Public reporting of AVR outcomes linked to decreased access

An increase in public reporting of aortic valve surgery outcomes has been tied to a decrease in AVR access for patients with infective endocarditis—the unintended consequence of a push for greater transparency in healthcare.

A study led by Simeon D. Kimmel, MD, of Boston Medical Center, revealed the link after Kimmel and his team reviewed five years’ worth of data from the National Inpatient Sample. They focused on a subset of patients aged 18-65 who were diagnosed with endocarditis between 2010 and 2015, including both injection drug use-associated diagnoses and non-injection drug use-associated diagnoses in their study population.

“Given the mortality and morbidity related to endocarditis, we wanted to examine if the decision to have hospitals and surgeons make their outcomes data publicly reportable would impact whether or not they would do these life-saving surgeries on patients with endocarditis,” Kimmel said in a statement, noting mortality and surgical complication rates are much higher for endocarditis-associated valve procedures than those recommended for other reasons.

The Society of Thoracic Surgeons started publicly reporting AVR outcomes data in 2013 as part of an effort to increase transparency between the medical community and those it serves. Reports included risk-adjusted in-hospital and 30-day mortality rates and 30-day morbidity rates for patients after aortic valve replacement.

Kimmel et al. found that, among 36,542 patients with injection drug use-associated endocarditis and 119,316 patients with non-injection drug use-associated endocarditis, the odds of receiving an AVR after 2013 decreased by 4% per quarter with no difference in injection drug use status. The authors said their data suggests surgeons might be operating less because they’re worried about having to report poor outcomes in higher-risk cases.

“The intentions of making this data publicly available were to promote transparency and improve the quality of care, but our study suggests that it may have had the unintended consequence of reducing access to valve replacement surgery, a potentially life-saving procedure for people with endocarditis,” Kimmel said.

The researchers said future studies will need to break down how, exactly, reduced valve surgery impacts overall mortality rates. Their work was published Oct. 10 in Clinical Infectious Diseases.