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Published on: March 27, 2018
[Trends in coronary artery bypass surgery: changes in the profile of the surgical patient]
Rafael García Fuster1, José A Montero, Oscar Gil
1Servicio de Cirugía Cardíaca, Hospital General Universitario de Valencia, Valencia, España. rgfuster@terra.com
Insights
The risk profile of patients undergoing coronary artery bypass surgery has worsened due to older age and more comorbidities. However, risk-adjusted mortality has decreased, indicating improved surgical outcomes despite increased patient risk.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes Research
- Patient Risk Stratification
Context:
- Coronary artery bypass surgery (CABG) patient demographics have shifted.
- An increasing proportion of high-risk individuals are undergoing CABG.
- Older age and prevalent comorbid conditions are key risk factors.
Purpose:
- To confirm the evolving risk profile of CABG patients.
- To assess the impact of this changing profile on surgical results.
- To evaluate the influence of novel surgical techniques.
Summary:
- A retrospective analysis of 1360 CABG patients (1993-2001) revealed a worsening risk profile over time (increased age, comorbidities, poorer ventricular function).
- Despite higher predicted mortality (EuroSCORE), risk-adjusted mortality decreased across historical cohorts (3.7% to 1.5%).
- Overall morbidity and mortality remained stable, with a trend towards reduced in-hospital events with off-pump surgery and arterial grafting.
Impact:
- Surgical outcomes have improved despite an increasing number of high-risk patients undergoing coronary artery bypass surgery.
- New surgical techniques like off-pump surgery and arterial grafting show potential benefits.
- Further research is needed to corroborate the advantages of these advanced surgical methods.
Introduction And Objectives:
In the last few years, the percentage of high-risk patients proceeding to coronary artery bypass surgery has increased. The most common risk factors are older age and the presence of comorbid complaints. We carried out a retrospective study to confirm this new risk profile and to evaluate its impact on surgical results.
Patients And Method:
We analyzed the changing risk profile of 1360 patients who underwent coronary artery bypass surgery in our hospital between 1993 and 2001, divided into three historical cohorts: 1993-1996, 1997-1999 and 2000-2001. The main factors associated with morbidity and mortality were analyzed by logistic regression analysis. The introduction of new operative techniques, such as off-pump surgery and arterial grafting, was also evaluated.
Results:
The patients' risk profile worsened over time: patients were older, comorbid complaints were more common, and ventricular function was poorer. EuroSCORE figures reflected this trend: estimated mortality in the three historical cohorts was 2.0%, 4.0% and 4.2%, respectively (P<.001). However, risk-adjusted mortality, at 3.7%, 2.7% and 1.5%, respectively, decreased (P<.05), and combined overall morbidity and mortality remained stable, at 16.7%, 16.4% and 13.8%, respectively, (P<.39). There was a non-significant tendency for arterial grafting and off-pump surgery to reduce in-hospital morbidity and mortality.
Conclusions:
The risk profile of patients undergoing surgery has worsened as their mean age has increased and as comorbid complaints have become more prevalent. However, there has been no simultaneous increase in risk-adjusted mortality. The potential benefits of new surgical advances such as off-pump surgery and multiple arterial grafting must be corroborated by future studies.
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