(Circulation. 1997;96:1575-1579.)
© 1997 American Heart Association, Inc.
Articles |
Effect of Cardiac Surgery Patient Characteristics on Patient Outcomes From 1981 Through 1995
From Emory Healthcare, Atlanta, Ga.
Correspondence to Christi D. Warner, PhD, RN, School of Nursing, Emory University, 531 Asbury Circle, Atlanta, GA 30322. E-mail cwarner{at}nurse.emory.edu
Background Previous studies have demonstrated increased risk in patients undergoing coronary artery bypass surgery (CABG), but the effect of this increasing risk on outcomes has not been well documented. The purposes of this study were (1) to evaluate patients who had CABG from 1993 to 1995 (group III) and compare them with patients from 1981 through 1987 (group I) and 1988 through 1992 (group II) to determine if the trend toward higher-risk patients continued and (2) to evaluate what effect risk had on in-hospital outcomes.
Methods and Results Data were collected prospectively on patients undergoing CABG. Patients from the three time periods were compared by use of univariate and multivariate statistics. Risk models for mortality were developed by use of logistic regression. Significant changes were noted in the three time periods, with risk increasing over time. Increased risk was associated with increased mortality in group II, but mortality declined in group III despite the continued increase in patient risk. Group II had an increase in complications, with little change in group III. The actual mortality rate was lower than predicted in group III.
Conclusions Patients undergoing CABG are increasingly high risk. In-hospital mortality rates declined during the period from 1993 through 1995 and were lower than predicted despite the increase in risk. This decreased mortality rate may reflect greater experience in providing care to high-risk patients and improved myocardial protection and surgical and anesthetic techniques. Although continued analysis of patient risk and benefit is needed, researchers must be cognizant of the rapid changes in technology and knowledge and should correlate changes in the process of care with outcomes.
Key Words: cardiopulmonary bypass • patients • surgery • risk factors • survival
This article has been cited by other articles:
 |
|
 |
|
  E. J. Giltay, R. V.H.P. Huijskes, K. H. Kho, B. A. Blansjaar, and P. M.J. Rosseel Psychotic symptoms in patients undergoing coronary artery bypass grafting and heart valve operation. Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 140 - 147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Rastan, J. F. Gummert, N. Lachmann, T. Walther, D. V. Schmitt, V. Falk, N. Doll, P. Caffier, M. M. Richter, C. Wittekind, et al. Significant value of autopsy for quality management in cardiac surgery J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1292 - 1300. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. R. Ramnarine, A. D. Grayson, W. C. Dihmis, N. K. Mediratta, B. M. Fabri, and J. A.C. Chalmers Timing of intra-aortic balloon pump support and 1-year survival Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 887 - 892. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Gaudino, F. Glieca, F. Alessandrini, G. Nasso, C. Pragliola, N. Luciani, M. Morelli, and G. Possati High risk coronary artery bypass patient: incidence, surgical strategies, and results Ann. Thorac. Surg., February 1, 2004; 77(2): 574 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Bucerius, J. F. Gummert, M. A. Borger, T. Walther, N. Doll, V. Falk, D. V. Schmitt, and F. W. Mohr Predictors of delirium after cardiac surgery delirium: Effect of beating-heart (off-pump) surgery J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 57 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Davierwala, M. Maganti, and T. M. Yau Decreasing significance of left ventricular dysfunction and reoperative surgery in predicting coronary artery bypass grafting-associated mortality: A twelve-year study J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1335 - 1344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Pinna Pintor, M. Bobbio, S. Colangelo, F. Veglia, R. Marras, and M. Diena Can EuroSCORE predict direct costs of cardiac surgery? Eur. J. Cardiothorac. Surg., April 1, 2003; 23(4): 595 - 598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Pinna Pintor, S. Colangelo, and M. Bobbio Evolution of case-mix in heart surgery: from mortality risk to complication risk Eur. J. Cardiothorac. Surg., December 1, 2002; 22(6): 927 - 933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Shahian, S.-L. Normand, D. F. Torchiana, S. M. Lewis, J. O. Pastore, R. E. Kuntz, and P. I. Dreyer Cardiac surgery report cards: comprehensive review and statistical critique Ann. Thorac. Surg., December 1, 2001; 72(6): 2155 - 2168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Shahian, G. J. Heatley, and G. A. Westcott Relationship of hospital size, case volume, and cost for coronary artery bypass surgery: Analysis of 12,774 patients operated on in Massachusetts during fiscal years 1995 and 1996 J. Thorac. Cardiovasc. Surg., July 1, 2001; 122(1): 53 - 64. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Ovrum, G. Tangen, C. Schiott, and S. Dragsund Rapid recovery protocol applied to 5,658 consecutive ""on-pump"" coronary bypass patients Ann. Thorac. Surg., December 1, 2000; 70(6): 2008 - 2012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. H. Thourani, W. S. Weintraub, J. M. Craver, E. L. Jones, E. M. Mahoney, and R. A. Guyton Ten-year trends in heart valve replacement operations Ann. Thorac. Surg., August 1, 2000; 70(2): 448 - 455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kuhn, U. Muller-Werdan, D.V. Schmitt, H. Lange, G. Pilz, E. Kreuzer, F.W. Mohr, H.-R. Zerkowski, and K. Werdan Improved outcome of APACHE II score-defined escalating systemic inflammatory response syndrome in patients post cardiac surgery in 1996 compared to 1988-1990: the ESSICS-study pilot project Eur. J. Cardiothorac. Surg., January 1, 2000; 17(1): 30 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Lebuffe, C. Decoene, A. Pol, A. Prat, and B. Vallet Regional Capnometry with Air-Automated Tonometry Detects Circulatory Failure Earlier Than Conventional Hemodynamics After Cardiac Surgery Anesth. Analg., November 1, 1999; 89(5): 1084 - 1084. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Roques, S.A.M. Nashef, P. Michel, E. Gauducheau, C. de Vincentiis, E. Baudet, J. Cortina, M. David, A. Faichney, F. Gavrielle, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients Eur. J. Cardiothorac. Surg., June 1, 1999; 15(6): 816 - 823. [Abstract] [Full Text] [PDF]
|
|