COMPARISON OF RESULTS AND RISK-FACTORS OF CARDIAC-SURGERY IN 2 3-YEARTIME PERIODS IN THE 1990

With the increasing number of treatment options for heart disease, dec ision-making requires profiles of risk for conventional cardiac surger y. Refinements in techniques and clinical practices seem to have reduc ed surgical risk. This study was performed to determine current risk f actors. From July 1, 1990, to June 30, 1996, 1,036 consecutive patient s underwent 1,042 heart operations using standard incisions and cardio pulmonary bypass with cardioplegia. Univariate and multivariate analys es using a logistic regression model were performed to determine facto rs significant for combined 30-day and hospital mortality. To determin e if there were trends in the results and the risk factors, the last 5 00 consecutive cases in the series were analyzed separately. Overall, 30-day mortality was 17 of 1,042 (1.6%) and combined 30-day and hospit al mortality was 27 of 1,042 (2.6%). Significant risk factors for comb ined 30-day and hospital mortality by multivariate analyses were: emer gent/resuscitative status, preoperative dialysis, left ventricular eje ction fraction less than or equal to 30%, valve operation, and creatin ine greater than or equal to 1.5 mg/dl. Comparison with baseline chara cteristics of the patients undergoing the last 500 consecutive operati ons to the earlier 542 operations in the study group showed that risk factors had a very similar profile for the 2 groups. The overall 30-da y mortality for the last 500 consecutive operations was 5 of 500 (1.0% ) and combined 30-day and hospital mortality was 8 of 500 (1.6%). The significant risk factors by multivariate analyses were reduced to left ventricular ejection fraction less than or equal to 30% and creatinin e greater than or equal to 1.5 mg/dl. These results indicate that mode rn techniques and clinical practices have mitigated well-recognized ri sk factors in conventional cardiac surgery and this trend is ongoing. (C) 1998 by Excerpta Medica, Inc.