title: The changing face of cardiac surgery: practice patterns and outcomes 2001-2010.
abstract: BACKGROUND
  Advances in cardiac surgical care have allowed for successful surgery in high-risk elderly patients. Advances in percutaneous coronary intervention (PCI) techniques and expanded indications for PCI have resulted in a decrease in referrals for coronary artery bypass grafting (CABG). Our objective was to document changes in practice patterns and outcomes in a single tertiary cardiac surgery centre serving a large geographic area.
  
  
  METHODS
  For all cardiac surgery cases performed from 2001-2010 we examined its use, patient clinical characteristics, and outcomes. Frailty was assessed using a measure we have previously demonstrated to be associated with adverse outcomes.
  
  
  RESULTS
  During the study period, annual case volume decreased by 13%. The number of isolated CABG cases declined, and valve surgery and other complex procedures increased. The proportion of patients aged ≥ 80 years rose from 7%-12%, and the proportion of frail patients increased from 4%-10%. Although unadjusted in-hospital mortality remained relatively unchanged, intensive care unit (ICU) stays and prolonged institutional care increased. Older age and frailty were associated with mortality, prolonged ICU stays, prolonged institutional care, and a composite of mortality and major morbidities.
  
  
  CONCLUSIONS
  Our findings showed a decline in CABG, an increase in more complex operations, and an increase in prolonged ICU stays and prolonged institutional care. The proportion of frail and elderly patients increased over time and these patient groups were at higher risk of adverse postoperative outcomes. Particular attention is required in the decision for surgery and perioperative management of these patients.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: kbuth@dal.ca.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Buth
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Gainer
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Legare
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Hirsch
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000639:trends*; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009674:Nova Scotia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D017678:Sex Distribution; D013531:Surgicenters / Q000639:trends*; D015996:Survival Rate / Q000639:trends