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Coronary bypass surgery: what is changing? Analysis of 3834 patients undergoing primary isolated myocardial
L Noyez1, D P Janssen, J A van Druten
1Department of Thoracic and Cardiac Surgery, University Hospital Nijmegen, Netherlands. L.Noyez@thchir.azn.nl
Insights
Older patients with more co-existing conditions are increasingly undergoing myocardial revascularization. While hospital mortality remains stable, major postoperative morbidity has significantly increased in this evolving patient population.
Area of Science:
- Cardiovascular Surgery
- Clinical Outcomes Research
- Epidemiology of Cardiac Disease
Background:
- The patient demographic undergoing myocardial revascularization has shifted.
- Understanding these demographic changes is crucial for quality control and economic decision-making in cardiac surgery.
- Assessing the impact of these changes on morbidity and mortality is essential for future research.
Purpose of the Study:
- To analyze trends in patient characteristics and outcomes for myocardial revascularization.
- To evaluate the influence of demographic shifts on postoperative morbidity and mortality.
- To provide data supporting informed decision-making in coronary artery surgery.
Main Methods:
- Retrospective analysis of 3834 primary isolated coronary artery bypass graft operations.
- Data collected from January 1987 to December 1995.
- Patients divided into three time cohorts: 1987-1989, 1990-1992, and 1993-1995.
Main Results:
- Mean patient age increased significantly from 60.4 to 62.9 years.
- Significant increases observed in patients with diabetes, pulmonary, neurological, and uro-nephrological conditions.
- Use of arterial grafts increased; hospital mortality remained stable at approximately 2.5%, but postoperative pulmonary, neurological, and uro-nephrological complications rose significantly.
Conclusions:
- Myocardial revascularization is increasingly performed on older patients with more comorbidities.
- Despite stable hospital mortality rates, there is a notable increase in major postoperative morbidity.
- These findings highlight the evolving complexity of patients undergoing coronary artery bypass surgery.
Objective:
The patient population undergoing myocardial revascularization has changed during the last few years. Knowledge of these changes, and of the subsequent influence on morbidity and/or mortality is important, not only for up-dating quality control, but also to support decision-making in financial and economical aspects, and in further research concerning coronary artery surgery.
Methods:
Pre-, per- and postoperative data of 3834 primary isolated coronary bypass operations, January 1987 December 1995 were analyzed. The total group was divided into three time cohorts. Group A: 1987 1989 (n = 1292); group B: 1990-1992 (n = 1130); and group C: 1993-1995 (n = 1412).
Results:
Mean age increased from 60.4 +/- 9.0 (S.D.) years in group A to 62.9 +/- 9.9 (S.D.) years in group C (P < 0.0005). Patients with insulin-dependent diabetic (P = 0.005), uro-nefrological (P = 0.002), pulmonary (P < 0.0005)and neurological (P = 0.003) pathology increased significantly, and there was a significant increase in the use of arterial grafts (P < 0.05). Postoperative, hospital mortality remained stable (+/- 2.5%). However, there was a significant increasing percentage of patients with pulmonary (P = 0.04), neurological (P = 0.02) and uro-nefrological (P < 0.0005) problems.
Conclusion:
During the last few years there has been a trend in myocardial revascularization of older patients, with more coexisting disease. Despite the fact that hospital mortality seems stable, there is an increase in major postoperative morbidity.
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