RISK STRATIFICATION USING THE SOCIETY-OF-THORACIC-SURGEONS PROGRAM

In an era of progressive cost containment and public scrutiny, the wis dom of aggressive surgical therapy for high-risk candidates has been q uestioned. At our center in the previous 24 months, 728 patients with coronary artery disease were entered into The Society of Thoracic Surg eons national database, and the hospital outcomes plus length of stay were analyzed. Patients were separated according to the predicted mort ality based on the groupings in The Society of Thoracic Surgeons datab ase: 0 to 5% (453 patients); 5% to 10% (126 patients); 10% to 20% (96 patients); 20% to 30% (17 patients); and 30% and greater (36 patients) . There was a close correlation with the predicted rates of mortality. importantly the preoperative risk stratification demonstrated a stron g correlation with the significant morbidity and excessive length of s tay in the highest-risk groups (predicted risk of 20% to greater than or equal to 30%). The incidences of the most common complications in t he group with the highest predicted risk (greater than or equal to 30% ) were 28%, renal failure; 33%, ventilator dependence; and 17%, cardia c arrest. In addition, at short-term follow-up (6 to 8 months), a 24.3 % mortality was identified in patients with a predicted mortality that exceeded 20%. These data quantify the risks and morbidities associate d with the care of seriously ill patients with coronary artery disease and demonstrate the need for professional and public discussions focu sing on the association of a high preoperative risk status and the con sumption of resources.