Hospital variability of postoperative sepsis and sepsis-related mortality after elective coronary artery bypass grafting surgery


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Abstract

Purpose:Hospital variability of postoperative sepsis and sepsis-related mortality after elective CABG surgery was not known in Australia.Material and methods:Population-based analysis of all elective patients who underwent CABG surgery in public and private hospitals between 2007 and 2014 using linked data from the state-wide Admitted Patient Data Collection and the NSW Registry of Births, Deaths, and Marriages.Results:We identified 18,928 (9464 pairs) matched patients who had elective CABG surgery in public hospitals (n = 9) and private hospitals (n = 13) during the study period. When compared to public hospital patients, private hospital patients had a significantly lower rate of post-CABG sepsis (13.3 vs 20.4 per 1000 admissions, P < 0.001; treatment effects: −7.1, 95%CI: −11.1 to −3.3), a lower in-hospital mortality rate (6.1 vs 9.9 per 1000 admissions, P = 0.006; treatment effects: −3.8, 95%CI: −6.5 to −1.1), and a lower rate of 30-day readmission (11.9% vs 13.9%, P < 0.001; treatment effects: −2.0%, 95%CI: −3.1% to −1.0%). In addition, for both public and private hospital groups, there were significant differences for all outcomes when comparing the worst and best performance quintile hospitals.Conclusions:Hospital variability of postoperative sepsis, in-hospital mortality and readmission after elective CABG existed between and within public and private hospitals.HighlightsRates of postoperative sepsis, hospital mortality and readmission varied between and within public and private hospitals.Private hospitals had reduced rates of sepsis incidence, hospital mortality and readmission compared to public hospitals.Significant differences persisted in CABG outcomes between the worst and best performing public and private hospitals.

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