Coronary bypass surgery: what is changing?: Analysis of 3834 patients undergoing primary isolated myocardial revascularization

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Abstract

Objective:

The patient population undergoing myocardial revascularization has changed during the last few years. Knowledge of these changes, and of the subsequent influence on morbidity and/or mortality is important, not only for up-dating quality control, but also to support decision-making in financial and economical aspects, and in further research concerning coronary artery surgery.

Methods:

Pre-, per- and postoperative data of 3834 primary isolated coronary bypass operations, January 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 increased 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 diabetic (P=0.005), uro-nefrological (P=0.002), pulmonary (P<0.0005) and neurological (P=0.003) pathology increased significantly, and there 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 pulmonary (P=0.04), neurological (P=0.02) and uro-nefrological (P<0.0005) problems.

Conclusion:

During the last few years there has been a trend in myocardial revascularization of older patients, with more coexisting disease. Despite the fact that hospital mortality seems stable, there is an increase in major postoperative morbidity.

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