Report: For Heart Surgery, Closer Is Better

MAYS LANDING — Local cardiac surgery patients should know they don’t have to go far to put their hearts in good hands, according to a recently released state report.
On May 4, the state Department of Health and Senior Services (DHSS) announced the release of its Cardiac Surgery in New Jersey 2007, a healthcare quality assessment. This was the state’s 11th such report and showed a 54 percent mortality rate decline since the first report covering the years 1994-1995.
“One important goal of this report is to provide New Jersey hospitals and surgeons with data they can use in assessing quality of care related to bypass surgery,” the report’s executive summary stated. “More importantly, this report presents patients and families of patients with important information they can use in discussing questions and issues related to bypass surgery with their physicians.”
In the report, the DHSS collected data on 8,460 patients undergoing open-heart surgery at 18 hospitals in 2007. Of those patients, 4,943 had coronary artery bypass graft surgery. Of those nearly 5,000 bypass surgeries, 99 died while in the hospital or within 30 days after surgery for a statewide risk-adjusted mortality rate of 2 percent, which was the same rate as in 2006.
“New Jersey’s hospitals and physicians have worked hard to improve the quality of cardiac surgical care, and that has meant better health for patients and hundreds of lives saved,” DHSS Commissioner Dr. Poonam Alaigh stated in a release.
AtlantiCare Regional Medical Center, the only hospital in this region certified in heart surgery, finished with one of the lowest mortality rates in the state. In 2007, surgeons at AtlantiCare performed 148 bypass procedures and had a .7 percent mortality rate. AtlantiCare surgeons also performed 87 other procedures in 2007.
When asked what these figures meant for local heart patients, Dr. Howard Levite, medical director of AtlantiCare’s Heart Institute, said their hearts were in exceptionally good hands.
“We’re one of a handful of hospitals with cardiac surgery mortality rates under 1 percent,” Levite told the Herald. “We have experienced surgeons and a team trained to deal with very sick patients in a timely fashion.”
Only three hospitals had lower mortality rates than AtlantiCare — Englewood Hospital and Medical Center, St. Francis Medical Center (Trenton) and the University of Medicine and Dentistry of New Jersey Hospital (Newark). Those hospitals had no bypass surgery deaths during 2007 for a mortality rate of zero.
“We think these reports are one good way to get information out to the public,” said AtlantiCare spokesperson Jennifer Tornetta. “We have a link to this and other similar reports on our Web site (atlanticare.org).”
Dr. Howard Axelrod, one of the AtlantiCare Heart Institute’s two cardiac surgeons expounded on what Levite said.
“The faster you deal with cardiac surgery patients, the better the outcome for the individuals,” Axelrod explained. “Shifting patients to other hospitals works to the detriment of patients. There aren’t many heart conditions that can’t be managed today, but delay is the one thing that can hurt.”
In mid-2001, AtlantiCare began its cardiac surgery program after receiving a state certificate of need. Since that time AtlantiCare’s surgical team has remained progressive utilizing the latest minimally invasive techniques in the field, Axelrod said.
Despite AtlantiCare’s reputation for quality care, this region’s high over-65 population and the fact that it has no competition in over 50 miles, only 14 percent of AtlantiCare’s cardiac surgery patients are referred from just a few Cape May County cardiologists.
The AtlantiCare doctors said many local patients think that Philadelphia is the place to go for heart surgery.
For instance, Shore Memorial Hospital’s spokesperson Courtney Spahr said that through the hospital’s affiliation with Penn Cardiac Care, its patients have access to the Penn Heart Rescue Program, which assures 24-7 availability for emergency transport to Philadelphia via ambulance or PennStar helicopter.
Levite said AtlantiCare could handle the volume of surgical patients in the tri-county area, but many are “convinced to go elsewhere for care.”
Dr. Suketu Nanavati, a cardiologist who practices medicine at Cape Heart Clinic in Court House, told the Herald that he is one of the few local doctors who refers patients to AtlantiCare.
“I have a zero mortality rate for my patients sent to AtlantiCare, and I’m very happy with the expert care given by Dr. Axelrod and Dr. (James) Dralle (AtlantiCare’s other heart surgeon),” Nanavati told the Herald. “If I had a heart attack, my first call would be to Dr. Levite. I would trust him and AtlantiCare’s surgical staff with my life.”
Nanavati said he doesn’t see the need to send patients to Philadelphia hospitals when there is a state-of-the-art surgical facility and excellent surgeons nearby. He said the cost of airlifting a patient by helicopter is also prohibitive, sometimes costing thousands of dollars.
“In cardiology, time is muscle,” he said. “The faster doctors can see a patient in an emergency situation, the better the prognosis.”
The Herald asked Cape Regional Medical Center and Shore Memorial Hospital why they did not perform cardiac procedures and, since they did not, where their patients went for surgery.
“As a community hospital, Cape Regional Medical Center does not perform cardiac surgery,” replied Cape Regional spokesperson Tom Piratzky. “Most cardiac surgeries are performed at major teaching hospitals or specialty hospitals.”
“Patients, in consultation with their cardiologist, are free to select the hospital of their choice for cardiac surgery,” he added.
Shore Memorial’s response was similar.
“We do not currently offer coronary artery bypass graft surgeries at Shore Memorial,” Spahr said. “The Atlantic and Cape May County community is best served by high-volume cardiac surgery centers that perform this procedure on a routine basis.”
“As stewards of our healthcare resources, it is best to align with a high volume, high quality provider rather than to duplicate existing services,” Spahr added, noting the Penn Heart Rescue program.
She also noted that use rates for bypass procedures are declining as new, less invasive (and less expensive) alternatives such as stenting and medical management of cardiac conditions continue to advance.
Why is the Cardiac Surgery report for 2007 only now being released?
In the report, three of the 18 hospitals — Cooper University Medical Center (Camden), Deborah Heart and Lung Center (Browns Mills), and St. Mary’s Hospital (Passaic) — had statistically significantly higher mortality rates than the statewide rate. Levite said the data was ready to be released a year ago, but it was held up in litigation by one of the hospitals, challenging its findings.
From 2006 through 2007, Axelrod performed 239 open-heart procedures, including 158 bypass surgeries with three patient operative deaths. His colleague, Dralle, performed 229 procedures, including 138 bypasses with one death.
Axelrod noted that AtlantiCare’s surgical team takes care of incredibly sick people and doesn’t worry about statistics.
“In this era of the surgical report card, we don’t turn any patients away,” he said.