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Ann Thorac Surg 2003;75:1856-1865
© 2003 The Society of Thoracic Surgeons
a Denver Department of Veterans Affairs Medical Center, and University of Colorado Health Sciences Center, Denver, Colorado, USA
b Duke Clinical Research Institute, Durham, North Carolina, USA
c The Society of Thoracic Surgeons, Chicago, Illinois, USA
d LSU Health Sciences Center, New Orleans, Louisiana, USA
e University of Florida Health Sciences Center, Jacksonville, Florida, USA
* Address reprint requests to Dr Shroyer, Denver Department of Veterans Affairs Medical Center, 1055 Clermont St (112R), Denver, CO 80220, USA
e-mail: laurie.shroyer{at}med.va.gov
Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.
BACKGROUND: Although 30day risk-adjusted operative mortality (ROM) has been used for quality assessment, it is not sufficient to describe the outcomes after coronary artery bypass grafting (CABG) surgery. Risk-adjusted major morbidity may differentially impact quality of care (as complications occur more frequently than death) and enhance a surgical team’s ability to assess their quality. This study identified the preoperative risk factors associated with several complications and a composite outcome (the presence of any major morbidity or 30-day operative mortality or both).
METHODS: For CABG procedures, the 1997 to 1999 Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database was used to develop ROM and risk-adjusted morbidity (ROMB) models. Risk factors were selected using standard STS univariate screening and multivariate logistic regression approaches. Risk model performance was assessed. Across STS participating sites, the association of observed-to-expected (O/E) ratios for ROM and ROMB was evaluated.
RESULTS: The 30-day operative death and major complication rates for STS CABG procedures were 3.05% and 13.40%, respectively (503,478 CABG procedures), including stroke (1.63%), renal failure (3.53%), reoperation (5.17%), prolonged ventilation (5.96%), and sternal infection (0.63%). Risk models were developed (c-indexes for stroke [0.72], renal failure [0.76], reoperation [0.64], prolonged ventilation [0.75], sternal infection [0.66], and the composite endpoint [0.71]). Only a slight correlation was found, however, between ROMB and ROM indicators.
CONCLUSIONS: Used in combination, ROMB and ROM may provide the surgical team with additional information to evaluate the quality of their care as well as valuable insights to allow them to focus on areas for improvement.
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J. R. Edgerton, M. A. Herbert, S. L. Prince, J. L. Horswell, L. Michelson, M. J. Magee, T. M. Dewey, Z. J. Edgerton, and M. J. Mack Reduced Atrial Fibrillation in Patients Immediately Extubated After Off-Pump Coronary Artery Bypass Grafting Ann. Thorac. Surg., June 1, 2006; 81(6): 2121 - 2127. [Abstract] [Full Text] [PDF]
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T. A. Vassiliades Jr, J. S. Douglas, D. C. Morris, P. C. Block, Z. Ghazzal, S. T. Rab, and C. U. Cates Integrated coronary revascularization with drug-eluting stents: Immediate and seven-month outcome J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 956 - 962. [Abstract] [Full Text] [PDF]
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D. S. Likosky, W. C. Nugent, R. A. Clough, P. W. Weldner, H. B. Quinton, C. S. Ross, and G. T. O'Connor Comparison of Three Measurements of Cardiac Surgery Mortality for the Northern New England Cardiovascular Disease Study Group Ann. Thorac. Surg., April 1, 2006; 81(4): 1393 - 1395. [Abstract] [Full Text] [PDF]
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L. Abrahamyan, A. Demirchyan, M. E Thompson, and H. Hovaguimian Determinants of Morbidity and Intensive Care Unit Stay after Coronary Surgery Asian Cardiovasc Thorac Ann, April 1, 2006; 14(2): 114 - 118. [Abstract] [Full Text] [PDF]
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O. V. Hein, J. Birnbaum, K. Wernecke, M. England, W. Konertz, and C. Spies Prolonged Intensive Care Unit Stay in Cardiac Surgery: Risk Factors and Long-Term-Survival Ann. Thorac. Surg., March 1, 2006; 81(3): 880 - 885. [Abstract] [Full Text] [PDF]
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Preoperative statin treatment is associated with reduced postoperative mortality and morbidity in patients undergoing cardiac surgery: an 8-year retrospective cohort study. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 679 - 685.
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W. A. Cooper, S. M. O'Brien, V. H. Thourani, R. A. Guyton, C. R. Bridges, L. A. Szczech, R. Petersen, and E. D. Peterson Impact of Renal Dysfunction on Outcomes of Coronary Artery Bypass Surgery: Results From the Society of Thoracic Surgeons National Adult Cardiac Database Circulation, February 28, 2006; 113(8): 1063 - 1070. [Abstract] [Full Text] [PDF]
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W. S. Weintraub Evaluating the Risk of Coronary Surgery and Percutaneous Coronary Intervention J. Am. Coll. Cardiol., February 7, 2006; 47(3): 669 - 671. [Full Text] [PDF]
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E. L. Hannan, C. Wu, E. V. Bennett, R. E. Carlson, A. T. Culliford, J. P. Gold, R. S.D. Higgins, O. W. Isom, C. R. Smith, and R. H. Jones Risk Stratification of In-Hospital Mortality for Coronary Artery Bypass Graft Surgery J. Am. Coll. Cardiol., February 7, 2006; 47(3): 661 - 668. [Abstract] [Full Text] [PDF]
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F. Seccareccia, C. A. Perucci, P. D'Errigo, M. Arca, D. Fusco, S. Rosato, D. Greco, and on behalf of the research group of the Italian CAB The Italian CABG Outcome Study: short-term outcomes in patients with coronary artery bypass graft surgery Eur. J. Cardiothorac. Surg., January 1, 2006; 29(1): 56 - 62. [Abstract] [Full Text] [PDF]
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F. H. Edwards, R. M. Engelman, P. Houck, D. M. Shahian, and C. R. Bridges The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part I: Duration Ann. Thorac. Surg., January 1, 2006; 81(1): 397 - 404. [Full Text] [PDF]
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 P. F. Hoilund-Carlsen, A. Johansen, H. W. Christensen, W. Vach, M. Moldrup, P. Bartram, A. Veje, T. Haghfelt, and for the Myocardial Ischemia Logistics Evaluation S Potential impact of myocardial perfusion scintigraphy as gatekeeper for invasive examination and treatment in patients with stable angina pectoris: observational study without post-test referral bias Eur. Heart J., January 1, 2006; 27(1): 29 - 34. [Abstract] [Full Text] [PDF]
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K. F. Welke, M. J. Barnett, M. S. Vaughan Sarrazin, and G. E. Rosenthal Limitations of Hospital Volume as a Measure of Quality of Care for Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., December 1, 2005; 80(6): 2114 - 2119. [Abstract] [Full Text] [PDF]
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K. Karkouti, G. Djaiani, M. A. Borger, W. S. Beattie, L. Fedorko, D. Wijeysundera, J. Ivanov, and J. Karski Low Hematocrit During Cardiopulmonary Bypass is Associated With Increased Risk of Perioperative Stroke in Cardiac Surgery Ann. Thorac. Surg., October 1, 2005; 80(4): 1381 - 1387. [Abstract] [Full Text] [PDF]
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D. N. Wijeysundera, W. S. Beattie, G. Djaiani, V. Rao, M. A. Borger, K. Karkouti, and R. J. Cusimano Off-Pump Coronary Artery Surgery for Reducing Mortality and Morbidity: Meta-Analysis of Randomized and Observational Studies J. Am. Coll. Cardiol., September 6, 2005; 46(5): 872 - 882. [Abstract] [Full Text] [PDF]
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G. Ambler, R. Z. Omar, P. Royston, R. Kinsman, B. E. Keogh, and K. M. Taylor Generic, Simple Risk Stratification Model for Heart Valve Surgery Circulation, July 12, 2005; 112(2): 224 - 231. [Abstract] [Full Text] [PDF]
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R. Jin, G. L. Grunkemeier, A. P. Furnary, J. R. Handy Jr, and for the Providence Health System Cardiovascular St Is Obesity a Risk Factor for Mortality in Coronary Artery Bypass Surgery? Circulation, June 28, 2005; 111(25): 3359 - 3365. [Abstract] [Full Text] [PDF]
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A. Zacharias, T. A. Schwann, C. J. Riordan, S. J. Durham, A. Shah, T. J. Papadimos, M. Engoren, and R. H. Habib Is Hospital Procedure Volume a Reliable Marker of Quality for Coronary Artery Bypass Surgery? A Comparison of Risk and Propensity Adjusted Operative and Midterm Outcomes Ann. Thorac. Surg., June 1, 2005; 79(6): 1961 - 1969. [Abstract] [Full Text] [PDF]
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F. H. Edwards, V. A. Ferraris, D. M. Shahian, E. Peterson, A. P. Furnary, C. K. Haan, and C. R. Bridges Gender-Specific Practice Guidelines for Coronary Artery Bypass Surgery: Perioperative Management Ann. Thorac. Surg., June 1, 2005; 79(6): 2189 - 2194. [Abstract] [Full Text] [PDF]
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M. J. Mack, M. Herbert, S. Prince, T. M. Dewey, M. J. Magee, and J. R. Edgerton Does reporting of coronary artery bypass grafting from administrative databases accurately reflect actual clinical outcomes? J. Thorac. Cardiovasc. Surg., June 1, 2005; 129(6): 1309 - 1317. [Abstract] [Full Text] [PDF]
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P.-E. Falcoz, S. Chocron, C. Binquet, L. Stoica, D. Kaili, C. Quantin, and J.-P. Etievent Revascularization of the Right Coronary Artery: Grafting or Percutaneous Coronary Intervention? Ann. Thorac. Surg., April 1, 2005; 79(4): 1232 - 1239. [Abstract] [Full Text] [PDF]
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F. Kerendi, J. D. Puskas, J. M. Craver, W. A. Cooper, E. L. Jones, O. M. Lattouf, J. D. Vega, and R. A. Guyton Emergency Coronary Artery Bypass Grafting Can Be Performed Safely Without Cardiopulmonary Bypass in Selected Patients Ann. Thorac. Surg., March 1, 2005; 79(3): 801 - 806. [Abstract] [Full Text] [PDF]
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A. A. Fox and N. A. Nussmeier Does Gender Influence the Likelihood or Types of Complications Following Cardiac Surgery? Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2004; 8(4): 283 - 295. [Abstract] [PDF]
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M. Caputo, B. C. Reeves, C. A. Rogers, R. Ascione, and G. D. Angelini Monitoring the performance of residents during training in off-pump coronary surgery J. Thorac. Cardiovasc. Surg., December 1, 2004; 128(6): 907 - 915. [Abstract] [Full Text] [PDF]
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J. P. Gold, K. E. Torres, W. Maldarelli, I. Zhuravlev, D. Condit, and J. Wasnick Improving Outcomes in Coronary Surgery: The Impact of Echo-Directed Aortic Cannulation and Perioperative Hemodynamic Management in 500 Patients Ann. Thorac. Surg., November 1, 2004; 78(5): 1579 - 1585. [Abstract] [Full Text] [PDF]
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D. M. Shahian, E. H. Blackstone, F. H. Edwards, F. L. Grover, G. L. Grunkemeier, D. C. Naftel, S. A.M. Nashef, W. C. Nugent, and E. D. Peterson Cardiac Surgery Risk Models: A Position Article Ann. Thorac. Surg., November 1, 2004; 78(5): 1868 - 1877. [Abstract] [Full Text] [PDF]
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C. Weissman Pulmonary Complications After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 185 - 211. [Abstract] [PDF]
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S. Garwood Renal Insufficiency After Cardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2004; 8(3): 227 - 241. [Abstract] [PDF]
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