It seems to be a combination of factors. Patient characteristics, less experienced doctors and less experienced hospitals. I also found it interesting that they attributed bad outcomes to inappropriate surgery, which was done more often in minorities than whites.
These surgeons are caught in a catch 22. If you have a patient that meets evidence based guidelines for performing it (such as the amount of stenosis in a symptomatic patient) but the patient is too sick or the expected outcome is bad, they could be sued for not conforming to guidelines of therapy if the patient condition decompensates. If they perform the surgery in patients who meet criteria, even with worse underlying disease, they are bashed for doing them in patients who are too sick, but patients believe that everything that could be done was done. It's the same for bloodless surgery.
You can't have it both ways. Sick patients get sicker whether you do surgery or not. Claiming they did worse because of surgery is premature. Perhaps their rate of death or disability would be much higher had they not undergone the surgery.
Perhaps blacks and Hispanics, who smoke more often than whites decided to light 'em up the day after getting home.
Deciding when to offer surgery and when not to is not as simple as saying
Patient to sick for surgery
You never know until after the fact whether they would have a bad outcome or not.
