Subject(s)
Angina, Unstable/psychology , Myocardial Infarction/psychology , Quality of Life , Aged , Angina, Unstable/therapy , Female , Humans , Male , Middle Aged , Myocardial Infarction/therapy , Predictive Value of Tests , Prospective Studies , Risk Factors , Surveys and Questionnaires , VeteransABSTRACT
BACKGROUND: The impact of off-pump median sternotomy coronary artery bypass grafting procedures on risk-adjusted mortality and morbidity was evaluated versus on-pump procedures. METHODS: Using the Department of Veterans Affairs Continuous Improvement in Cardiac Surgery Program records from October 1997 through March 1999, nine centers were designated as having experience (with at least 8% coronary artery bypass grafting procedures performed off-pump). Using all other 34 Veterans Affairs cardiac surgery programs, baseline logistic regression models were built to predict risk of 30-day operative mortality and morbidity. These models were then used to predict outcomes for patients at the nine study centers. A final model evaluated the impact of the off-pump approach within these nine centers adjusting for preoperative risk. RESULTS: Patients treated off-pump (n = 680) versus on-pump (n = 1,733) had lower complication rates (8.8% versus 14.0%) and lower mortality (2.7% versus 4.0%). Risk-adjusted morbidity and mortality were also improved for these patients (0.52 and 0.56 multivariable odds ratios for off-pump versus on-pump, respectively, p < 0.05). CONCLUSIONS: An off-pump approach for coronary artery bypass grafting procedures is associated with lower risk-adjusted morbidity and mortality.
Subject(s)
Cardiopulmonary Bypass , Coronary Artery Bypass , Coronary Disease/surgery , Minimally Invasive Surgical Procedures , Angina Pectoris/mortality , Angina Pectoris/surgery , Coronary Disease/mortality , Heart Failure/mortality , Heart Failure/surgery , Hospital Mortality , Hospitals, Veterans , Humans , Postoperative Complications/mortality , Risk , Survival AnalysisABSTRACT
BACKGROUND: Although gender is known to be an independent predictor of 30-day operative mortality (OM) after coronary artery bypass grafting, the purpose of this study was to determine whether race-alone or in combination with gender-affects OM. METHODS: For 1994 to 1996, The Society of Thoracic Surgeons database records for 441,542 coronary artery bypass grafting-only procedures were analyzed. Baseline annual multivariate models were built. Gender and race were added to each model. Risk-adjusted OM rates were then calculated for race, gender, and their combination. Patients were also stratified into groups of comparable predicted OM to allow for a direct comparison of risk-matched Caucasians and non-Caucasians. RESULTS: Of the procedures, 28.2% were on women and 8.5% on non-Caucasians. Overall, OM was 3.29%. Multivariate risk-adjusted OM varied by gender and race (p < 0.10). Risk-adjusted OM rates (with 95% confidence intervals) were 4.0% (3.9% to 4.1%) for females and 3.2% (3.2% to 3.3%) for males. Risk-adjusted OM rates were 3.9% (3.7% to 4.1%) for non-Caucasians and 3.3% (3.2% to 3.3%) for Caucasians. Among equally risk-matched Caucasians and non-Caucasians, non-Caucasians had significantly higher (p < 0.005) mortality among the lower risk subgroups (up to 10% predicted OM) but not among the higher risk subgroups. CONCLUSIONS: Race and gender are independent predictors of adverse outcome following coronary artery bypass grafting, holding all other risk factors constant.
Subject(s)
Coronary Artery Bypass/mortality , Ethnicity/statistics & numerical data , Postoperative Complications/mortality , Aged , Cause of Death , Databases, Factual , Female , Humans , Male , Middle Aged , Multivariate Analysis , Risk Assessment , Sex Factors , Treatment OutcomeABSTRACT
BACKGROUND: The Society of Thoracic Surgeons Adult Cardiac National Database has recently completed the update for the 1996 risk model to be used to estimate the risk of operative death for isolated coronary artery bypass graft (CABG) procedures. METHODS: We placed emphasis on clinical relevance, data quality, data completeness, and univariate analyses. A logistic regression approach was used to develop the 1996 CABG-only risk model. RESULTS: Odds ratios for the factors with highest risk are multiple reoperations (OR = 4.3), emergent salvage status (OR = 3.7), and first reoperation (OR = 2.7). Standard performance measures indicated the model had high predictive power and an acceptable level of calibration after adjustment for a large sample size effect. CONCLUSION: The most current STS risk model of CABG operative mortality is a reliable and statistically valid tool. The 1996 CABG-only model has been approved for use by The Society of Thoracic Surgeons.
