Abstract
Objective: We assessed the operative mortality of coronary artery bypass grafting (CABG) surgery using risk stratification.Methods: In 294 consecutive patients who underwent CABG with or without concomitant surgery from August 1994 to December 1999, we compared operative mortality calculated conventionally and by risk stratification. Scores for each patient were calculated using the Parsonnet additive model and stratified based on the probability of operative mortality.Results: Overall crude hospital mortality was 4.8%–4.0% among patients younger than 80 years and 14% among those 80 years of age or older (p=0.0692). Hospital mortality was 12% in urgent/emergency surgery, and 1.5% in elective surgery (p<0.0002), and 4.5% in CABG alone and 7.4% in CABG with concomitant surgery (p=0.3763), and 25% in patients receiving vein grafts only and 3.0% in those receiving at least 1 artery graft (p=0.0003). Overall patient distribution was 32% good, 20% fair, 20% poor, 11% high-risk, and 16% extremely high-risk. Predicted mortality was 2.2% for patients who were a good risk, 6.7% for fair-risk, 12% for poor-risk, 16% for high-risk, and 25% for extremely high-risk patients. Actual operative mortality was 1.0% for good-risk, 0% for fair-risk, 3.4% for poor-risk, 6.3% for high-risk, and 18% for extremely high-risk patients, making actual mortality significantly lower than that predicted.Conclusion: Comparing predicted mortality and actual mortality enabled us to objectively calculate operative results and assess operative quality.
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References
Bernstein AD, Parsonnet V. Bedside estimation of risk as an aid for decision-making in cardiac surgery. Ann Thorac Surg 2000; 69: 823–8.
Ferguson TB Jr, Dziuban SW Jr, Edwards FH, Eiken MC, Shroyer LW, Pairolero PC, et al., The STS National Database: current changes and challenges for the new millennium. Ann Thorac Surg 2000; 69: 680–91.
Geissler HJ, Holzl P, Marohl S, Kuhn-Regnier F, Mehlhorn U, Sudkamp M, et al., Risk stratification in heart surgery: comparison of 6 score systems. Eur J Cardio-Thorac Surg 2000: 17: 400–406.
Hattler BG, Madia C, Johnson C, Armitage JM, Hardesty RL, Korms RL, et al., Risk stratification using the Society of Thoracic Surgeons program. Ann Thorac Surg 1994; 58: 1348–52.
Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R, European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardio-Thorac Surg 1999; 16: 9–13.
Parsonnet V, Dean D, Bernstein AD. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease. Circulation 1989; 79 (Suppl I):.
Dziuban SW Jr. Using database information in your clinical practice. Ann Thorac Surg 1999; 68: 350–2.
Grover FL. The Society of Thoracic Surgeons National Database: current status and future directions. Ann Thorac Surg 1999; 68: 367–73.
Parsonnet V. Risk stratification in cardiac surgery: Is it worthwhile?. J Card Surg 1995; 10: 690–8.
Clark RE, Edwards FH, Schwartz M. Profile of preoperative characteristics of patients having CABG over the past decade. Ann Thorac Surg 1994; 58: 1863–5.
Committee of Science, Yasuda K, Ayabe H, Ide H, Uchida Y. Thoracic and cardiovascular surgery in Japan during 1998. Annual report by the Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg 2000; 48: 401–15.
Gabrielle F, Roques F, Michel P, Bernard A, de Vicentis C, Roques X, et al., Is the Parsonnet’s score a good predictive score of mortality in adult cardiac surgery: assessment by French multicentre study. Eur J Cardio-Thorac Surg 1997; 11: 406–414.
Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg 1998; 66: 125–31.
Edwards FH, Clark RE, Schwartz M. Coronary artery bypass grafting: The Society of Thoracic Surgeons National Database experience. Ann Thorac Surg 1994; 57: 12–9.
Edwards FH, Clark RE, Schwartz M. Impact of internal mammary artery conduits on operative mortality in coronary revascularization. Ann Thorac Surg 1994; 57: 27–32.
Grover FL, Johnson RR, Marshall G, Hammermeister KE. Department of Veterans Affairs Cardiac Surgeons. Impact of mammary grafts on coronary bypass operative mortality and morbidity. Ann Thorac Surg 1994; 57: 599–69.
Jamieson WRE, Edwards FH, Schwarz M, Bero JW, Clark RE, Grover FL, et al., Risk stratification for cardiac valve replacement: National Cardiac Surgery Database. Ann Thorac Surg 1999; 67: 943–51.
Parsonnet V, Bernstein AD, Gera M. Clinical usefulness of risk-stratified outcome analysis in cardiac surgery in New Jersey. Ann Thorac Surg 1996; 61: S8–11.
Roques F, Nashef SAM, Michel P, Gauducheau E, de Vincentiis C, Baudet E, et al., Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardio-Thorac Surg 1999; 15: 816–23.
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Kawachi, Y., Nakashima, A., Toshima, Y. et al. Risk stratification analysis of operative mortality in coronary artery bypass surgery. Jpn J Thorac Cardiovasc Surg 49, 557–563 (2001). https://doi.org/10.1007/BF02913532
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DOI: https://doi.org/10.1007/BF02913532