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Changes over time in risk profiles of patients who undergo coronary artery bypass graft surgery: the Veterans Affairs
Lorraine D Cornwell1, Shuab Omer1, Todd Rosengart2
1Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Division of Cardiothoracic Surgery, Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
JAMA Surgery
|February 12, 2015
Summary
Coronary artery bypass grafting (CABG) patients are older and sicker, with increased rates of diabetes and heart failure. Despite this, operative mortality decreased significantly from 1997 to 2011.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Public Health
Background:
- The patient population undergoing coronary artery bypass grafting (CABG) has evolved, with indications suggesting an increase in overall patient acuity.
- Understanding changes in the risk profile of patients undergoing CABG is crucial for surgical quality improvement and resource allocation.
Purpose of the Study:
- To evaluate temporal trends in the risk profile of patients undergoing isolated primary CABG within the Veterans Affairs (VA) healthcare system.
- To assess changes in patient demographics, comorbidities, and surgical outcomes over a 14-year period.
Main Methods:
- A retrospective review of 65,097 patients who underwent isolated primary CABG between October 1, 1997, and April 30, 2011, was conducted.
- Data were sourced from the VA Surgical Quality Improvement Program (VASQIP).
- Linear regression analysis was used to determine the significance of changes in risk factors and outcomes over time.
Main Results:
- Patient age, body mass index, and the prevalence of diabetes, NYHA class III/IV heart failure, and left main coronary artery disease significantly increased.
- The prevalence of advanced angina, previous myocardial infarction, and low ejection fraction decreased.
- Perioperative mortality rates and predicted risk of mortality significantly decreased over the study period.
- Overall CABG volume decreased, while the prevalence of previous percutaneous coronary intervention increased.
Conclusions:
- The CABG population in the VA system has become older and sicker, with a higher burden of comorbidities like diabetes and heart failure.
- Despite the increased patient complexity, significant improvements in surgical outcomes, including reduced mortality, were observed.
- These findings highlight advancements in CABG care within the VA system, possibly due to earlier referrals, improved medical management, or refined patient selection.
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