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Comparative Study
. 2009 Oct;52(5):394-400.

Recent evolution in demographic and clinical characteristics and in-hospital morbidity in patients undergoing coronary surgery

Richard G Baillot  1 , Denis R Joanisse, Louis Mathieu Stevens, Daniel P Doyle, Brigitte Dionne, François Lellouche
Affiliations
Comparative Study

Recent evolution in demographic and clinical characteristics and in-hospital morbidity in patients undergoing coronary surgery

Richard G Baillot et al. Can J Surg. 2009 Oct.

Abstract
in English, French

Background: Over the last 12 years, the demographic and clinical characteristics of patients undergoing myocardial revascularization surgery have evolved rapidly. The goal of our study was to analyze the evolution of these trends and the results of these surgical interventions.

Methods: We identified patients who underwent a first or second myocardial revascularization between 1993 and 2004, and we arbitrarily divided them into 2 groups: 1 cohort of patients who underwent surgery between 1993 and 1998 and 1 cohort of patients who underwent surgery between 1999 and 2004. We compared demographic and clinical characteristics between the 2 cohorts and determined which variables were significant predictors of morbidity and mortality.

Results: From 1993 to 2004, 12 202 patients underwent a first (95.5%) or second (4.5%) myocardial revascularization. Patients in the later cohort presented with a high-risk profile. They were older and had metabolic syndrome or diabetes and peripheral vascular disease. On the other hand, there were fewer active smokers in this group. Whereas the rate of postoperative infarction and renal insufficiency was higher in the second cohort, this group had a lower incidence of stroke and prolonged mechanical ventilation and shorter hospital stays. Overall, observed mortality decreased in spite of a steady increase in predicted mortality. Identified predictors of mortality were age, stroke, female sex, nonelective surgery, renal insufficiency, peripheral vascular disease, chronic obstructive pulmonary disease, ventricular dysfunction and stenosis of the left main trunk.

Conclusion: Our study confirmed current trends that show an increase in the at-risk population with dysmetabolic syndrome in cardiac surgery, as well as constant improvements in tertiary care in anesthesia and coronary surgery.

Contexte: Les caractéristiques démographiques et cliniques des patients qui subissent une revascularisation myocardique chirurgicale ont évolué rapidement au cours des 12 dernières années. L’objectif de notre étude était d’analyser l’évolution de ces tendances ainsi que les résultats de ces interventions.

Méthodes: Nous avons identifié les patients ayant subi une première ou une seconde revascularisation myocardique de 1993 à 2004, et nous les avons arbitrairement divisé en 2 groupes, soit une cohorte de patients opérés de 1993 à 1998 et une de 1999 à 2004. Nous avons comparé les charactéristiques démographiques et cliniques entre les 2 groupes et nous avons identifié les variables qui avaient un pouvoir prédictif significatif pour la morbidité et la mortalité.

Résultats: De 1993 à 2004, 12 202 patients ont subi une première (95,5%) ou une seconde (4,5%) revascularisation myocardique. Les patients de la cohorte récente présentent un profil de risque accru; ils sont plus âgés, sont atteints de syndrome métabolique ou de diabète ainsi que de maladie vasculaire périphérique. Par ailleurs, on retrouve dans ce groupe moins de fumeurs actifs. Bien que les taux d’infarctus et d’insuffisance rénale postopératoire soient plus élevés, pour cette deuxième cohorte, on note une moindre incidence d’accident vasculaire cérébral et d’intubation prolongée, et le séjour hospitalier est plus court. Enfin, la mortalité observée diminue malgré une augmentation constante de la mortalité prédite. Les prédicteurs de mortalité identifiés sont l’âge, l’accident vasculaire cérébral, le sexe féminin, la chirurgie non élective, l’insuffisance rénale, la maladie vasculaire périphérique, la maladie pulmonaire obstructive chronique, la dysfonction ventriculaire et la sténose du tronc commun.

Conclusion: Notre étude confirme les tendances actuelles en ce qui a trait à l’augmentation des populations à risque et dysmétaboliques en chirurgie cardiaque ainsi que l’amélioration constante des soins tertiaires en anesthésie et en chirurgie coronarienne.

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Figures

Fig. 1
Fig. 1
Evolution of the percentage of men and women with diabetes from 1993 to 2004.
Fig. 2
Fig. 2
Lipid levels among (A) patients without diabetes and (B) patients with diabetes. HDL = high-density lipoprotein; LDL = low-density lipoprotein; TC = total cholesterol; TG = trigliceride.
Fig. 3
Fig. 3
Prevalence of metabolic syndrome for a first surgery from 2000 to 2004 (NCEP-ATPIII criteria).
Fig. 4
Fig. 4
Evolution of observed (black line) and predicted (bar) operative mortality for a first aortocoronary shunt surgery from 1993 to 2004.
See this image and copyright information in PMC

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