INTERNATIONAL PATIENTS
Clinical Outcomes at Fortis Healthcare
Clinical Outcomes are the globally agreed upon, evidence-based measurable changes in health or quality of life resulting from patient care. Reporting of outcomes and their continuous monitoring provides an opportunity for both assessing and improving the quality of patient health and care.
Fortis Healthcare Limited, one of the largest integrated, healthcare service provider in the country is the first hospital network to implement and monitor clinical outcomes in India. This initiative further strengthens our commitment to PATIENT CENTRICITY by striving towards continuous clinical excellence through improvement and enhancement of our clinical care services. Further, the introduction of Patient-Reported Outcomes Measurement [PROM] lends the voice of the patient to the entire process and helps enhance patient engagement and experience. Constant evaluation of our clinical outcomes against best available global standards motivates our medical workforce to continuously improve all aspects of our practice.
Fortis clinical outcomes are based on measurement of disease course and progression, quality of clinical care being provided, the success of the procedures/interventions carried out, and actual benefit perceived by the patient.
Details of individual procedure outcomes as measured using internationally accepted parameters and criteria, and further validated by our clinical experts, are published here and showcase our commitment to transparency in healthcare. Fortis is the FIRST to embark on the journey of publishing clinical outcomes data in the public realm.
Fortis Clinical Outcomes Journey
Kick off with
Clinical Outcomes
Monitoring for
3 procedures – CABG,
PTCA, KTP
Fortis joins the
ICHOM Working Group
on
Coronary Artery Disease (CAD)
January 2014
Fortis joins the
ICHOM Working Group
on
Coronary Artery Disease (CAD)
Partnership with Vital Health
(ICHOM certified
software supplier)
Implementation of
ICHOM CAD standard set
Implementation of
ICHOM CAD standard set
1st In India to publish
clinical outcomes
data
on website
CAD PROM
implemented
CAD PROM
implemented
We at Fortis continuously monitor and evaluate our outcomes for the following procedures and specialities
Coronary Artery Bypass Graft (CABG)
ABOUT THE PROCEDURE
Coronary Artery Bypass Graft (CABG), commonly known as Heart Bypass surgery/ Coronary Bypass surgery, is a surgical procedure which 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 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 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 CABG, and our performance consistently matches the global benchmarks set by best-in-class hospitals.
Outcome Parameters:
Use of left Internal Thoracic Artery graft Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 # | 84.83% | 74.20% * |
Need for a Bail out Intra-Aortic Balloon Pump (IABP) Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 # | 2.27% | -- |
Perioperative Myocardial Infarction Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 # | 0.33% | 0.96%** |
Post procedure neurological stroke Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 # | 0.36% | 1.30%¶ |
Need of Re-exploration surgery Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 # | 1.21% | 3.90%¶ |
Deep sternal wound infection Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 # | 0.42% | 0.30%¶ |
Predicted mortality (using EuroScore II) Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 # | 3.0% | -- |
Observed mortality Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 # | 2.24% | -- |
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 partsA heart attack occurring during or immediately after CABG. It is a predictor for short and long term disability and deathA Brain stroke occurring after CABG due to reduced blood flow to a brain partRedo surgery which may be needed to explore for any abnormal or unusual bleeding after CABGInfection involving tissue/muscle/bone involved in the surgical wound; this may require aggressive treatment including further surgeryThis 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 surgeryNumber of deaths reported in the observed patient group across different risk categories, expressed in percentage# Includes clinical outcome from those Fortis hospitals whose data is published on FHL website; doesn't represent all Fortis hospitals across India
References
- ¶STS Annual Report 2019
- *Cleveland Clinic Outcomes Report 2014
- **Texas Heart Institute 2014
Percutaneous Transluminal Coronary Angioplasty (PTCA)
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.
Outcome Parameters:
Emergency CABG for failed procedure Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 0.06% | 1.2% |
Vascular complication at puncture site requiring intervention (beyond simple compression) Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 0.2% | 1.1%* |
Acute vessel occlusion requiring emergency re-intervention Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 0.08% | -- |
Post procedure neurological stroke Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 0.04% | 0.284%** |
Post procedure Renal failure requiring haemodialysis Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 0.23% | -- |
Any Bleeding event requiring transfusion/intervention (within 72 hrs.) Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 0.27% | 4.0%* |
Delayed vascular complication at puncture site Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 0.12% | -- |
Readmission with acute Myocardial Infarction within 30 days Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 0.22% | -- |
Mortality during same hospital admission µ Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2019 | 1.70% | 1.7%* |
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 requiredSudden narrowing of the blood vessel which requires urgent repeat/additional procedure to restore the blood supplyA Brain stroke occurring after PTCA due to reduced blood flow to a brain partAcute 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 dialysisIn a few cases, acute bleeding may occur after PTCA from the puncture site and evidence shows 4% of such incidences may require blood transfusion 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 dischargeA heart attack occurring immediately or within 30 days after PTCA. It is a predictor for long term disability and deathThough 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, other conditions# Includes clinical outcome from those Fortis hospitals whose data is published on FHL website; doesn't represent all Fortis hospitals across India
µ Non risk adjusted
References
- *US National Registry Data 2013
- **Cleveland Clinic Outcomes Report 2014
Kidney Transplant
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.
Outcome Parameters:
One year survival Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| (Apr’ 2018 - Mar’ 2019) | 96.26% | 90-95%* 90-95%** 97%*** |
References
- *Kidney Research UK
- **Kidney Foundation of Canada
- ***National Kidney Foundation, USA
Radiation Oncology
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.
Outcome Parameters:
Treatment aim – Curative Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2016 | 77% | -- |
Treatment aim – Palliative Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2016 | 23% | -- |
Acute morbidity post Radiotherapy (Grade 3 and 4) Know more
| Period | Outcome | Benchmarks |
|---|---|---|
| 2016 | 6.4% | 5 – 15% |
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 expectancyDepending upon various factors systemic toxicity may affect different body systems involving Skin, Nervous system, lungs, Heart, Fertility etc.References
Radiation Therapy Oncology Group (RTOG) common toxicity criteria (CTC) v.2.0 Toxicity severity grading:-
- Grade 0—Absent or none
- Grade 1—Mild
- Grade 2—Moderate
- Grade 3—Severe and undesirable
- Grade 4—Life-threatening or disabling
- Grade 5—Death
Endoscopic Retrograde Cholangio Pancreatography (ERCP)
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 ERCP CLINICAL 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.
Outcome Parameters:
Successful CBD Cannulation
| Period | Outcome |
|---|---|
| 2019 # | 92.05% |
Stone Successful Extraction
| Period | Outcome |
|---|---|
| 2019 # | 89.18 % |
Intended Outcome Achieved
| Period | Outcome |
|---|---|
| 2019 # | 90.07 % |
Major Post Procedure Complication
| Period | Outcome |
|---|---|
| 2019 # | 90.07 % |
In-hospital Mortality
| Period | Outcome |
|---|---|
| 2019 # | 0 % |
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 expectancyDepending upon various factors systemic toxicity may affect different body systems involving Skin, Nervous system, lungs, Heart, Fertility etc.# Includes clinical outcome from those Fortis hospitals whose data is published on FHL website; doesn't represent all Fortis hospitals across India
Clinical outcomes of following procedures and specialities are also monitored and shall be published
Total Knee Replacement (TKR)
Mental Health
Caesarean Section
Hysterectomy
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