Minimal early mortality in CABG--simply a question of surgical quality?
BACKGROUND
The increasing number of risk scores and models for the evaluation of the early risk after cardiac surgery reflects the interest in 'calculating' the risk of adverse events. Different time intervals, but also different 'types' of death are generally accepted in the evaluation of early mortality. The aim of this study was to focus on the differences in the calculation of early mortality and to focus on their potentially misleading impact on risk stratification.


METHODS
We investigated 7,436 patients who underwent coronary artery bypass grafting from June 30, 1988 through June 30, 2001. A follow-up was performed 180 days after operation (98.7 % complete).


RESULTS
According to the definition of 30-day mortality to represent the total time interval between an intervention and the 30th postoperative day, the 30-day mortality was 5.92 % (n = 440 patients). Hospital mortality reflects the number of deaths from the day of intervention through the patient's individual discharge, independent of any fixed time interval. Hospital mortality was 5.86 % (n = 436 patients) in our patient group. 30-day hospital mortality requires the investigation of hospital mortality until the 30th postoperative day; in-hospital and general mortality after the 30th postoperative day remained excluded from the analysis; 30-day hospital mortality was 5.19 % (n = 386 patients). Assuming a maximum hospital stay of 5 days, hospital mortality would decrease to 2.64 % (n = 196 patients).


CONCLUSIONS
30-day mortality, hospital mortality and 30-day hospital mortality are used to determine early outcome. The present data indicate the vulnerability of non-standardized time intervals to discharge policy. However, both hospital mortality and 30-day hospital mortality are predominantly used in current risk scores and models. In view of the comparability and meaning of data, the methodology for the evaluation of early risk should be reconsidered.
Osswald
B R
BR
University of Heidelberg, Department of Cardiac Surgery, Germany. brigitte_oswald@med.uni-heidelberg.de
Tochtermann
U
U
Schweiger
P
P
Göhring
D
D
Thomas
G
G
Vahl
C F
CF
Hagl
S
S
D001026:Coronary Artery Bypass / Q000401:mortality*; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011787:Quality of Health Care; D018570:Risk Assessment / Q000379:methods* / Q000592:standards