Weighing hospital outcomes against local convenience

[ALCapshaw2]

I stopped reading half way through this thread.

You need to know that Steve (Epstein) had his surgery performed by Dr. Patrick McCarthy who was "stolen" from the Cleveland Clinic (in the words of Ross, our former moderator), SO, he had a CC Surgeon in his back yard. DO YOU ?

My Local Hospital does 700 to 900 OHS annually with 4 highly regarded surgeons with good outcomes.
The Vast Majority of those surgeries are (relatively simple) Coronary Artery ByPass Grafts.
They won't tell me how many valve replacements they do.

When I needed AVR, my Cardio suggested that I go to the University of Alabama at Birmingham (100 miles away) which has been rated as high as #10 in the nation and is a Heart Transplant Center. I'm glad I went there.

The TOP Heart Hospitals in California are Stanford and UCLA from what I can tell.
There are several excellent and experienced AVR surgeons at both facilities.

 

[mitchner9g]

Thanks - lots of useful feedback here.

[...]

Here's a related question: if I were to have the surgery done elsewhere, would my local support for any ensuing complications or issues suffer for that?

Glad you're asking this question up front, Pem. Even in the best circumstances, there are communication issues between your local provider and the one who did the knife-work. I've dealt with this a lot, even when the hospital performing the surgery was only 50 miles away from where I normally went for clinic visits. If your routine care is not on the same campus as the big stuff, they might as well be 1000 miles away. Shakespearean torment, that.

If you make this decision to fly to cleveland, make sure up front that your local support staff have your back, and know completely what they're signing on for. Don't try this with a laissez faire local doctor as they will fail you repeatedly. Expect to have to ride herd on office clerks at both locations to push stupid fax buttons. Make sure the referring physician for Cleveland is entered correctly at the beginning (it's hell to change after the fact, CCF will never be able to change it, ask me how I know).

Also, budget as much time as you can stand post-op just cooling your heels in cleveland afterwards. in case you have some post-op things to sort through, like say infections, or getting your coumadin dosage right should you choose a mechanical prosthesis. CCF has 3 extended stay hotels on campus of various levels of quality. the bottom line one is a depressing block of concrete which I think they are planning on demolishing sometime soon. I nearly did it myself with my bare hands when I was there.

 

[auricula]

Pem, if you are considering D.C., why not come an hour further north and check out Johns Hopkins, the #3 heart hospital in the country? I think my surgeon, Duke Cameron, is extraordinary. Pat

 

[Duffey]

I think most if not all of the isolated AVRs are done by the same surgeon. He does about 200 procedures/year - not sure how many of those are AVRs combined with other things. Would that still give you pause? Or is the concern more about facility rate than surgeon rate?

Thanks,
pem

Facility pause.

 

[JulieS]

Pem - what date is your surgery scheduled for in July?

 

[pem]

Pem - what date is your surgery scheduled for in July?

Just got a date of July 15. Why do you ask?

Thanks,
pem

 

[Lynlw]

Facility pause.

Since you (PEM) said Originally Posted by pem
I think most if not all of the isolated AVRs are done by the same surgeon. He does about 200 procedures/year - not sure how many of those are AVRs combined with other things. Would that still give you pause? Or is the concern more about facility rate than surgeon rate?

Thanks,
pem

I personaly would want to know how many OHS /or complex OHS, ALL the surgeons combined do in a year, instead of just 1 surgeon, IF I was trying to figure out if the facility had "enough experience" to feel comfortable that they could handle any bumps in the road. Also I prefer centers IF they have dedicated Cardiac ICUs and floors so that ALL the staff takes care of day in and out are heart patients so really understand post op heart patients and the more common complications, and not just know a little about all different kinds of surgical patients. Hopefully you won't run into be complications, but it is a little encouraging if you do to know they have pretty much /been the done that.

Also I know you probably know this, but this looks like a good thread to mention this in, beside ranking the "best" hospitals in the Nation by specialty, this year US News started ranking the bests hospitals by "metro Area", http://health.usnews.com/best-hospitals/area incase people are wonderring which of their "local' hospitals would be the best by specialty. When it breaks it down by hospital, they also show which are ranked in the top 50 of the national for each specialty or which are "high performing" for example heres the best in the DC area over all and broken down by which are highly ranked by specialty http://health.usnews.com/best-hospitals/area/washington-dc/specialty

It's not perfect since some areas have 75-100 or more hospitals they have to compete against to be ranked the best in that area, and other areas have less than 20 hospitals but I think it is a good place to start looking if someone would like to stay local to see which would be the best.

 

[joanie]

I had my aortic valve replaced at the Cleveland Clinic a year ago. My initial decision was much like yours . . . there's a very good surgeon locally but he doesn't do the volume CCF surgeons do and I was somewhat hesitatant about the care I'd receive at a hospital that doesn't see as many heart, specifically valve, patients as CCF. I was also hesitant about the travel issue, especially after surgery.

After doing my research I came to the conclusion the CCF was the place for me. And it was! I can't say enough about the care I received there. I had already decided I wanted a tissue valve, but my surgeon did discuss the relative merits of tissue and mechanical valves with me. Although the CCF does implant far more tissue valves than mechanical, I felt that I could have chosen a mechanical valve and would have had the same excellent results.

I was lucky, no post-op complications. I was dicharged 6 days after surgery and flew home 2 days later. The flight home was easy. (Although I live near a regional airport and usully have to change plans at least once to get anywhere, there was a direct flight from Clevelnad on Continental.)

Good luck making your decisions.

 

[Gail in Ca]

For myself, I chose one of the best surgeons in the country, and he does surgery at Stanford Hospital. My own close hospital does OHS, but my husband and family was willing to drive almost an hour vs 8 minutes for me to have a great surgeon. Of course, across state lines would be a more difficult choice. I would think you have a great surgeon/hospital closer to you than Cleveland?

 

[Natina13]

Pem
There are no Cardiothoracic surgeons,in my town, nor do they do OHS at either of the 2 hospitals in my town, so...I went an hour away, to Fresno, to a Cardiothoracic group,which is a satellite of Stanford in Ca. I chose Dr Richard Gregory, partially, because my primary care physician, whom has been my care provider for over 20 yrs, told me, if he needed OHS surgery , this surgeon is the one he would have do it. Then, I spoke to his nursing staff, as well as other nurses in my area, who work in a Heart Hospital.. being a nurse myself, for over 30 yrs, the assessments they gave me, were thrown into the mix. My family and close friends live in Ca....and I knew, they wanted to be able to be with me, so I added this factor in. I did research his background, though I think, my impression of him at my initial appointment, sealed the deal. I figured, if I trusted him to open my chest..then...I trusted his judgment as to which hospital he preferred to do my surgery in... so he picked, St. Agnes, in Fresno, Ca. I was allowed to visit the Cardiac ICU and step-down section, I was totally satisfied with their ability to give me great care...and they did . I had no complications . Also...my insurance has a contract with that hospital, as well as several others in my area....so although, my surgery cost over $200,000, my share of the cost, is only $77. I definitely would not have wanted to pay 20% of that bill, which would have been my share of cost, if I picked an out of plan facility. Silly me though..if I am 100% honest, my personal belief, in "If it's your time to go, it will not matter where you are" probably was weighed, by me as well. (This was my first OHS , I am 59, and had no other medical problems to factor in)
Best of luck with your decision. Which ever you choose, I will be praying for you to have an uneventful surgery and a speedy recovery. Welcome to the family.
Renee
Go Team 2011 !!!!!
Dx BAV and 3 proximal arteries 75% occluded 11/2010 AVR 4/14/2011 with a Edwards "Magna" Bovine Tissue Valve and a Triple Bypass Dr.Richard Gregory St.Agnes, Fresno, Ca.