[Activity and morbimortality of coronary surgery in Spain]

The goal of the study is to describe the current knowledge about coronary artery by-pass surgery in Spain related to activity, institutions, and clinical outcomes. A search in the MEDLINE (1982-97) and IME (1976-97) databases and manual search in medical journals, official publications of scientific societies was performed. References whose authors or institutions in charge were located in Spain, and including data on activity, mortality and morbidity of coronary artery bypass surgery alone or in combination with other procedures. In 1995, 7,936 coronary procedures were carried out (alone or in combination) in 51 Spanish centres, representing an increase of 123% in those procedures registered and published in 1988. Hospital mortality, according to the Registry of the Spanish Society of Cardiovascular Surgery (1995), was 7.2%. Data from multicenter studies showed, allowing for variations among centres, 8.8% (1975-82) and 8.1% (1994) mortality in isolated coronary revascularization. Other studies refer to the particular experience in a centre, examining either predictive mortality factors or outcomes in specific clinical conditions. Surgical mortality has been only partially analysed in multicentre studies, although several groups refer to the incidence of their own specific complications. There are few multicentre studies assessing morbidity and mortality in coronary artery surgery and some results (quality of life, economical) have been poorly evaluated. An alternative to be considered is the creation of an advisory commission aimed at establishing health care standards and at supporting an information system on the patients characteristics, techniques applied, and results obtained in the provision of cardiological procedures that, due to their invasiveness, complexity and cost, can be considered as tertiary cardiological care.