Determinants of mortality after cardiac surgery: results of the registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte (ALKK)on 10525 Patients

Background Mortality from cardiac surgery is an essential indicator of qual ity and forms the basis of treatment strategy decisions in eligible patient s. No contemporary complete data on unselected adult cardiac surgery patien ts are available in Germany. Methods and Results A registry was started in June 1997 of all patients ref erred to surgery from 85 cardiology centres in Germany. The registry was in tended to include 10 000 patients and this number was reached in March 1998 . Follow-up of the patients was by simple questionnaire, reporting the date of surgery, major complications, and symptomatic improvement. If the quest ionnaire was not returned, a reminder letter was sent and, if necessary, fu rther telephone investigations were performed. This resulted in 99.9% compl ete data. Of 10 525 patients operated on, 3.91% had died by 30 days after s urgery. The overall operative mortality was 4.57%, which included 69 patien ts who died after more than 30 days from complications related to surgery. By multivariate analysis, the following predictors of mortality were identi fied: previous surgery, emergency or complex operation; age >75 years, fema le gender, cardiac failure, angina CCS class IV, and three-vessel corollary disease. An integral part of the registry was a pre-operative prediction o f surgical risk in five categories. This risk estimate revealed a surprisin gly correct prediction of the mortality observed. Conclusions In a representative unselected group of cardiac surgery patient s, operative mortality was 4.57%. Several procedural and clinical parameter s were significantly correlated with mortality, but the risk increment by e ach of these factors was small. Unstructured clinical judgement reliably pr edicted the operative risk. (Eur Heart J 2000; 21: 28-32) (C) 2000 The Euro pean Society of Cardiology.