Clinical Outcomes at Fortis Healthcare

ABOUT THE PROCEDURE

Coronary Artery Bypass Graft (CABG), commonly known as Heart Bypass surgery/ Coronary Bypass surgery, is a surgical procedure that creates alternate routes for blood to flow to the heart tissue, bypassing the narrowed/blocked arteries (leading to what is known as Coronary Artery Disease). For this purpose, a healthy blood vessel (also called a graft) taken from one area of the patient’s own body is placed around the narrowed/blocked area to restore blood flow to the heart. The goal of this procedure is to relieve symptoms of coronary artery disease (including angina), enable the patient to resume a normal lifestyle, and to lower the risk of a heart attack or other heart problems.

ABOUT CABG CLINICAL OUTCOMES

CABG outcome indicators provide measures of the overall success of the surgery and the patient’s post-procedure clinical condition. These parameters are globally accepted evidence-based scientific criteria to indicate the quality of the procedure and the patient’s health status. Fortis hospitals measure the following outcome parameters for CABG, and our performance consistently matches the global benchmarks set by best-in-class hospitals.

Parameter	Outcome	Benchmarks
Use of left Internal Thoracic Artery graft Internal Mammary (Thoracic) Artery grafts are associated with long-term patency and improved outcomes as compared to all other grafts	86.36%	74.20% *
Need for Bail out Intra Aortic Balloon Pump (IABP) This is an urgent life-saving procedure where an inflatable balloon is placed in the aorta to help the heart pump blood to the vital organs and body parts	0.98%	--
Perioperative Myocardial Infarction A heart attack occurring during or immediately after CABG. It is a predictor for short and long term disability and death.	0.07%	0.96%**
Post procedure neurological stroke A Brain stroke occurring after CABG due to reduced blood flow to a brain part	0.20%	0.80% *
Need of Re-exploration surgery Redo surgery which may be needed to explore for any abnormal or unusual bleeding after CABG	2.02%	3.50% *
Deep sternal wound infection Infection involving tissue/muscle/bone involved in the surgical wound; this may require aggressive treatment including further surgery	0%	0.20% *
Predicted mortality This is a predictor for risk of death after a cardiac operation. It is a globally accepted scoring system based on multiple factors like patient’s age, gender, clinical conditions and type of surgery	2.71%	--
Mortality during same hospital admission Number of deaths reported in the observed patient group across different risk categories, expressed in percentage	2.02%	--

ABOUT THE PROCEDURE

Percutaneous coronary intervention (PCI/PTCA), also known as coronary angioplasty, is a nonsurgical technique for treating narrowed/blocked coronary arteries which supply blood to the heart muscle. PTCA involves inserting a tiny balloon or stent across the narrowed part to widen the affected artery and restore blood flow to the heart muscle without requiring an open-heart surgery.

ABOUT PTCA CLINICAL OUTCOMES

PTCA outcome indicators provide measures of overall success of the surgery and patient’s post-procedure clinical condition. These parameters are globally accepted evidence-based scientific criteria to indicate quality of procedure and patient’s health status. Fortis hospitals measure the following outcomes parameters for PTCA, and our performance consistently matches the global benchmarks set by best-in-class hospitals.

Parameter	Outcome	Benchmarks
Emergency CABG for failed procedure Emergency cardiac revascularisation (restore blood flow to part of the heart) surgery like CABG may be required to correct an emergency complication of PTCA such as abrupt closure of a vessel, perforation and injury to vessels.	0.04%	1.2% *
Vascular complication at puncture site requiring intervention Local injury to the blood vessel puncture site [usually groin or wrist] may occur. Usually these require only pressure being applied by mechanical compression, but sometimes additional surgical or non-surgical measures may be required	0.04%	1.1% *
Acute vessel occlusion requiring emergency re-intervention Sudden narrowing of the blood vessel which requires urgent repeat/additional procedure to restore the blood supply	0.23%	--
Post procedure neurological stroke A Brain stroke occurring after PTCA due to reduced blood flow to a brain part	0.12%	0.284 % **
Post procedure Renal failure requiring hemodialysis Acute renal (kidney) failure is a rare but known complication resulting from acute kidney injury, more so in pre-existing renal failure patients, and may require dialysis	0.13%	--
Any Bleeding event requiring transfusion/intervention (within 72 hrs) In a few cases, acute bleeding may occur after PTCA from the puncture site and evidence shows 4% of such incidences may require blood transfusion	0.17%	4.0 % *
Delayed vascular complication at puncture site Vascular complications which may include occlusions at insertion site, peripheral embolization, tear and injury to blood vessels, bulging of the arterial wall and/or AV fistulas, may occur at a later period after procedure, even after discharge	0.02%	--
Readmission with acute Myocardial Infarction within 30 days A heart attack occurring immediately or within 30 days after PTCA. It is a predictor for long term disability and death	0.06%	--
Mortality during same hospital admission Though rare, both sudden cardiac death and death at a later stage my occur depending on a number of factors including Patient history of heart attack, multi-vessel disease, advanced age, complex lesions, Location of the blockage in the coronary artery etc	1.81%	1.7 % *

ABOUT THE PROCEDURE

Kidney transplantation means replacement of the failed kidney with a healthy kidney from another person, called a donor, living or deceased. When kidneys fail to filter fluid and wastes, these may accumulate in the body to the harmful level. When the kidneys have lost about 90 percent of their normal functioning ability, patients have kidney failure (or End-stage Renal Disease) and require either dialysis or transplantation to sustain their life. Kidney transplant provides significant quality-of-life benefits and survival in patients with end-stage kidney disease/Kidney failure/ in this condition.

ABOUT KTP CLINICAL OUTCOME

Monitoring of patient survival over longer and defined periods is regarded as successful outcomes of kidney transplant procedure. Acute rejection within the first-year post-transplantation is a negative predictor of long-term renal allograft survival.

Parameter	Outcome	Benchmarks
Kidney Transplant	95.4%	90-95%*, 90-95%**, 97% ***

ABOUT THE PROCEDURE

Radiation is one of the most common treatments for cancer, and is utilised for more than 60% of cancer therapy. It uses carefully measured and optimally controlled high-energy particles or waves, such as x-rays, gamma rays, electron beams or protons aimed to destroy cancer cells in body. This therapy can also be combined with other treatment options like chemotherapy and surgery. The goal is to use this as primary curative treatment for cancer or adjuvant therapy or to prevent recurrence of tumour and improve a person’s quality of life.

Sometimes in advanced or late-stage of a cancer, it is not possible to destroy all of the tumour cells, then doctors may use palliative radiation therapy to shrink tumours and relieve/reduce pain, pressure and other symptoms.

ABOUT OUTCOMES

Every person reacts differently to treatment. Acute radiation toxicities are side effects that may occur during treatment or in the immediate post-treatment period, depending on the type of cancer, location, dose and length of radiation and patient’s general health. Onset may be 2–3 weeks after the commencement of a regimen of radiation therapy. Typically, severity and timing are tied to the total biologic dose and the turnover rate of the tissue in question, respectively.

Parameter	Outcome	Benchmarks
Treatment Completion	100%	--
Treatment – Curative It is aimed at curing the cancer completely	73.4%	--
Treatment – Palliative Radiation therapy may be given to relieve pain and other symptoms only in cancer patients when complete cure is not possible, in most cases patients with short term life expectancy	26.6%	--
Acute morbidity post Radiotherapy (Grade 3 and 4) Depending upon various factors systemic toxicity may affect different body systems involving Skin, Nervous system, lungs, Heart, Fertility etc.	0%	5 – 15 %

ABOUT THE PROCEDURE

Endoscopic Retrograde Cholangiopancreatography, also known as ERCP, is a minimally invasive procedure that combines use of X-ray and an endoscope. This procedure is used to diagnose and treat problems of the upper Gastrointestinal Tract and related organs like Liver, Gall Bladder, Bile ducts and Pancreas. It uses a thin, long, flexible, lighted tube called endoscope which is inserted through the mouth and down the throat into the small intestine and a dye (contrast material) is then injected to highlight these organs under X-ray. The procedure is used to detect a block and identify probable cause, or infection in a bile duct or pancreatic duct; and to collect samples of cells or tissue (called a biopsy). Sometimes a stent may be placed through the scope to relieve any blockage in these ducts to allow passage of bile or pancreatic juice onto the intestine.

ABOUT OUTCOMES

A commonly performed endoscopic procedure, ERCP is usually safe and well-tolerated, though success of the procedure may vary depending upon various patient and care related factors like age, gender, presence of anatomical variants, previous upper abdominal surgery, the success of the cannulation, technique etc. A higher success rate of biliary cannulation leads to better outcome and lower complications.

Parameter	Outcome	Benchmarks
Successful CBD cannulation The rate of successful common bile duct (CBD) cannulation at ERCP is usually used as a surrogate marker of competence at ERCP. Difficult cannulation may sometime lead to perforation and bleeding or inflammation	94.4%	--
Successful extraction Successful removal of stone(s) using a tiny basket or balloon inserted through the ERCP endoscope	84.6%	--
Intended outcome achieved	95.4%	--
Major Post procedure complication A few risks are known to be associated with this technically demanding procedure. Pancreatitis (inflammation of the Pancreas) is the most common major complication followed by infection, bleeding and perforation	2.25%	--
In-hospital mortality Very rarely ERCP related death may occur due to severe complications	0.06%	--