L, 1.HV.90.GR-^^, 1.HV.90.WJ-^^)
  2. Episodes with core concomitant procedures. Please see the CCQI General Methodology Notes (PDF) for the detailed list of procedures and codes.
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<tr><td>Numerator</td><td>

Description:
Number of hospitalization episodes in the denominator that resulted in an in-hospital death within 30 days of CABG and AVR surgery

Inclusions:

  1. In-hospital death (Discharge Disposition = 07, 72*, 74*)

Note
*2018–2019 data onward.

Exclusions:
None

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<div role="button" class="expandableTitle" aria-controls="backgroundRegion">Background, Interpretation and Benchmarks</div>

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<tr><td>Rationale</td><td>

Considering that about 2.4 million Canadians are living with heart disease and that Canada's population is increasingly at risk,1 it's important to examine the quality of cardiac care in order to support improvements in care and ultimately in the health of Canadians.

CABG is a well-established procedure to treat coronary artery stenosis and AVR is a common procedure to treat aortic valve stenosis. An increasing number of people in the aging population suffer from the combination of coronary artery stenosis and aortic valve stenosis and are candidates for a combined CABG and AVR surgery. In most cardiac care centres, this is the third most frequent cardiac surgery (after isolated CABG and isolated AVR). Short-term mortality following CABG and AVR surgery has been identified as a key quality indicator for cardiac surgery care by the Canadian Cardiovascular Society.2 Combined CABG and AVR surgery is considered to be high risk compared with isolated CABG and isolated AVR.

The indicator can provide direction for quality improvement and can help hospitals identify peers to facilitate knowledge sharing around best practices of care.

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<tr><td>Interpretation</td><td>

Lower rates are desirable.

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<tr><td>HSP Framework Dimension</td><td>

Health System Outputs: Appropriate and effective

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<tr><td>Areas of Need</td><td>

Getting Better

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<tr><td>Targets/Benchmarks</td><td>

Not applicable

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<tr><td>References</td><td>
  1. Government of Canada. Heart Disease in Canada. Accessed February 22, 2019.
  2. Canadian Cardiovascular Society. Quality Indicators for Cardiac Surgery (PDF). 2015.
  3. Donabedian A. The Criteria and Standards of Quality. 1982.
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    <div role="button" class="expandableTitle" aria-controls="availabilityRegion">Availability of Data Sources and Results</div>
    
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    <tr><td>Data Sources</td><td>
    
    DAD, HMDB, NACRS
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    <tr><td>Available Data Years</td><td>
    
    Type of Year:
    Fiscal
    First Available Year:
    2013
    Last Available Year:
    2018
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    <tr><td>Geographic Coverage</td><td>
    
    All provinces/territories
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    <tr><td>Reporting Level/Disaggregation</td><td>
    
    National, Province/Territory, Facility
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    <div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>
    
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    <tr><td>Update Frequency</td><td>
    
    Every year
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    <tr><td>Indicator Results</td><td>
    
    Web Tool:
    Cardiac Care Quality Indicators Report
    URL: https://www.cihi.ca/en/cardiac-care
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    <tr><td>Updates</td><td>
    
    Please refer to the CCQI General Methodology Notes (PDF).
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    <div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div>
    
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    <tr><td>Caveats and Limitations</td><td>
    
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<tr><td>Trending Issues</td><td>

Not applicable

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<tr><td>Comments</td><td>

This indicator belongs to a suite of Cardiac Care quality indicators (CCQI) that provide pan-Canadian comparable information on outcomes related to selected cardiac interventions. The goal is to support monitoring and quality improvement in cardiac care.

More information on the CCQI Report is available on our Cardiac Care web page.

Publicly available indicator results are based on 3 years of pooled data.

Indicator results based on 1 year of data are also available

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