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The Annals of Thoracic Surgery, Vol 50, 12-26, Copyright © 1990 by The Society of Thoracic Surgeons
FL Grover, KE Hammermeister and C Burchfiel
This study was authorized by the Department of Veterans Affairs to improve
the quality assurance of cardiac surgery by assessing preoperative risk
factors and relating them to operative mortality. Data were received on
10,480 patients over a 2-year period. Preoperative risk variables were
subjected to univariate and multivariate logistic regression analyses.
Significant variables for coronary artery bypass grafting after logistic
regression analysis in order of importance are previous cardiac operation,
priority of operation, New York Heart Association functional class,
peripheral vascular disease, age, pulmonary rales, current diuretic use,
and chronic obstructive pulmonary disease. For patients undergoing valve or
other cardiac operations with or without coronary artery bypass grafting,
those variables found to be significant after multivariate logistic
regression analysis are priority of operation; age; peripheral vascular
disease; great vessel repair; all other except aortic valve replacement,
mitral valve replacement, and great vessel repair; mitral valve
replacement; and cardiomegaly. By identifying these current risk factors
and the coefficients from the multivariate stepwise logistic regression
analysis, expected mortality can be calculated. We propose that the ratio
of observed to expected mortality is a better measure of quality of care
than unadjusted mortality.
ARTICLES
Initial report of the Veterans Administration Preoperative Risk Assessment Study for Cardiac Surgery
Cardiothoracic Surgery Section, Audie L. Murphy Veterans' Hospital, San Antonio, Texas 78284.
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S. J. Hoff, W. H. Merrill, J. R. Stewart, and H. W. Bender Jr Safety of Remote Aortic Valve Replacement After Prior Coronary Artery Bypass Grafting Ann. Thorac. Surg., June 1, 1996; 61(6): 1689 - 1691. [Abstract] [Full Text]
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A. L. W. Shroyer, G. Marshall, B. A. Warner, R. R. Johnson, W. Guo, F. L. Grover, and K. E. Hammermeister No Continuous Relationship Between Veterans Affairs Hospital Coronary Artery Bypass Grafting Surgical Volume and Operative Mortality Ann. Thorac. Surg., January 1, 1996; 61(1): 17 - 20. [Abstract] [Full Text]
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F. L. Grover, K. E. Hammermeister, and A. L. W. Shroyer Quality Initiatives and the Power of the Database: What They Are and How They Run Ann. Thorac. Surg., November 1, 1995; 60(5): 1514 - 1521. [Full Text]
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P. Menasche, W. R. E. Jamieson, W. Flameng, M. K. Davies, and on behalf of the Multinational Acadesine Study Gro ACADESINE: A NEW DRUG THAT MAY IMPROVE MYOCARDIAL PROTECTION IN CORONARY ARTERY BYPASS GRAFTINGResults of the first international multicenter study J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 1096 - 1106. [Abstract] [Full Text]
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A. Cohen, M. Katz, R. Katz, E. Hauptman, and A. Schachner Chronic obstructive pulmonary disease in patients undergoing coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., March 1, 1995; 109(3): 574 - 581. [Abstract] [Full Text]
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K. E. Hammermeister Risk, Predicting Outcomes, and Improving Care Circulation, February 1, 1995; 91(3): 899 - 900. [Full Text]
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C. S. Rihal, K. A. Eagle, M. C. Mickel, E. D. Foster, G. Sopko, and B. J. Gersh Surgical Therapy for Coronary Artery Disease Among Patients With Combined Coronary Artery and Peripheral Vascular Disease Circulation, January 1, 1995; 91(1): 46 - 53. [Abstract] [Full Text]
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