Progressively increasing operative risk among patients referred for coronary artery bypass surgery

Advances in surgical, anaesthetic and percutaneous interventional techniques may have led to higher risk patients being referred for coronary artery bypass graft surgery (CABG). The purpose of this study was to compare the predicted mortality risk (EuroSCORE) of a contemporary cohort of patients referred for isolated elective CABG (2002) with that of a cohort referred five years previously (1997) and to examine temporal trends in patient demographics.

Records (n=2873) of weekly cardiac surgical referral meetings were examined and the age, sex, type of operation and surgical decision for every patient referred from 1997 to 2002 inclusive were recorded. Furthermore samples of patients referred in 1997 (n=111) and in 2002 (n=110) were chosen, and a complete EuroSCORE was calculated for each patient and compared between groups.

In both 1997 and 2002 the median EuroSCORE among patients not accepted for surgery was significantly higher than those accepted (1997; 3 vs 2, p < 0.001. 2002; 5 vs. 2, p < 0.001). The median EuroSCORE of patients referred in 2002 was significantly higher than those referred in 1997 (3 vs. 2; p < 0.001). There was a progressive increase in median patient age throughout the study period and this accounted for the observed temporal increase in EuroSCORE.

Predicted mortality risk among patients referred for coronary artery bypass surgery is increasing, mainly due to patient age at referral.