Original article: cardiovascular
A decade of change—risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990–1999: a report from the STS National Database Committee and the Duke Clinical Research Institute

https://doi.org/10.1016/S0003-4975(01)03339-2Get rights and content

Abstract

Background. The Society of Thoracic Surgeons National Adult Cardiac Database is the largest voluntary clinical database in medicine. Using this database we examined changes in the risk profile of patients undergoing isolated coronary artery bypass grafting (CABG) and their outcomes during the decade 1990 to 1999.

Methods. Trends in 23 preoperative risk factors were tracked for CABG cases during this decade. Using a multivariate logistic risk model, we also determined the degree to which operative risk and risk-adjusted operative mortality changed during this 10-year interval.

Results. Between 1990 and 1999, 1,154,486 patient records were harvested by the Society of Thoracic Surgeons National Adult Cardiac Database for isolated CABG procedures performed at 522 Society of Thoracic Surgeons participant sites in the United States and Canada. Over time, CABG patients were more likely to be older (mean age 63.7 in 1990, 65.1 in 1999), of female gender (25.7% women in 1990, 28.7% in 1999), and have a history of smoking, diabetes mellitus, renal failure, hypertension, stroke, chronic lung disease, New York Heart Association functional class IV, and three-vessel disease (p < 0.0001). Patients’ predicted operative risk increased by 30.1%, from 2.6% in 1990 to 3.4% in 1999. Despite higher risk, observed operative mortality decreased by 23.1%, from 3.9% in 1990 to 3.0% in 1999 (p < 0.0001). During the decade, a Medicare-aged subset (n = 629,174) experienced similar increases in risk and declines in mortality.

Conclusions. Patients referred for isolated CABG are significantly older, sicker, and have a higher risk than a decade ago. Despite this, CABG mortality rates have declined substantially. These results highlight the excellent progress in the care of CABG patients achieved during the past decade.

Section snippets

The Society of Thoracic Surgeons National Cardiac Database

Currently, patient data are harvested semiannually from the individual participant site providers contributing to the NCD [5]. Data are uploaded to a central warehouse facility, the Duke Clinical Research Institute. Certain data quality standard benchmarks need to be met both locally and nationally before a site’s data are included on the aggregate national set. Aggregate data are analyzed twice a year for site-specific feedback reporting, and benchmarked against regional and national

Results

Table 1documents the annual harvest data for the entire patient dataset from 1990 to 1999. A total of 1,154,486 CABG patient records were included in this analysis. Both the cumulative aggregate total record numbers and the aggregate Medicare population numbers are shown (n = 629,174). The cumulative aggregate number of harvest sites has grown fivefold during this decade.

Table 2displays the changes in risk factor frequency during this time interval. For display purposes, we concentrated on the

Operative mortality trends over time

The present study is the first published report from a multisite national dataset (in contrast to reports from large, single-institution databases 11, 12, 13, 14, 15) analyzing trends in CABG mortality. These results confirm that during the past decade patients undergoing CABG are older and with more comorbidities. Despite this, there has been a significant decline in overall operative mortality and risk-adjusted mortality for CABG during the decade from 1990 to 1999 (Fig 1).

Changing risk profile in CABG

The present study

Acknowledgements

The authors thank all STS participants who have contributed data to the STS National Database during the past decade. In addition, we extend our appreciation to the Society, the Officers, and the Members of the National Database Committee over the decade who have supported this National Database effort.

References (25)

  • K.V Arom et al.

    Establishing and using a local/regional Cardiac Surgery Database

    Ann Thorac Surg

    (1997)
  • W Ko et al.

    Survival analysis of octogenarian patients with coronary artery disease managed by elective coronary bypass surgery versus conventional medical treatment

    Circulation

    (1992)
  • Cited by (0)

    View full text