Fatores preditores da mortalidade hospitalar e de complicaçöes per-operatórias graves em cirurgia de revascularizaçäo do miocárdio / Predictive factors of in-hospital mortality and of severe perioperative complications in myocardial revascularization surgery

OBJECTIVE: To investigate preoperative predictive factors of severe perioperative intercurrent events and in-hospital mortality in coronary artery bypass graft (CABG) surgery and to develop specific models of risk prediction for these events, mainly those that can undergo changes in the preoperative period. METHODS: We prospectively studied 453 patients who had undergone CABG. Factors independently associated with the events of interest were determined with multiple logistic regression and Cox proportional hazards regression model. RESULTS: The mortality rate was 11.3 percent (51/453), and 21.2 percent of the patients had 1 or more perioperative intercurrent events. In the final model, the following variables remained associated with the risk of intercurrent events: age 70 years, female sex, hospitalization via SUS (Sistema Unico de Saúde - the Brazilian public health system), cardiogenic shock, ischemia, and dependence on dialysis. Using multiple logistic regression for in-hospital mortality, the following variables participated in the model of risk prediction: age 70 years, female sex, hospitalization via SUS, diabetes, renal dysfunction, and cardiogenic shock. According to the Cox regression model for death within the 7 days following surgery, the following variables remained associated with mortality: age 70 years, female sex, cardiogenic shock, and hospitalization via SUS. CONCLUSION: The aspects linked to the structure of the Brazilian health system, such as factors of great impact on the results obtained, indicate that the events investigated also depend on factors that do not relate to the patient's intrinsic condition

Prevalência de microorganismos isolados em mediastinites pós-cirurgia cardíaca / Prevalence of microorganisms isolated in mediastinitis pos-cardiac surgery

As infecçöes pós-cirurgia cardíaca se constituem em uma das complicaçöes que elevam as taxas de morbidade e mortalidade após estes procedimentos. As mediastinites, por sua vez, säo uma das mais graves intercorrências, determinando aumento significativo dos custos de internaçäo, além de promover, muitas vezes, limitaçäo na capacidade produtiva dos sobreviventes. O rigoroso controle de infecçöes pode determinar a prevençäo e/ou o diagnóstico precoce da afecçäo; a rapidez da instituiçäo da terapêutica indicada, pode minorar o sofrimento do paciente e os gastos com internaçäo hospitalar. No período de janeiro de 1989 a agosto de 1992, 1588 pacientes foram submetidos à cirurgia cardíaca em nossa instituiçäo, sendo 687 coronarianos, 609 valvulopatas, 292 congênitos. Ocorreram 33 casos de mediastinites, o que representa 2,1% do total. O microorganismo mais frequentemente isolado nas culturas foi o Staphylococcus aureus em 17 pacientes.