Heart Surgery Hospital Rankings: Why Most Lists Get It Wrong
When you or someone you love is facing heart surgery, one of the first things most people do is search for the "best" hospital. You pull up U.S. News & World Report, maybe a state health department website, maybe a friend's recommendation. You see rankings, stars, badges, and designations. And you assume, reasonably, that the hospital at the top of the list is the obvious choice.
As a cardiac surgeon who has operated at multiple institutions and reviewed cases from hospitals across the country, I can tell you: it is not that simple. Some of the metrics behind popular heart surgery hospital rankings are meaningful. Others are misleading. A few are essentially marketing. The difference between these categories can have real consequences for your care.
This article is not meant to discourage you from doing your homework. Quite the opposite. I want to help you ask sharper questions and focus on the data points that actually predict whether you will do well after surgery. Because the best cardiac surgery centers are not always the ones with the flashiest advertising budgets.
Understanding STS Star Ratings: The Closest Thing to a Gold Standard
If you are going to look at one quality measure, the Society of Thoracic Surgeons (STS) star rating system is the most clinically credible metric available to patients. Here is why.
The STS maintains the largest cardiac surgery database in the world, with data from over 6.8 million surgical records and more than 3,800 participating surgeons. Hospitals that participate voluntarily submit detailed outcome data on every cardiac operation they perform, including coronary artery bypass grafting (CABG), aortic valve replacement, and mitral valve surgery.
The STS then risk-adjusts this data. That is critical. A hospital that operates on sicker, higher-risk patients should not be penalized for having slightly higher complication rates compared to a center that primarily treats healthier patients. Risk adjustment levels the playing field.
Hospitals receive one of three ratings:
- Three stars: Performance above what would be expected given the patient population (roughly the top 10-15% of programs)
- Two stars: Performance as expected (the majority of programs)
- One star: Performance below what would be expected
STS star rating hospitals earn their designation based on a composite score that includes operative mortality, major complications (stroke, renal failure, prolonged ventilation, deep sternal wound infection), and reoperation. These are outcomes that matter directly to you as a patient.
You can look up a hospital's STS star rating for free at the STS public reporting website. If a hospital does not participate in STS reporting at all, that itself is worth noting. Most serious cardiac surgery programs consider participation a baseline commitment to transparency.
What the STS Ratings Do Not Tell You
No metric is perfect. STS ratings are procedure-specific, so a hospital might earn three stars for isolated CABG but have unremarkable outcomes for valve surgery. The ratings also update periodically, and a program's performance can shift over time as surgeons join or leave.
Additionally, STS star ratings reflect programmatic outcomes, not individual surgeon outcomes. A three-star hospital may have one surgeon who is exceptional and another who is average. This is one of many reasons why a second opinion from an independent cardiac surgeon can add clarity that no ranking system provides.
Beyond Star Ratings: Other Quality Metrics for Evaluating the Best Cardiac Surgery Centers
STS ratings are a strong starting point, but they are not the only data worth reviewing. Here are other metrics and factors I recommend patients consider:
Surgical Volume
Decades of research support a consistent relationship between hospital surgical volume and patient outcomes. A landmark study published in the New England Journal of Medicine demonstrated that hospitals performing higher volumes of CABG surgery had lower operative mortality rates. The ACC/AHA guidelines reference this volume-outcome relationship as well.
As a general benchmark, you want a hospital that performs at least 200-300 open heart operations per year for the full range of cardiac procedures, and ideally more. For specific complex operations, such as aortic root replacement or reoperative surgery, volume becomes even more important. Ask the hospital directly: how many of the specific operation you need do they perform each year?
Complication Rates and Readmission Data
Mortality is the most dramatic outcome measure, but it is not the only one that affects your life after surgery. Look for data on:
- Stroke rate (one of the most feared complications of cardiac surgery)
- Infection rates, particularly deep sternal wound infection
- 30-day readmission rates
- Prolonged ventilation (remaining on a breathing machine longer than 24 hours)
- Length of stay compared to national benchmarks
Some of this information is available through the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. It is less granular than STS data but still useful, particularly for readmission and mortality metrics.
Accreditations and Certifications
Look for whether the hospital has earned accreditation from organizations such as The Joint Commission for specific cardiac care pathways. Some centers carry designations as Comprehensive Cardiac Centers or have earned Magnet status for nursing, which reflects staffing quality and institutional commitment to patient care standards.
Availability of a Heart Team
Modern cardiac care guidelines from the ACC/AHA and European Society of Cardiology emphasize the Heart Team approach for complex decisions, particularly for patients with multivessel coronary artery disease or valvular heart disease where multiple treatment options exist. A Heart Team typically includes a cardiac surgeon, an interventional cardiologist, an imaging cardiologist, and sometimes an anesthesiologist or heart failure specialist.
Ask whether the hospital uses a multidisciplinary Heart Team conference for surgical decision-making. Hospitals that do this consistently tend to be more thoughtful about patient selection, which directly affects outcomes.
Red Flags: When a Hospital's Reputation May Not Match Reality
In my years of practice and reviewing cases for patients across the country, I have seen patterns that should raise concern. Not every red flag means a hospital is unsafe, but each one is worth investigating further.
- The hospital does not participate in STS data reporting. This does not automatically mean poor quality, but it does mean you cannot independently verify outcomes. Ask why they do not participate.
- You cannot get a straight answer about volume. If a surgeon or hospital administrator cannot or will not tell you how many of your specific procedure they perform annually, that is a problem.
- The recommendation is for a complex procedure, but the hospital is not a high-volume center for that operation. For example, being told you need a complex aortic root operation at a community hospital that performs a handful per year warrants getting another perspective.
- There is no Heart Team discussion, and you are given only one treatment option. Especially for conditions like severe aortic stenosis, multivessel coronary disease, or mitral regurgitation, there are usually multiple valid approaches. If no one has discussed alternatives with you, that is a gap in your evaluation.
- Published rankings are heavily based on reputation surveys rather than outcome data. Some well-known ranking systems weight peer reputation scores significantly. Reputation is not irrelevant, but it can lag behind actual current performance by years.
If any of these scenarios apply to your situation, getting an independent review of your case can help you determine whether the proposed plan at the proposed hospital makes sense. Our free cardiac surgery risk calculator is a quick way to start understanding your individual risk profile before having those conversations.
Practical Steps: How to Research and Compare Hospitals Before Heart Surgery
Here is what I recommend to my own patients and their families when they are evaluating where to have cardiac surgery:
Step 1: Check the STS star rating. Go to the STS public reporting website and look up the hospital's rating for your specific procedure. A three-star rating is excellent. A two-star rating means the program is performing as expected, which for most operations at most hospitals is perfectly reasonable. One star deserves a closer look.
Step 2: Ask about volume. Call the hospital or surgeon's office. Ask how many of your specific operation the surgeon performs per year, and how many the hospital performs per year. Do not accept vague answers. You have every right to this information.
Step 3: Look at CMS Hospital Compare data. Search for the hospital on Medicare's Hospital Compare tool. Review 30-day mortality and readmission rates for cardiac surgery. These numbers are risk-adjusted and publicly available.
Step 4: Ask about the Heart Team. Was your case discussed in a multidisciplinary conference? If not, was there a reason? For straightforward cases, a Heart Team conference may not always be necessary. For complex cases, it should be standard.
Step 5: Consider geography — but do not let it be the deciding factor. Having surgery close to home has real advantages for recovery, follow-up, and family support. But if the local hospital has significantly lower volume or lower-quality metrics for your specific procedure, traveling to a stronger center can be worth it. Studies consistently show that outcomes for complex cardiac surgery are better at experienced, high-volume centers.
Step 6: Get an independent opinion. Even if you are confident in the hospital, having a second set of eyes on your imaging, catheterization results, and surgical plan is one of the most important things you can do. Research suggests that cardiac surgery second opinions change the recommended treatment plan in a meaningful percentage of cases. This is not about distrust. It is about thoroughness.
The Metric That No Database Captures
After twenty years in this field, I will tell you something that no ranking system measures: the quality of communication between you and your surgical team. Do they explain your options clearly? Do they answer your questions without rushing? Do they acknowledge uncertainty when it exists? Do they respect your values and preferences?
These things are harder to quantify than mortality rates or STS star ratings, but they matter enormously. A surgeon who takes the time to explain why a particular approach is recommended for your specific anatomy, your specific risk factors, and your specific goals is a surgeon who is treating you as a person, not a procedure.
Quality metrics will help you narrow the field. The human interaction will help you make your final decision.
If you are facing a cardiac surgery recommendation and want clarity about whether the proposed hospital and plan are right for your situation, a WhiteGloveMD second opinion can help. We provide independent, surgeon-led case reviews using your existing medical records, imaging, and test results. Our goal is simple: to make sure the plan you are following is the right plan for you. Learn how our process works or start your review today.