CORONARY-BYPASS SURGERY - WHAT IS CHANGING - ANALYSIS OF 3834 PATIENTS UNDERGOING PRIMARY ISOLATED MYOCARDIAL REVASCULARIZATION

Objective: The patient population undergoing myocardial revascularizat ion has changed during the last few years. Knowledge of these changes, and of the subsequent influence on morbidity and/or mortality is impo rtant, not only for up-dating quality control, but also to support dec ision-making in financial and economical aspects, and in further resea rch concerning coronary artery surgery. Methods: Pre-, per- and postop erative data of 3834 primary isolated coronary bypass operations, Janu ary 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 incr eased 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 diabet ic (P = 0.005), uro-nefrological (P = 0.002), pulmonary (P < 0.0005)an d neurological (P = 0.003) pathology increased significantly, and ther e 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 pulmo nary (P = 0.04), neurological (P = 0.02) and uro-nefrological (P < 0.0 005) problems. Conclusion: During the last few years there has been a trend in myocardial revascularization of older patients, with more coe xisting disease. Despite the fact that hospital mortality seems stable , there is an increase in major postoperative morbidity. (C) 1998 Else vier Science B.V. All rights reserved.