[Emergencies (outpatients) in cardiosurgery: national multicenter study. Gruppo di Studio SIAARTI "Anestesia e Rianimazione in Cardiochirurgia"].
BACKGROUND
Heart Surgery Italian Centres participated in this study to define the rate and the outcome of outpatients' cardiovascular emergencies. Hospital patients and heart and/or lung transplants were excluded.


METHODS
Data were prospectively collected over 6 months (from April 1 through September 30, 1996) and analyzed using SPSS stat programme.


RESULTS
731 emergencies (5.8% of 12551 cardiosurgical procedures) have been recorded. 85.8% of the patients were admitted to the surgical units, coming from other hospitals. 31.6% of emergencies were admitted in the night. 37.2% of the patients were admitted because of myocardial infarction or unstable angina in spite of e.v. drugs; 28.3% because of dissection of thoracic aorta; 18.2% were congenital heart diseases; 9.2% valvular or valve prosthesis dysfunctions; 7.1% were affected by other cardiovascular diseases. On admission, 48.7% of the patients were in cardiogenic shock or severe heart failure, 27.9% presented respiratory failure, 11.8% renal failure, 5.1% brain injury (coma and/or plegia or paresis). 500 (68.4%) patients needed invasive and or not invasive diagnostic procedures. 33 (4.5%) patients died early after admission to the hospital. 30 patients, who did not need surgery, were discharged few days after admission. 668 (91.4%) patients underwent surgery. Overall perioperative mortality was 21.7%: 31.6% in the aortic group, 21.6% in the congenital heart disease group, 24.6% in the valve group, 15.2% in the coronary group.


CONCLUSIONS
The cost of outpatients' cardiovascular emergencies is very high. First of all, overall mortality and perioperative mortality are greater when compared to elective surgical procedures; moreover expensive tools and continuous availability of skilled anaesthesiologists, cardiologists and surgeons are mandatory. In order to optimize results (cost/benefit) and looking for lowering mortality, the approach to outpatients' cardiovascular emergencies in Italy must be reorganized, in order to refer emergencies to few, high qualified, "ad hoc" organized Centres properly placed on the national territory.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D013903:Thoracic Surgery / Q000706:statistics & numerical data*