Effect of different preoperative patient characteristics on coronary surgery outcome: a comparative study between a developing and a developed country.
OBJECTIVE
To evaluate the impact of the preoperative patient characteristics on the results of coronary surgery in a developing country compared with a developed country.


METHODS
Preoperative risk factors for coronary artery disease (CAD) and intraoperative and immediate postoperative variables for coronary surgery were compared. Sixty patients were operated at Ain Shams University in Cairo (Egypt) between March and September 1999, compared with 60 patients operated at Hannover medical school (Germany) between March and September 2001. By using univariate analysis and multivariate logistic regression, model predictors for hospital mortality were determined.


RESULTS
Groups were comparable regarding a majority of risk factors except age, diabetes, chronic obstructive pulmonary disease (COPD), and hypertension. Seventy percent of the Egyptian patients presented in New York Heart Association (NYHA) class III, whereas 50% of the German patients were in NYHA class II. Fifty percent of the German patients showed left ventricular ejection fraction (LVEF) >60%, whereas 52% of the Egyptian patients had LVEF between 40% and 59%. Diabetes (56.6%) and COPD (43.3%) are the major predictors of hospital mortality among the Egyptian patients as proved by high odds ratio (4.6 and 3.4, respectively). Egyptian patients required prolonged mechanical ventilation and extended intensive care unit and hospital stay. Hospital mortality was 6.7% in the Egyptian versus 1.7% in the German group.


CONCLUSIONS
Diabetes mellitus, COPD, and prolonged mechanical ventilation are the major predictors of hospital mortality in Egypt. This study tries to underline problems of coronary artery bypass graft surgery in different populations.
Sayed
Sameh
S
Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Hannover, Germany. samsayed@mailcity.com
Fischer
Stefan
S
Karck
Matthias
M
Hassouna
Ahmed
A
Haverich
Axel
A
D000367:Age Factors; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D019049:Developed Countries; D003906:Developing Countries; D048909:Diabetes Complications / Q000150:complications / Q000453:epidemiology*; D004534:Egypt / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors