Not exactly where I would want to have my surgary at. But I'm sure he'll be fine.


September 6, 2004
Clinton Surgery Puts Attention on Death Rate
By LAWRENCE K. ALTMAN

he hospital where former President Bill Clinton awaits bypass surgery has the highest death rate for the operation in New York State, according to the state's Health Department. While the death rate is quite low - fewer than 4 percent of all bypass operations - it is still nearly double the average for hospitals in the state that perform bypasses.

The Clinton family had no comment on the Health Department's statistical profile, which showed that the hospital, Columbia-Presbyterian Center of New York-Presbyterian Hospital, had a 3.93 percent overall death rate for coronary bypass surgery in 2001, the latest year for which data were available. Mr. Clinton, 58, has been a patient at the hospital since Friday.

The figure for the hospital was nearly double the 2.18 percent overall death rate for coronary bypass operations in all 35 hospitals that perform the procedure in the state.

Last night, The Associated Press reported that a person close to Mr. Clinton, who spoke only on the condition of anonymity, said the former president had told him that the surgery would take place this morning.

A spokesman for the hospital, a major teaching center for the Columbia University College of Physicians and Surgeons located in the Washington Heights neighborhood of Manhattan, said no one was available yesterday for comment on the state data.

The state uses several statistical measures and adjusts the overall statistics to account for about 45 risk factors - like differences in the severity of illness among patients, the state of patients' health before the operation, the skill of the operating team and general postoperative care after the surgery - to arrive at risk-adjusted death rates for all the hospitals.

Columbia-Presbyterian and Westchester Medical Center were the only two hospitals in the state that had risk-adjusted death rates that were significantly higher than the statewide rate. The rate for Westchester Medical Center, in Valhalla, was 3.27. There was no indication that the Clinton family was aware of the state report when Mr. Clinton checked in on Friday with blockages in a number of coronary arteries.

Indeed, like many people who suddenly learn they have heart disease and need bypass surgery, Mr. Clinton had little chance to study statistics or consult experts on where to go. He simply found himself on a medical-referral track that led from a small hospital near his home in Chappaqua, N.Y., to the Westchester Medical Center, where tests revealed the extent of his problem and cardiologists suggested Columbia-Presbyterian.

Speaking to reporters in Syracuse on Friday, Mrs. Clinton said her husband "is in excellent hands at one of the great hospitals in the world." Columbia-Presbyterian is well-regarded for its teaching, research and patient care, and like many hospitals, it features its reputation in a wide range of advertising and promotional efforts.

For each of the past 14 years, the Health Department has provided a report, which includes statistics on various types of heart surgery, for patients who are considering such surgery and their families. The aim is to help better inform patients in deciding where they want to go for the operation, which is considered major surgery.

The state also provides the data to health care providers to improve the quality of care for heart disease, which is the leading cause of death in this country. State Health Department officials have cited the use of such reports for gradually reducing the death rate from bypass surgery over the years. "Whether patients recover quickly, experience complications or die following a procedure is in part a result of the kind of medical care they receive," the state report said.

The Health Department monitors changes in the annual rates because they often change, as they did for the two hospitals. In 2000, when the overall statewide rate was 2.32 percent, the rates for Columbia-Presbyterian and Westchester Medical Center were within the usual range, at 2.24 and 2.91, respectively.

The two hospitals with the most favorable rates in 2001 were Staten Island University-North and New York Weill Cornell Center in Manhattan. Their risk adjusted rates were 0.34 percent and 0.95 percent, respectively, compared with that of the state.

The state also provides specific death rates for each surgeon performing coronary bypass operations.

Mr. Clinton, his family and the hospital have provided few details about the impending surgery, and have not publicly identified the surgeons who will perform the bypass. The state's death statistics cover bypass patients who die in the hospital during or after surgery. If a patient is discharged from the hospital, a death is reflected in the statistics if it occurs within 30 days of the procedure.

One reason for the two-year delay in providing the figures is that the state has to await information about deaths of patients who were operated on in New York but died elsewhere, said Dr. O. Wayne Isom, the vice chairman of the committee that advises the state on its monitoring program for adult cardiac surgery.

The state does not analyze the cause of the deaths, Dr. Isom, a cardiac surgeon and surgeon in chief at Weill Cornell Center, said in an interview.

Deaths during bypass surgery from complications of anesthesia and other aspects of the operation once were an important risk but now rarely occur, he said.

A major reason for the favorable change is that doctors have used newer drugs and devices to help stabilize a patient's condition before performing coronary bypass surgery, Dr. Isom said.

Now the most frequent causes of death in the first month after bypass surgery include uncontrollable abnormal heart rhythms, shock, strokes, respiratory insufficiency from chronic lung disease, and infections.

In reporting the statistics, the state says it "encourages doctors to discuss this information with their patients and colleagues as they develop treatment plans."

Doctors do so in different ways. Dr. Isom said he tells patients general information about the risk of death and other complications but does not routinely provide the state data unless patients or their families ask.

It is not known what Mr. Clinton's doctors told him before he was admitted to Columbia-Presbyterian. Like many heart patients, he was transferred to a major teaching hospital after first seeking care at a small local hospital, Northern Westchester Hospital in Mount Kisco, after he began experiencing the sudden onset of chest pains and shortness of breath on Thursday afternoon while at home in Chappaqua.

Initial tests did not show evidence of a heart attack, but at 6 a.m. on Friday he arrived at Westchester Medical Center for additional tests.

There, Mr. Clinton underwent an angiogram, an X-ray test in which opaque dye is injected in the blood to outline the contours of the heart. The angiogram showed significant blockage in a number of coronary arteries, normal heart function and no heart attack.

The Westchester doctors said Mr. Clinton needed a bypass operation and referred him to Columbia-Presbyterian. Mrs. Clinton, a strong advocate for consumerism in health care, has spoken at the hospital many times about health care issues.

The New York State Health Department has pioneered the use of information that all hospitals in the state are required to report to develop guides for heart surgery for patients and health care providers.

It publishes the number of operations each hospital and surgeon performs, the number of deaths and the death rate. It also publishes the number of deaths that would be expected at the hospital based on the experience at all the other hospitals.

The risk-adjusted death rate that the state uses is what the hospital's or surgeon's death rate would have been if all patients were identical, and if the hospitals' and surgeons' performances were identical throughout the state. As he reflected on the state's report, which he said he received on Aug. 30, Dr. Isom said he and other heart surgeons bitterly opposed efforts by the late Dr. David Axelrod, then the state health commissioner, to provide the statistics to patients in the late 1980's and early 1990's.

But now, Dr. Isom said, "everyone has come to accept that the statistics are an important tool in making informed health care choices and that doctors and hospitals should be accountable."

New York's program has become a model that other states are trying to adopt as some find that the death rate in some hospitals elsewhere in the country reach 15 to 20 percent, Dr. Isom said.

The report is available through the state's Web site, www.health.state .ny.us/nysdoh/heart/pdf/1999-2001 _cabg.pdf.



www.nytimes.com/2004/09/06/health/06hosp.html?ei=5006&en=8481f89bc6d221a1&ex=1095048000&partner=ALTAVISTA1&pagewanted=print&position=

Doesn't sound good.

Hillary probably picked it.

Granted, I don't like their latest patient, but....the article fails to mention a CRITICAL point here.

The numbers/stats games can be very deceiving to a an uneducated observer. Bypass surgery typically has a 1-2% mortality rate. Many hospitals do not want to buck this number because of this type of press having a possible bad impact on their intake numbers. I can speak from personal experience as I've run into quite a few of these patients in my 14 years of EMS in NYC(4) and on Long Island(10).

When a patient presents with a complicated history/high surgical risk factors  they often get turned down for the surgery due to the risk of increased chance of fatality.

"Sure you are a sick, you are really sick, so sick infact, we won't touch you with a ten foot pole, but we know a place that will."


Hospitals that are willing to take the high risk patients are giving them a shot at life when no one else will. The downside is(and the patient is fully/ extesively) informed of the increased risk factors with regards to their particular malady that may result in a slightly higher(read 1%-2%) chance of fatality duing their surgery. So naturaly, there wil be a higher fatality rate as the sickest of the sick patients have to go to these places to get their surgery done. The upside is that there are some of the best doctors in the world doing their surgery.

I have friends that work at NYP as medics and nurses. It's a great hospital.

Yup, you are absolutely correct.  Hospitals will say goto the public hospital down the street.  They will risk the surgery but we wont.  

It would suck if bubba dies.....can you imagine having to listen to all the media going on and on and on and on and on and on and on about how great he was?

Not to mention the sympathy vote this would generate for kerry just because he's a dem.

Quoted: .

Hey guys... first of all, I am NO FAN of Slick Willie, but remember all the DUh's that were dancing on Reagan's grave? How pissed it got some of us? Hey, like it or not he WAS the president at one point. Lets now lower our standards to the likings of the DUh's.

Second, ITS BYPASS SURGERY!!!! 98% success rate. They guy is in good health otherwise. He will be fine. Regardless of the man, whether you like the guys politics or not... the position should be respected. Even if you feel the man that sat in that seat didnt respect it.

Capsice?

I hope all goes well. ANY president, past or present, deserves respect regardless if you agree with his stances or not.

Quoted: Quoted: . Hey guys... first of all, I am NO FAN of Slick Willie, but remember all the DUh's that were dancing on Reagan's grave? How pissed it got some of us? Hey, like it or not he WAS the president at one point. Lets now lower our standards to the likings of the DUh's. Second, ITS BYPASS SURGERY!!!! 98% success rate. They guy is in good health otherwise. He will be fine. Regardless of the man, whether you like the guys politics or not... the position should be respected. Even if you feel the man that sat in that seat didnt respect it. Capsice?

While I agree with you, that man also gleefully abused that position to take away many of the rights I hold dear.

I have no respect for an ex president who had no respect for the office.  

Quoted: Quoted: Quoted: . Hey guys... first of all, I am NO FAN of Slick Willie, but remember all the DUh's that were dancing on Reagan's grave? How pissed it got some of us? Hey, like it or not he WAS the president at one point. Lets now lower our standards to the likings of the DUh's. Second, ITS BYPASS SURGERY!!!! 98% success rate. They guy is in good health otherwise. He will be fine. Regardless of the man, whether you like the guys politics or not... the position should be respected. Even if you feel the man that sat in that seat didnt respect it. Capsice? While I agree with you, that man also gleefully abused that position to take away many of the rights I hold dear.

Brother, I agree with you 100%. But when a man is on his death bed (Not that he is on a death bed) or when a person passes on, I feel that one should leave their emotions at the door and pay respect to LIFE and DEATH. No matter the politics, he is still someone's father, son, brother and husband.

(Can you tell I am a recovering Liberal?)

Quoted: Brother, I agree with you 100%. But when a man is on his death bed (Not that he is on a death bed) or when a person passes on, I feel that one should leave their emotions at the door and pay respect to LIFE and DEATH. No matter the politics, he is still someone's father, son, brother and husband. (Can you tell I am a recovering Liberal?)

I AM a liberal and I agree with you 100%. I was no fan of Reagan but when he passed on it was not an excuse for me to trash the man or even air my disagreements about his policies. Having respect for someone in these circumstances does not mean you condone his actions. It also shows you have self-respect.  The old saying about "If you can't say something good about someone then say nothing at all." is not always applied (nor should it be) but it is appropriate in this case

Quoted: I have no respect for an ex president who had no respect for the office. .

Then I request that you consider giving the office the respect that you think that it is due.

wganz
¶

The Office? WTF is that supposed to mean? The Office isn't gonna die. I don't respect him in life, why should I respect him in death?

Quoted: The Office? WTF is that supposed to mean? The Office isn't gonna die. I don't respect him in life, why should I respect him in death?

There are a lot of people I do not respect but I would not wish them dead.

We dont need him dying right now.  I may not like his views but he doesn't deserve to die for them. Now "insert certain someones name here" on the other hand..........

I said this before in a previous thread; Bill is no longer usefull to the dark side and he will be crushed-out like the midnight cigarette that he was. The great whore is about to fall off of the lap of the beast.

The Hildebeast does not need his excess baggage around for her run in 2008 (or sooner).

Bill will probably die (God Forbid) and he will be canonized as "Saint Bill" by the liberal leftwing. Hitlery will be the strong grieving widow whao has been left to carry on and "lead the US out of darkness, as Saint Bill would have wanted it."

SHEEE's EEEEVVVILLL! I TELL YOU, EEEVVVIIILL!!!

Quoted: !

Well I appreciate you doing all you can to get this thread locked.

Quoted: I said this before in a previous thread; Bill is no longer usefull to the dark side and he will be crushed-out like the midnight cigarette that he was. The great whore is about to fall off of the lap of the beast. The Hildebeast does not need his excess baggage around for her run in 2008 (or sooner). Bill will probably die (God Forbid) and he will be canonized as "Saint Bill" by the liberal leftwing. Hitlery will be the strong grieving widow whao has been left to carry on and "lead the US out of darkness, as Saint Bill would have wanted it." SHEEE's EEEEVVVILLL! I TELL YOU, EEEVVVIIILL!!!

Heaven forbid that Bill would bite the big one, but if such a tragedy came to pass, would Hillary re-marry, and if so, who would she choose to be her new man?

Serious replies only.

Quoted: Quoted: I said this before in a previous thread; Bill is no longer usefull to the dark side and he will be crushed-out like the midnight cigarette that he was. The great whore is about to fall off of the lap of the beast. The Hildebeast does not need his excess baggage around for her run in 2008 (or sooner). Bill will probably die (God Forbid) and he will be canonized as "Saint Bill" by the liberal leftwing. Hitlery will be the strong grieving widow whao has been left to carry on and "lead the US out of darkness, as Saint Bill would have wanted it." SHEEE's EEEEVVVILLL! I TELL YOU, EEEVVVIIILL!!! Heaven forbid that Bill would bite the big one, but if such a tragedy came to pass, would Hillary re-marry, and if so, who would she choose to be her new man? Serious replies only.

No one, she is evil incarnate and was made human form just to keep an eye on Bill who was a mortal puppet!

One chest cutter please,.. , hillery found him.

violation of prior warning