Predictive factors of in-hospital mortality and of severe perioperative complications in myocardial revascularization surgery.
OBJECTIVE
To investigate preoperative predictive factors of severe perioperative intercurrent events and in-hospital mortality in coronary artery bypass graft (CABG) surgery and to develop specific models of risk prediction for these events, mainly those that can undergo changes in the preoperative period.


METHODS
We prospectively studied 453 patients who had undergone CABG. Factors independently associated with the events of interest were determined with multiple logistic regression and Cox proportional hazards regression model.


RESULTS
The mortality rate was 11.3% (51/453), and 21.2% of the patients had 1 or more perioperative intercurrent events. In the final model, the following variables remained associated with the risk of intercurrent events: age > or = 70 years, female sex, hospitalization via SUS (Sistema nico de Sa de - the Brazilian public health system), cardiogenic shock, ischemia, and dependence on dialysis. Using multiple logistic regression for in-hospital mortality, the following variables participated in the model of risk prediction: age > or = 70 years, female sex, hospitalization via SUS, diabetes, renal dysfunction, and cardiogenic shock. According to the Cox regression model for death within the 7 days following surgery, the following variables remained associated with mortality: age > or = 70 years, female sex, cardiogenic shock, and hospitalization via SUS.


CONCLUSIONS
The aspects linked to the structure of the Brazilian health system, such as factors of great impact on the results obtained, indicate that the events investigated also depend on factors that do not relate to the patient's intrinsic condition.
Almeida
Fernanda Fuscaldi
FF
Universidade Federal de Minas Gerais, Brazil.
Barreto
Sandhi Maria
SM
Couto
Bráulio Roberto G M
BR
Starling
Carlos E F
CE
D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003695:Delivery of Health Care / Q000592:standards; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects* / Q000401:mortality; D011300:Preoperative Care; D012720:Severity of Illness Index