• May Hua, Damon C Scales, Zara Cooper, Ruxandra Pinto, Vivek Moitra, and Hannah Wunsch.
• From the Department of Anesthesiology, Columbia University College of Physicians and Surgeons (M.H., V.M., H.W.); Department of Critical Care Medicine, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada (D.C.S., H.W.); Department of Medicine, Interdepartmental Division of Critical Care (D.C.S.), Department of Anesthesia (H.W.), and Interdisciplinary Department of Critical Care Medicine (H.W.), University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (Z.C.); and Department of Critical Care Medicine, Sunnybrook Research Institute, Toronto, Ontario, Canada (R.P., H.W.).
• Anesthesiology. 2017 Dec 1; 127 (6): 953-960.

BackgroundRecent reports have raised concerns that public reporting of 30-day mortality after cardiac surgery may delay decisions to withdraw life-sustaining therapies for some patients. The authors sought to examine whether timing of mortality after coronary artery bypass graft surgery significantly increases after day 30 in Massachusetts, a state that reports 30-day mortality. The authors used New York as a comparator state, which reports combined 30-day and all in-hospital mortality, irrespective of time since surgery.MethodsThe authors conducted a retrospective cohort study of patients who underwent coronary artery bypass graft surgery in hospitals in Massachusetts and New York between 2008 and 2013. The authors calculated the empiric daily hazard of in-hospital death without censoring on hospital discharge, and they used joinpoint regression to identify significant changes in the daily hazard over time.ResultsIn Massachusetts and New York, 24,864 and 63,323 patients underwent coronary artery bypass graft surgery, respectively. In-hospital mortality was low, with 524 deaths (2.1%) in Massachusetts and 1,398 (2.2%) in New York. Joinpoint regression did not identify a change in the daily hazard of in-hospital death at day 30 or 31 in either state; significant joinpoints were identified on day 10 (95% CI, 7 to 15) for Massachusetts and days 2 (95% CI, 2 to 3) and 12 (95% CI, 8 to 15) for New York.ConclusionsIn Massachusetts, a state with a long history of publicly reporting cardiac surgery outcomes at day 30, the authors found no evidence of increased mortality occurring immediately after day 30 for patients who underwent coronary artery bypass graft surgery. These findings suggest that delays in withdrawal of life-sustaining therapy do not routinely occur as an unintended consequence of this type of public reporting.

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