Gathering Information

[tomkanis]

I?ve been gathering information in order to make the necessary decisions on surgeon, hospital, valve, surgery type, etc.

Although the decisions are largely made at this point, I?d like to solicit comment on how to gather information on various aspects of AVR.

Things I had trouble getting info in were:

-Surgeon?s AVR procedure numbers

-Surgeon?s operative mortality rate

-Hospital?s AVR procedure numbers

-Hospital?s operative mortality rate

-Surgeon?s complication rate


I also asked to speak to five of the surgeon?s former patients and hit a brick wall there, but that wasn?t unexpected (HIPPA and all). It took some sleuthing, but I got to talk to three of them, all with good experience. It took about two months to do this, but I think it was worth it. Glad I had the time to do it.


Tom in Cincinnati
________________
Mod to Severe Asymptomatic AS
Bicuspid AV
Looking forward to the Op in Oct

 

[davidfortune]

Tom,
Ask your surgeon. My experience shows that most top-flight surgeon will tell you their stats. They're usually Type-A that wouldn't denigrate themselves with falsehoods. They take pride in being "one of the best".

There is no central registry so I have had dismal luck finding real stats on an individual surgeon anywhere else. Lots of web stories, blogs, etc... but no REAL stats without asking.

 

[StretchL]

David's Right

David's Right

The guys I've talked with have been very forthcoming.

Ask and ye shall receive.

FWIW, I'm of the opinion that the hospitals that have done the most AVR's aren't necessarily the ones I'd go to. I think I might rather be a big fish in a relatively smaller pond than just another tiny fish in the ocean.

I've read a couple of things about people not even meeting their surgeon until after the procedure at the bigger places, and that just doesn't sit well with me. Guess it makes me feel more like a piece of meat than a patient.

Just my 2 cents-

 

[PegB]

Tom,

I don't know if you're planning to stay in Cinti. for your surgery, but most of the Drs. here seem to think that Christ is the best for heart surgery. I'm going up to Cleveland Clinic for mine (3 weeks from today!), but that's just one of many options available to you. CC does have almost all those stats that you're looking for on their website, not sure if Christ lists them or not. Is your Dr. making any recommendations or leaving it all up to you? You mainly want to get someone who has done a lot of your specific surgery. It's pretty mindboggling to begin with, but try not to be intimidated, and keep asking questions.

 

[tomkanis]

Having been in the nuclear industry, I guess I just don?t trust anything anyone says about themselves. We always got third-party information inn order to have a good picture of what?s going on with a given source of service or supply.

Yes, Christ Hospital has a good rep. The old Operations VP there was a classmate of mine. But there are several other hospitals in the area that are as good: University and Bethesda North. Docs who work at Christ and at some of the others say that Christ is at its peak, while the others are just as good and getting better.

One of my cardiologist friends says that after a certain level of excellence is achieved, it?s the surgeon and not the hospital that makes the most difference in outcome. And, if you select the surgeon, that pretty much determines the hospital, since they have their favorites. The surgeon I?m favoring at this point, is the head of Cardiac surgery at a particular hospital, so that really locks it in. The only real problem is that he wants to do 2 CABGs that my cardio doesn?t want me to do. My cardiologist says these decisions are mine to make.

Cleveland Clinic is of course excellent. Good choice for you Peg. But being single and living alone means that I would have a rough time with my support structure that?s 200+ miles away from the hospital. As it is, I?ll have to hire a nurse for 24/7 care the first week back home. That?s about $3500.00 that insurance won?t cover. I?m thinking that a nursing home stay might be covered. More as this develops.

Tom in Cincinnati
Looking at surgery in October

 

[Nan]

I am not sure if the Ohio Department of Health does what NY State does, but NY does have much of the information you are looking for on their main web site. Stats for both hospitals and for individual surgeons, both number of surgeries and mortality rate. You might take a look at the Ohio web site and see if they have anything similar.

The only draw back is that the data is about 2 years old... but still gives you an idea.

Good luck.

 

[Mary]

Tom,
You want to get the best surgeon you can and then go with the hospital he uses. The facility's heart unit really does follow his dictates, and that's what you want. A good surgeon has a good team.

And Stretch, when you're in the hospital recovering, you will be darn glad you're in a facility that does many valve replacements. Your thoughts of
"big fish/little fish" will have been left by the wayside when you face the reality of what you're experiencing.

 

[MikeHeim]

I'd like to echo some of the others in that my surgeon had absolutely no problem rattling off statistic after statistic about both himself and the hospital. In fact, that's one of the things I really liked. There wasn't any BS or small talk when he came into the room for my surgical consult - just my options and the stats associated with them. I was (like most people) nervous beyond belief, and the last thing I wanted was to talk to a guy who was pretending to be my friend. I know others are looking for more of a personal touch, and there's certainly nothing wrong with that.

 

[StretchL]

And Stretch, when you're in the hospital recovering, you will be darn glad you're in a facility that does many valve replacements. Your thoughts of
"big fish/little fish" will have been left by the wayside when you face the reality of what you're experiencing.

I don't think so.

I was at Beth Israel hospital this past weekend to meet with Dr. Paul Stelzer. He came in on a Saturday and spent five-and-a-half hours talking with my wife and I. While we were in his office, the chief of cardiothoracic surgery came by. He had assisted Stelzer with a complicated surgery on Friday, the day before. That day, both men checked on the patient, who was still in cardiac ICU.

Now, how many patients at CCF would have that kind of attention from their surgeon and the CT chief? And on a holiday weekend at that... VERY few if any, I imagine.

So, would I rather be just another patient in the largest cardiac hospital in the country and have my surgeon's attention divided between me, dozens of other patients, and God knows what kind of administrative work load, OR would I prefer to be in a smaller hospital and have the attention of my surgeon not only during the time I'm on the table, but pre- and post-op as well?

I'd rather have the second.

I would agree with what Tom said his cardio said, "after a certain level of excellence is achieved, it?s the surgeon and not the hospital that makes the most difference in outcome."

 

[Mary]

FWIW, I'm of the opinion that the hospitals that have done the most AVR's aren't necessarily the ones I'd go to. I think I might rather be a big fish in a relatively smaller pond than just another tiny fish in the ocean.

I've read a couple of things about people not even meeting their surgeon until after the procedure at the bigger places, and that just doesn't sit well with me. Guess it makes me feel more like a piece of meat than a patient.

Just my 2 cents-

Hey Stretech,

We're not on the same page here. I'm not seeking to compare Beth Israel or Cleveland Clinic in terms of their "fish holding capacity." I am comparing a community based hospital with Cedars-Sinai, Cleveland Clinic, UAB and others.

And yes, I too was headed to Beth Israel and Dr. Stelzer before circumstances intervened, but I believe that Dr. Stelzer makes Beth Israel and not vice versa.

After you undergo replacement, you might want to revisit your views concerning this subject, but that day's not here yet!

 

[MikeHeim]

So, would I rather be just another patient in the largest cardiac hospital in the country and have my surgeon's attention divided between me, dozens of other patients, and God knows what kind of administrative work load, OR would I prefer to be in a smaller hospital and have the attention of my surgeon not only during the time I'm on the table, but pre- and post-op as well?

I'd rather have the second.

It may sound crazy, but I'd rather have the first (I probably would have worded the options differently, but the sentiment remains the same). When I had my surgery, I was all about my surgery being "routine". I wanted a surgeon who had done hundreds of surgeries just like mine, and as a result had probably seen every set of conditions and complications imaginable, so he would almost certainly know how to deal with anything that might have come up. I would expect surgeons to be very busy. In fact, if they were not, I would probably wonder why no one is going to them.

Please don't for a second think that I consider your reasoning "wrong". Everyone is different and is looking for different things.

 

[StretchL]

I'm not seeking to compare Beth Israel or Cleveland Clinic in terms of their "fish holding capacity." I am comparing a community based hospital with Cedars-Sinai, Cleveland Clinic, UAB and others.

And yes, I too was headed to Beth Israel and Dr. Stelzer before circumstances intervened, but I believe that Dr. Stelzer makes Beth Israel and not vice versa.

I agree that, given the choice, I'd not have surgery in a smaller, community based hospital like the several here in Richmond, although people do it all the time and live to tell about it and more. I think it's important to remember that there are thousands, tens of thousands, of people out there who have AVRs and never visit this site, much less get into the conversation. These folks are likely getting a diagnosis from their cardio, going to the local surgical group she recommends, getting the valve they recommend, and then going on about their lives.

Anyway, as I said before, I agree that the surgeon is more important than the facility, after a certain point of expertise is realized. And yes, of course, Stelzer is the bright shining star in this business for Beth Israel. But that's exactly my point. For me, personally, I'd rather have someone of Stelzer's calibre and experience (especially with the Ross) looking after me closely, than go to a major heart center and have less personal attention from my surgeon, no matter who that person is.

Now, on the other hand, perhaps what's more important after surgery (for comfort as well as safety/recovery) would be the quality of the nursing staff and the patient/nurse ratio. That might be an indication to go with the larger centers. I don't know, but I'd be interested in hearing from others on this one. Perhaps I should start a new thread?