TY - JOUR
T1 - A decade of change - Risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999
T2 - A report from the STS National Database Committee and the Duke Clinical Research Institute
AU - Ferguson, T. Bruce
AU - Hammill, Bradley G.
AU - Peterson, Eric D.
AU - DeLong, Elizabeth R.
AU - Grover, Frederick L.
PY - 2002
Y1 - 2002
N2 - Background. The Society of Thoracic Surgeons National Adult Cardiac Database is the largest voluntary clinical database in medicine. Using this database we examined changes in the risk profile of patients undergoing isolated coronary artery bypass grafting (CABG) and their outcomes during the decade 1990 to 1999. Methods. Trends in 23 preoperative risk factors were tracked for CABG cases during this decade. Using a multivariate logistic risk model, we also determined the degree to which operative risk and risk-adjusted operative mortality changed during this 10-year interval. Results. Between 1990 and 1999, 1,154,486 patient records were harvested by the Society of Thoracic Surgeons National Adult Cardiac Database for isolated CABG procedures performed at 522 Society of Thoracic Surgeons participant sites in the United States and Canada. Over time, CABG patients were more likely to be older (mean age 63.7 in 1990, 65.1 in 1999), of female gender (25.7% women in 1990, 28.7% in 1999), and have a history of smoking, diabetes mellitus, renal failure, hypertension, stroke, chronic lung disease, New York Heart Association functional class IV, and three-vessel disease (p < 0.0001). Patients’ predicted operative risk increased by 30.1%, from 2.6% in 1990 to 3.4% in 1999. Despite higher risk, observed operative mortality decreased by 23.1%, from 3.9% in 1990 to 3.0% in 1999 (p < 0.0001). During the decade, a Medicare-aged subset (n = 629,174) experienced similar increases in risk and declines in mortality. Conclusions. Patients referred for isolated CABG are significantly older, sicker, and have a higher risk than a decade ago. Despite this, C0ABG mortality rates have declined substantially. These results highlight the excellent progress in the care of CABG patients achieved during the past decade.
AB - Background. The Society of Thoracic Surgeons National Adult Cardiac Database is the largest voluntary clinical database in medicine. Using this database we examined changes in the risk profile of patients undergoing isolated coronary artery bypass grafting (CABG) and their outcomes during the decade 1990 to 1999. Methods. Trends in 23 preoperative risk factors were tracked for CABG cases during this decade. Using a multivariate logistic risk model, we also determined the degree to which operative risk and risk-adjusted operative mortality changed during this 10-year interval. Results. Between 1990 and 1999, 1,154,486 patient records were harvested by the Society of Thoracic Surgeons National Adult Cardiac Database for isolated CABG procedures performed at 522 Society of Thoracic Surgeons participant sites in the United States and Canada. Over time, CABG patients were more likely to be older (mean age 63.7 in 1990, 65.1 in 1999), of female gender (25.7% women in 1990, 28.7% in 1999), and have a history of smoking, diabetes mellitus, renal failure, hypertension, stroke, chronic lung disease, New York Heart Association functional class IV, and three-vessel disease (p < 0.0001). Patients’ predicted operative risk increased by 30.1%, from 2.6% in 1990 to 3.4% in 1999. Despite higher risk, observed operative mortality decreased by 23.1%, from 3.9% in 1990 to 3.0% in 1999 (p < 0.0001). During the decade, a Medicare-aged subset (n = 629,174) experienced similar increases in risk and declines in mortality. Conclusions. Patients referred for isolated CABG are significantly older, sicker, and have a higher risk than a decade ago. Despite this, C0ABG mortality rates have declined substantially. These results highlight the excellent progress in the care of CABG patients achieved during the past decade.
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U2 - 10.1016/S0003-4975(01)03339-2
DO - 10.1016/S0003-4975(01)03339-2
M3 - Article
C2 - 11845863
AN - SCOPUS:0036164380
SN - 0003-4975
VL - 73
SP - 480
EP - 489
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -