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The Annals of Thoracic Surgery, Vol 57, 12-19, Copyright © 1994 by The Society of Thoracic Surgeons
FH Edwards, RE Clark and M Schwartz
The need for accurate risk assessment has become an indispensable element
in the practice of cardiac surgery. The Society of Thoracic Surgeons
National Cardiac Surgery Database allows subscribing institutions to
perform sophisticated patient risk assessment using traditional statistical
tools and a newly developed risk model of operative mortality. The database
experience with isolated coronary artery bypass grafting has been studied
most closely at this point and serves as the basis for this report. The
approach to operative risk assessment is presented along with an analysis
of important risk factors in the practice of coronary artery surgery from
1980 through 1990. The database contains records of 80,881 patients
undergoing coronary artery bypass grafting in numerous institutions from
1980 through 1990. These records were used to conduct a detailed analysis
of risk factors associated with coronary operations in this time interval
and to present statistical methods used to formulate a risk equation that
allows one to predict the probability of operative death. In the course of
this decade, there were clearly defined trends showing a statistically
significant increase in adverse patient risk factors. The risk model has
proven to be a reliable tool for predicting the probability of operative
death in an individual patient and may be valuable in both patient
counseling and medical decision making. Large multi-institutional databases
of this type are key ingredients of modern operative risk assessment. A
database containing a broad national experience of this type can represent
an aggregate experience that may well approximate a universally accepted
standard of care.
ARTICLES
Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experience
Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville 32209-6511.
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