Decreasing significance of XXXX and reoperative surgery in predicting coronary artery bypass grafting-associated mortality: a twelve-year study.

@entity1 @entity1095 @entity712 @entity101 @entity6 @entity1455 @entity1002
OBJECTIVES: @entity1 undergoing coronary artery bypass grafting are older and have greater comorbidity than those operated on previously. We evaluated the changes in the predictors of in-hospital mortality among @entity1 undergoing coronary artery bypass grafting during the last 12 years. METHODS: Data on demographic characteristics, preoperative risk factors, operative variables, and hospital outcomes were collected prospectively for all @entity1 undergoing isolated coronary artery bypass grafting at a single institution from January 1, 1990, to December 31, 2001. To examine the effect of time on @entity1 risk profiles and outcomes, we divided @entity1 into three groups according to year of operation (1990-1993 n = 5171, 1994-1997 n = 5977, 1998-2001 n = 6893). RESULTS: In-hospital mortality declined from 2.4% (1990-1993) to 1.2% (1998-2001, P <.0001). @entity1002 , increasing age, female gender, @entity101 , @entity6 , @entity1455 , congestive @entity712 , @entity1095 , reoperative coronary artery bypass grafting, left main disease, and urgent surgery independently predicted in-hospital mortality in the entire cohort of 18,041 @entity1 . Severe @entity1002 was the most significant predictor of in-hospital mortality in the 12-year cohort, but it had a declining influence with time (1990-1993 odds ratio 7.1, 1994-1997 odds ratio 5.1, 1998-2001 not statistically significant) because of improving outcomes. Reoperative coronary artery bypass grafting similarly decreased in significance as a predictor of mortality. Emergency coronary artery bypass grafting was performed less frequently in recent years, but the requirement for emergency surgery carried an increasing odds ratio for mortality. CONCLUSIONS: Despite increasing @entity1 age and comorbidity, improvements in perioperative management have reduced the significance of severe @entity1002 and reoperative coronary artery bypass grafting but not emergency surgery as predictors of in-hospital mortality.
