Cardiothoracic Surgery Insights From a Five-Year Cohort Study in a Low-Volume Referral Center

To characterize the clinical and sociodemographic variables of patients undergoing cardiac surgery at Hospital San Juan de Dios-Caja Costarricense de Seguro Social (HSJD-CCSS) between 2016 and 2020, and to identify predictors of in-hospital mortality.

A retrospective, observational study was conducted, including all patients ≥13 years who underwent cardiac surgery during the study period (n = 560). Sociodemographic variables, comorbidities, cardiovascular risk factors, European System for Cardiac Operative Risk Evaluation (EuroSCORE), New York Heart Association (NYHA) class, brain natriuretic peptide (BNP), type and urgency of surgery, use of cardiopulmonary bypass (CPB), and outcomes (complications, mortality, hospital and ICU stay) were collected. Descriptive statistics, association tests, and multivariable logistic regression models were applied; in subgroups with a low number of cases (endocarditis, aortic pathology), Firth regression was used.

The median age was 59 years, with a predominance of males (57.9%). The main surgical indication was valvular disease (55.2%), followed by coronary artery disease (25%). Although overall mortality decreased from 14.9% (2010-2015) to 11.6% in the current period, the change was not statistically significant. In the global model, independent predictors of mortality were elevated BNP levels, emergency surgery, and prolonged ICU stay. In subgroup analyses, mortality was associated with BNP and NYHA in valvular disease; age, BMI, and surgical urgency in coronary artery disease; BNP, BMI, CPB, and minimally invasive surgery (MIS) in endocarditis; and CPB time in aortic pathology.

In-hospital mortality in cardiac surgery at HSJD decreased compared to the previous five-year period. The identification of pathology-specific predictors supports the need for individualized approaches and optimization of critical resources to improve surgical outcomes in Costa Rica.