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The Annals of Thoracic Surgery, Vol 43, 59-64, Copyright © 1987 by The Society of Thoracic Surgeons
FL Junod, BJ Harlan, J Payne, EA Smeloff, GE Miller Jr, PB Kelly Jr, KA Ross, KG Shankar and JP McDermott
In the present climate of quality-assurance policies, rigorous requirements
for informed consent, and a constantly changing patient population, a
system of preoperative risk assignment and postoperative correlation was
developed to monitor and evaluate surgical performance. Patients were
categorized by operation, priority (emergent, urgent, elective), New York
Heart Association Functional Class, and risk. Risk was assigned before
operation using data from the Coronary Artery Surgery Study (CASS) and the
recent literature. Data were collected by a full-time data manager and were
stored and analyzed by computer. From January 1, 1984, to July 1, 1985,
1,303 patients underwent operation for acquired disease. This group
included 913 patients undergoing isolated primary coronary artery bypass
grafting (CABG). The comparison of predicted and observed results showed:
(Table: see text). For patients undergoing isolated primary CABG, the
elective group had an operative mortality of 0.6% (2/329); the urgent
group, 1.1% (5/450); and the emergent group, 5.2% (7/134). Preoperative
risk assignment is an effective method of quality assurance. Female sex and
age older than 60 years, which predicted an operative mortality of 2 to 5%
in the CASS study and other recent series, did not predict a similar risk
in our series.
ARTICLES
Preoperative risk assessment in cardiac surgery: comparison of predicted and observed results
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