Evaluation of perioperative risk factors

An increase in the operative mortality rate for some surgical procedures has occurred over the last decade in parallel with major improvement in surgical technique and changes in patient demographics. Analysis of mortality data from the Cleveland Clinic Foundation showed that surgical priority was clearly the major risk factor among patients undergoing resection of ventricular aneurysms. Age 70 years or more was the most important risk factor in aortic valve replacement, followed by atrial fibrillation and severe heart failure. Operative mortality associated with primary valve operations was related to the valve or valves being replaced. Surgical priority was consistently the most important risk factor in primary myocardial revascularizations, and age has become the second most important factor in this procedure. Left main coronary artery disease, although an important risk factor until the mid-1970s, is no longer as significant. The finding that the relative risk associated with various factors has changed over time is noteworthy.