title: The changing face of cardiac surgery patients: an insight into a Mediterranean region.
abstract: OBJECTIVE
  Data of 9 years of surgical activity (on about 10000 patients), obtained from the database of our cardiac surgery care centre, were analysed to assess time-related variations in demographics, clinical and surgical characteristics.
  
  
  METHODS
  Data of patients submitted to major cardiac surgery procedures between 1999 and 2007 were examined using the chi-square test, analysis of variance (ANOVA) test or non-parametric tests, where applicable. The 'linear-by-linear' association test was used to verify the existence of a time-related trend. A value of p<0.05 was considered significant.
  
  
  RESULTS
  In the time interval of 9 years, there was an increment of valve procedures and a decrease in coronary revascularisation surgery. Patients aged 75 years or more at the time of operation increased from 17% in 1999 to 29% in 2005, and the percentage of patients aged 80 or more demonstrated a threefold increase. Operated patients had more co-morbidity (the rate of hypertension rate 43.7% in 1999 and 68.9% in 2007, and obese patients were 13% in 1999 and 17.5% in 2007) and had worse functional and cardiac status (reduced ejection fraction (EF), haemodynamic instability and shock). As a consequence, there was an increased calculated surgical risk. At the same time, there was no significant increment in the observed mortality (3.1% in 1999 vs 3.8% in 2007 for all patients and 1.6% compared with 1.5% in isolated coronary artery bypass graft (CABG) patients).
  
  
  CONCLUSIONS
  These changes can reflect both a variation in the characteristics of the population and a major evolution in intervention cardiology and also impose more intensive and extensive postoperative treatment and less invasive cardiac surgery practice.
authors.affiliation: Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
authors.forename: Michele D
authors.initials: MD
authors.lastname: Pierri
authors.forename: Filippo
authors.initials: F
authors.lastname: Capestro
authors.forename: Carlo
authors.initials: C
authors.lastname: Zingaro
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D004812:Epidemiologic Methods; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged