Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients
Identifieur interne : 001780 ( Istex/Corpus ); précédent : 001779; suivant : 001781Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients
Auteurs : A. Vogt ; E. Grube ; H. G Glunz ; K. E Hauptmann ; U. Sechtem ; W. Ma Urer ; U. Tebbe ; K. W Heinrich ; H.-J Engel ; W. Kettner ; W. Krawietz ; K.-L NeuhausSource :
- European Heart Journal [ 0195-668X ] ; 2000-01-01.
English descriptors
Abstract
Background Mortality from cardiac surgery is an essential indicator of quality and forms the basis of treatment strategy decisions in eligible patients. No contemporary complete data on unselected adult cardiac surgery patients are available in Germany. Methods and Results A registry was started in June 1997 of all patients referred to surgery from 85 cardiology centres in Germany. The registry was intended to include 10000 patients and this number was reached in March 1998. Follow-up of the patients was by simple questionnaire, reporting the date of surgery, major complications, and symptomatic improvement. If the questionnaire was not returned, a reminder letter was sent and, if necessary, further telephone investigations were performed. This resulted in 99·9% complete data. Of 10525 patients operated on, 3·91% had died by 30 days after surgery. The overall operative mortality was 4·57%, which included 69 patients who died after more than 30 days from complications related to surgery. By multivariate analysis, the following predictors of mortality were identified: previous surgery, emergency or complex operation; age >75 years, female gender, cardiac failure, angina CCS class IV, and three-vessel coronary disease. An integral part of the registry was a pre-operative prediction of surgical risk in five categories. This risk estimate revealed a surprisingly correct prediction of the mortality observed. Conclusions In a representative unselected group of cardiac surgery patients, operative mortality was 4·57%. Several procedural and clinical parameters were significantly correlated with mortality, but the risk increment by each of these factors was small. Unstructured clinical judgement reliably predicted the operative risk.
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DOI: 10.1053/euhj.1999.1634
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients</title><author><name sortKey="Vogt, A" sort="Vogt, A" uniqKey="Vogt A" first="A" last="Vogt">A. Vogt</name><affiliation><mods:affiliation>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</mods:affiliation></affiliation></author><author><name sortKey="Grube, E" sort="Grube, E" uniqKey="Grube E" first="E" last="Grube">E. Grube</name><affiliation><mods:affiliation>Krankenhaus Siegburg GmbH, Medizinische Klinik, Siegburg</mods:affiliation></affiliation></author><author><name sortKey="Glunz, H G" sort="Glunz, H G" uniqKey="Glunz H" first="H. G" last="Glunz">H. G Glunz</name><affiliation><mods:affiliation>Klinikum Westpfalz, Kaiserslautern</mods:affiliation></affiliation></author><author><name sortKey="Hauptmann, K E" sort="Hauptmann, K E" uniqKey="Hauptmann K" first="K. E" last="Hauptmann">K. E Hauptmann</name><affiliation><mods:affiliation>Krankenhaus der Barmherzigen Brüder, Trier</mods:affiliation></affiliation></author><author><name sortKey="Sechtem, U" sort="Sechtem, U" uniqKey="Sechtem U" first="U" last="Sechtem">U. Sechtem</name><affiliation><mods:affiliation>Robert-Bosch-Krankenhaus, Stuttgart</mods:affiliation></affiliation></author><author><name sortKey="Ma Urer, W" sort="Ma Urer, W" uniqKey="Ma Urer W" first="W" last="Ma Urer">W. Ma Urer</name><affiliation><mods:affiliation>Klinikum Bayreuth, Bayreuth</mods:affiliation></affiliation></author><author><name sortKey="Tebbe, U" sort="Tebbe, U" uniqKey="Tebbe U" first="U" last="Tebbe">U. Tebbe</name><affiliation><mods:affiliation>Medizinische Klinik II, Klinikum Lippe-Detmold, Detmold</mods:affiliation></affiliation></author><author><name sortKey="Heinrich, K W" sort="Heinrich, K W" uniqKey="Heinrich K" first="K. W" last="Heinrich">K. W Heinrich</name><affiliation><mods:affiliation>Herzzentrum KWK, Duisburg</mods:affiliation></affiliation></author><author><name sortKey="Engel, H J" sort="Engel, H J" uniqKey="Engel H" first="H.-J" last="Engel">H.-J Engel</name><affiliation><mods:affiliation>Zentral-Krankenhaus Links der Weser, Bremen</mods:affiliation></affiliation></author><author><name sortKey="Kettner, W" sort="Kettner, W" uniqKey="Kettner W" first="W" last="Kettner">W. Kettner</name><affiliation><mods:affiliation>Klinik für Inner Medizin, Krankenhaus Altstadt, Magdeburg</mods:affiliation></affiliation></author><author><name sortKey="Krawietz, W" sort="Krawietz, W" uniqKey="Krawietz W" first="W" last="Krawietz">W. Krawietz</name><affiliation><mods:affiliation>Medizinische Klinik I, Klinikum Rosenheim, Rosenheim, Germany</mods:affiliation></affiliation></author><author><name sortKey="Neuhaus, K L" sort="Neuhaus, K L" uniqKey="Neuhaus K" first="K.-L" last="Neuhaus">K.-L Neuhaus</name><affiliation><mods:affiliation>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:518228A7E04A2BF981EBC4B280FE117823755E1E</idno><date when="2000" year="2000">2000</date><idno type="doi">10.1053/euhj.1999.1634</idno><idno type="url">https://api.istex.fr/document/518228A7E04A2BF981EBC4B280FE117823755E1E/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001780</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001780</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients</title><author><name sortKey="Vogt, A" sort="Vogt, A" uniqKey="Vogt A" first="A" last="Vogt">A. Vogt</name><affiliation><mods:affiliation>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</mods:affiliation></affiliation></author><author><name sortKey="Grube, E" sort="Grube, E" uniqKey="Grube E" first="E" last="Grube">E. Grube</name><affiliation><mods:affiliation>Krankenhaus Siegburg GmbH, Medizinische Klinik, Siegburg</mods:affiliation></affiliation></author><author><name sortKey="Glunz, H G" sort="Glunz, H G" uniqKey="Glunz H" first="H. G" last="Glunz">H. G Glunz</name><affiliation><mods:affiliation>Klinikum Westpfalz, Kaiserslautern</mods:affiliation></affiliation></author><author><name sortKey="Hauptmann, K E" sort="Hauptmann, K E" uniqKey="Hauptmann K" first="K. E" last="Hauptmann">K. E Hauptmann</name><affiliation><mods:affiliation>Krankenhaus der Barmherzigen Brüder, Trier</mods:affiliation></affiliation></author><author><name sortKey="Sechtem, U" sort="Sechtem, U" uniqKey="Sechtem U" first="U" last="Sechtem">U. Sechtem</name><affiliation><mods:affiliation>Robert-Bosch-Krankenhaus, Stuttgart</mods:affiliation></affiliation></author><author><name sortKey="Ma Urer, W" sort="Ma Urer, W" uniqKey="Ma Urer W" first="W" last="Ma Urer">W. Ma Urer</name><affiliation><mods:affiliation>Klinikum Bayreuth, Bayreuth</mods:affiliation></affiliation></author><author><name sortKey="Tebbe, U" sort="Tebbe, U" uniqKey="Tebbe U" first="U" last="Tebbe">U. Tebbe</name><affiliation><mods:affiliation>Medizinische Klinik II, Klinikum Lippe-Detmold, Detmold</mods:affiliation></affiliation></author><author><name sortKey="Heinrich, K W" sort="Heinrich, K W" uniqKey="Heinrich K" first="K. W" last="Heinrich">K. W Heinrich</name><affiliation><mods:affiliation>Herzzentrum KWK, Duisburg</mods:affiliation></affiliation></author><author><name sortKey="Engel, H J" sort="Engel, H J" uniqKey="Engel H" first="H.-J" last="Engel">H.-J Engel</name><affiliation><mods:affiliation>Zentral-Krankenhaus Links der Weser, Bremen</mods:affiliation></affiliation></author><author><name sortKey="Kettner, W" sort="Kettner, W" uniqKey="Kettner W" first="W" last="Kettner">W. Kettner</name><affiliation><mods:affiliation>Klinik für Inner Medizin, Krankenhaus Altstadt, Magdeburg</mods:affiliation></affiliation></author><author><name sortKey="Krawietz, W" sort="Krawietz, W" uniqKey="Krawietz W" first="W" last="Krawietz">W. Krawietz</name><affiliation><mods:affiliation>Medizinische Klinik I, Klinikum Rosenheim, Rosenheim, Germany</mods:affiliation></affiliation></author><author><name sortKey="Neuhaus, K L" sort="Neuhaus, K L" uniqKey="Neuhaus K" first="K.-L" last="Neuhaus">K.-L Neuhaus</name><affiliation><mods:affiliation>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><title level="j" type="abbrev">Eur Heart J</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2000-01-01">2000-01-01</date><biblScope unit="volume">21</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="28">28</biblScope><biblScope unit="page" to="32">32</biblScope></imprint><idno type="ISSN">0195-668X</idno></series><idno type="istex">518228A7E04A2BF981EBC4B280FE117823755E1E</idno><idno type="DOI">10.1053/euhj.1999.1634</idno><idno type="local">0.99916342.28</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cardiac surgery, bypass surgery, mortality, quality control.</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Mortality from cardiac surgery is an essential indicator of quality and forms the basis of treatment strategy decisions in eligible patients. No contemporary complete data on unselected adult cardiac surgery patients are available in Germany. Methods and Results A registry was started in June 1997 of all patients referred to surgery from 85 cardiology centres in Germany. The registry was intended to include 10000 patients and this number was reached in March 1998. Follow-up of the patients was by simple questionnaire, reporting the date of surgery, major complications, and symptomatic improvement. If the questionnaire was not returned, a reminder letter was sent and, if necessary, further telephone investigations were performed. This resulted in 99·9% complete data. Of 10525 patients operated on, 3·91% had died by 30 days after surgery. The overall operative mortality was 4·57%, which included 69 patients who died after more than 30 days from complications related to surgery. By multivariate analysis, the following predictors of mortality were identified: previous surgery, emergency or complex operation; age >75 years, female gender, cardiac failure, angina CCS class IV, and three-vessel coronary disease. An integral part of the registry was a pre-operative prediction of surgical risk in five categories. This risk estimate revealed a surprisingly correct prediction of the mortality observed. Conclusions In a representative unselected group of cardiac surgery patients, operative mortality was 4·57%. Several procedural and clinical parameters were significantly correlated with mortality, but the risk increment by each of these factors was small. Unstructured clinical judgement reliably predicted the operative risk.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>A Vogt</name><affiliations><json:string>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</json:string></affiliations></json:item><json:item><name>E Grube</name><affiliations><json:string>Krankenhaus Siegburg GmbH, Medizinische Klinik, Siegburg</json:string></affiliations></json:item><json:item><name>H.G Glunz</name><affiliations><json:string>Klinikum Westpfalz, Kaiserslautern</json:string></affiliations></json:item><json:item><name>K.E Hauptmann</name><affiliations><json:string>Krankenhaus der Barmherzigen Brüder, Trier</json:string></affiliations></json:item><json:item><name>U Sechtem</name><affiliations><json:string>Robert-Bosch-Krankenhaus, Stuttgart</json:string></affiliations></json:item><json:item><name>W Mäurer</name><affiliations><json:string>Klinikum Bayreuth, Bayreuth</json:string></affiliations></json:item><json:item><name>U Tebbe</name><affiliations><json:string>Medizinische Klinik II, Klinikum Lippe-Detmold, Detmold</json:string></affiliations></json:item><json:item><name>K.W Heinrich</name><affiliations><json:string>Herzzentrum KWK, Duisburg</json:string></affiliations></json:item><json:item><name>H.-J Engel</name><affiliations><json:string>Zentral-Krankenhaus Links der Weser, Bremen</json:string></affiliations></json:item><json:item><name>W Kettner</name><affiliations><json:string>Klinik für Inner Medizin, Krankenhaus Altstadt, Magdeburg</json:string></affiliations></json:item><json:item><name>W Krawietz</name><affiliations><json:string>Medizinische Klinik I, Klinikum Rosenheim, Rosenheim, Germany</json:string></affiliations></json:item><json:item><name>K.-L Neuhaus</name><affiliations><json:string>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Cardiac surgery, bypass surgery, mortality, quality control.</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>other</json:string></originalGenre><abstract>Background Mortality from cardiac surgery is an essential indicator of quality and forms the basis of treatment strategy decisions in eligible patients. No contemporary complete data on unselected adult cardiac surgery patients are available in Germany. Methods and Results A registry was started in June 1997 of all patients referred to surgery from 85 cardiology centres in Germany. The registry was intended to include 10000 patients and this number was reached in March 1998. Follow-up of the patients was by simple questionnaire, reporting the date of surgery, major complications, and symptomatic improvement. If the questionnaire was not returned, a reminder letter was sent and, if necessary, further telephone investigations were performed. This resulted in 99·9% complete data. Of 10525 patients operated on, 3·91% had died by 30 days after surgery. The overall operative mortality was 4·57%, which included 69 patients who died after more than 30 days from complications related to surgery. By multivariate analysis, the following predictors of mortality were identified: previous surgery, emergency or complex operation; age >75 years, female gender, cardiac failure, angina CCS class IV, and three-vessel coronary disease. An integral part of the registry was a pre-operative prediction of surgical risk in five categories. This risk estimate revealed a surprisingly correct prediction of the mortality observed. Conclusions In a representative unselected group of cardiac surgery patients, operative mortality was 4·57%. Several procedural and clinical parameters were significantly correlated with mortality, but the risk increment by each of these factors was small. Unstructured clinical judgement reliably predicted the operative risk.</abstract><qualityIndicators><score>7.395</score><pdfVersion>1.2</pdfVersion><pdfPageSize>595 x 842 pts (A4)</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>1</keywordCount><abstractCharCount>1753</abstractCharCount><pdfWordCount>2395</pdfWordCount><pdfCharCount>15874</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>254</abstractWordCount></qualityIndicators><title>Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients</title><refBibs><json:item><author><json:item><name>Aj Hartz</name></json:item><json:item><name>Em Kuhn</name></json:item><json:item><name>Db Pryor</name></json:item></author><host><volume>70</volume><pages><last>85</last><first>179</first></pages><author></author><title>Am J Cardiol</title><publicationDate>1992</publicationDate></host><title>Mortality after coronary angioplasty and coronary artery bypass surgery (the national medicare experience)</title><publicationDate>1992</publicationDate></json:item><json:item><author><json:item><name>B Bridgewater</name></json:item><json:item><name>H Neve</name></json:item><json:item><name>N Moat</name></json:item><json:item><name>T Hooper</name></json:item><json:item><name>M Jones</name></json:item></author><host><volume>79</volume><pages><last>5</last><first>350</first></pages><author></author><title>Heart</title><publicationDate>1998</publicationDate></host><title>Predicting operative risk for coronary artery surgery in the United Kingdom: a comparison of various risk prediction algorithms</title><publicationDate>1998</publicationDate></json:item><json:item><author><json:item><name>S Yusuf</name></json:item><json:item><name>D Zucker</name></json:item><json:item><name>P Peduzzi</name></json:item></author><host><volume>344</volume><pages><last>70</last><first>563</first></pages><author></author><title>Lancet</title><publicationDate>1994</publicationDate></host><title>Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the coronary artery bypass graft surgery trialists collaboration</title><publicationDate>1994</publicationDate></json:item><json:item><author><json:item><name>Sj Pocock</name></json:item><json:item><name>Ra Henderson</name></json:item><json:item><name>Af Rickards</name></json:item></author><host><volume>346</volume><pages><last>9</last><first>1184</first></pages><author></author><title>Lancet</title><publicationDate>1995</publicationDate></host><title>Meta-analysis of randomised trials comparing coronary angioplasty with bypass surgery</title><publicationDate>1995</publicationDate></json:item><json:item><author><json:item><name>E Wilde</name></json:item><json:item><name>K Christof</name></json:item><json:item><name>E Struck</name></json:item></author><host><volume>36</volume><pages><last>9</last><first>174</first></pages><author></author><title>Thorac Cardiovasc Surg</title><publicationDate>1988</publicationDate></host><title>Pilot study on quality assurance in cardiac surgery</title><publicationDate>1988</publicationDate></json:item><json:item><author><json:item><name>E Struck</name></json:item><json:item><name>De Vivie</name></json:item><json:item><name>Er Hehrlein</name></json:item><json:item><name>F </name></json:item></author><host><volume>38</volume><pages><last>34</last><first>123</first></pages><author></author><title>Thorac Cardiovasc Surg</title><publicationDate>1990</publicationDate></host><title>Multicentric quality assurance in cardiac surgery. QUADRA Study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: Quality Data Retrospective Analysis)</title><publicationDate>1990</publicationDate></json:item><json:item><author><json:item><name>P Kalmar</name></json:item><json:item><name>E Irrgang</name></json:item></author><host><volume>46</volume><pages><last>10</last><first>307</first></pages><author></author><title>Thorac Cardiovasc Surg</title><publicationDate>1998</publicationDate></host><title>Cardiac surgery in Germany during 1997. A report by the German Society for Thoracic and Cardiovascular Surgery</title><publicationDate>1998</publicationDate></json:item></refBibs><genre><json:string>other</json:string></genre><host><volume>21</volume><publisherId><json:string>eurheartj</json:string></publisherId><pages><last>32</last><first>28</first></pages><issn><json:string>0195-668X</json:string></issn><issue>1</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1522-9645</json:string></eissn><title>European Heart Journal</title></host><categories><wos><json:string>science</json:string><json:string>cardiac & cardiovascular systems</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>cardiovascular system & 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Krankenhausärzte (ALKK) on 10525 Patients</title><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>The European Society of Cardiology</p></availability><date>2000</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients</title><author xml:id="author-1"><persName><forename type="first">A</forename><surname>Vogt</surname></persName><affiliation>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</affiliation></author><author xml:id="author-2"><persName><forename type="first">E</forename><surname>Grube</surname></persName><affiliation>Krankenhaus Siegburg GmbH, Medizinische Klinik, Siegburg</affiliation></author><author xml:id="author-3"><persName><forename type="first">H.G</forename><surname>Glunz</surname></persName><affiliation>Klinikum Westpfalz, Kaiserslautern</affiliation></author><author xml:id="author-4"><persName><forename type="first">K.E</forename><surname>Hauptmann</surname></persName><affiliation>Krankenhaus der Barmherzigen Brüder, Trier</affiliation></author><author xml:id="author-5"><persName><forename type="first">U</forename><surname>Sechtem</surname></persName><affiliation>Robert-Bosch-Krankenhaus, Stuttgart</affiliation></author><author xml:id="author-6"><persName><forename type="first">W</forename><surname>Mäurer</surname></persName><affiliation>Klinikum Bayreuth, Bayreuth</affiliation></author><author xml:id="author-7"><persName><forename type="first">U</forename><surname>Tebbe</surname></persName><affiliation>Medizinische Klinik II, Klinikum Lippe-Detmold, Detmold</affiliation></author><author xml:id="author-8"><persName><forename type="first">K.W</forename><surname>Heinrich</surname></persName><affiliation>Herzzentrum KWK, Duisburg</affiliation></author><author xml:id="author-9"><persName><forename type="first">H.-J</forename><surname>Engel</surname></persName><affiliation>Zentral-Krankenhaus Links der Weser, Bremen</affiliation></author><author xml:id="author-10"><persName><forename type="first">W</forename><surname>Kettner</surname></persName><affiliation>Klinik für Inner Medizin, Krankenhaus Altstadt, Magdeburg</affiliation></author><author xml:id="author-11"><persName><forename type="first">W</forename><surname>Krawietz</surname></persName><affiliation>Medizinische Klinik I, Klinikum Rosenheim, Rosenheim, Germany</affiliation></author><author xml:id="author-12"><persName><forename type="first">K.-L</forename><surname>Neuhaus</surname></persName><affiliation>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</affiliation></author></analytic><monogr><title level="j">European Heart Journal</title><title level="j" type="abbrev">Eur Heart J</title><idno type="pISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2000-01-01"></date><biblScope unit="volume">21</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="28">28</biblScope><biblScope unit="page" to="32">32</biblScope></imprint></monogr><idno type="istex">518228A7E04A2BF981EBC4B280FE117823755E1E</idno><idno type="DOI">10.1053/euhj.1999.1634</idno><idno type="local">0.99916342.28</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2000</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Background Mortality from cardiac surgery is an essential indicator of quality and forms the basis of treatment strategy decisions in eligible patients. No contemporary complete data on unselected adult cardiac surgery patients are available in Germany. Methods and Results A registry was started in June 1997 of all patients referred to surgery from 85 cardiology centres in Germany. The registry was intended to include 10000 patients and this number was reached in March 1998. Follow-up of the patients was by simple questionnaire, reporting the date of surgery, major complications, and symptomatic improvement. If the questionnaire was not returned, a reminder letter was sent and, if necessary, further telephone investigations were performed. This resulted in 99·9% complete data. Of 10525 patients operated on, 3·91% had died by 30 days after surgery. The overall operative mortality was 4·57%, which included 69 patients who died after more than 30 days from complications related to surgery. By multivariate analysis, the following predictors of mortality were identified: previous surgery, emergency or complex operation; age >75 years, female gender, cardiac failure, angina CCS class IV, and three-vessel coronary disease. An integral part of the registry was a pre-operative prediction of surgical risk in five categories. This risk estimate revealed a surprisingly correct prediction of the mortality observed. Conclusions In a representative unselected group of cardiac surgery patients, operative mortality was 4·57%. Several procedural and clinical parameters were significantly correlated with mortality, but the risk increment by each of these factors was small. Unstructured clinical judgement reliably predicted the operative risk.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>Cardiac surgery, bypass surgery, mortality, quality control.</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2000-01-01">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-12-22">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/518228A7E04A2BF981EBC4B280FE117823755E1E/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="other"><front><journal-meta><journal-id journal-id-type="hwp">ehj</journal-id><journal-id journal-id-type="nlm-ta">Eur Heart J</journal-id><journal-id journal-id-type="publisher-id">eurheartj</journal-id><journal-title>European Heart Journal</journal-title><abbrev-journal-title abbrev-type="publisher">Eur Heart J</abbrev-journal-title><issn pub-type="ppub">0195-668X</issn><issn pub-type="epub">1522-9645</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">0.99916342.28</article-id><article-id pub-id-type="doi">10.1053/euhj.1999.1634</article-id><title-group><article-title>Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Vogt</surname><given-names>A</given-names></name><xref rid="A1"><sup>a</sup></xref><xref rid="FN1"><sup>f1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Grube</surname><given-names>E</given-names></name><xref rid="A2"><sup>b</sup></xref></contrib><contrib contrib-type="author"><name><surname>Glunz</surname><given-names>H.G</given-names></name><xref rid="A3"><sup>c</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hauptmann</surname><given-names>K.E</given-names></name><xref rid="A4"><sup>d</sup></xref></contrib><contrib contrib-type="author"><name><surname>Sechtem</surname><given-names>U</given-names></name><xref rid="A5"><sup>e</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mäurer</surname><given-names>W</given-names></name><xref rid="A6"><sup>f</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tebbe</surname><given-names>U</given-names></name><xref rid="A7"><sup>g</sup></xref></contrib><contrib contrib-type="author"><name><surname>Heinrich</surname><given-names>K.W</given-names></name><xref rid="A8"><sup>h</sup></xref></contrib><contrib contrib-type="author"><name><surname>Engel</surname><given-names>H.-J</given-names></name><xref rid="A9"><sup>i</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kettner</surname><given-names>W</given-names></name><xref rid="A10"><sup>j</sup></xref></contrib><contrib contrib-type="author"><name><surname>Krawietz</surname><given-names>W</given-names></name><xref rid="A11"><sup>k</sup></xref></contrib><contrib contrib-type="author"><name><surname>Neuhaus</surname><given-names>K.-L</given-names></name><xref rid="A1"><sup>a</sup></xref></contrib><aff id="A1"><label>a</label>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</aff><aff id="A2"><label>b</label>Krankenhaus Siegburg GmbH, Medizinische Klinik, Siegburg</aff><aff id="A3"><label>c</label>Klinikum Westpfalz, Kaiserslautern</aff><aff id="A4"><label>d</label>Krankenhaus der Barmherzigen Brüder, Trier</aff><aff id="A5"><label>e</label>Robert-Bosch-Krankenhaus, Stuttgart</aff><aff id="A6"><label>f</label>Klinikum Bayreuth, Bayreuth</aff><aff id="A7"><label>g</label>Medizinische Klinik II, Klinikum Lippe-Detmold, Detmold</aff><aff id="A8"><label>h</label>Herzzentrum KWK, Duisburg</aff><aff id="A9"><label>i</label>Zentral-Krankenhaus Links der Weser, Bremen</aff><aff id="A10"><label>j</label>Klinik für Inner Medizin, Krankenhaus Altstadt, Magdeburg</aff><aff id="A11"><label>k</label>Medizinische Klinik I, Klinikum Rosenheim, Rosenheim, Germany</aff></contrib-group><pub-date pub-type="ppub"><day>01</day><month>1</month><year>2000</year></pub-date><volume>21</volume><issue>1</issue><fpage>28</fpage><lpage>32</lpage><history><date date-type="accepted"><day>26</day><month>3</month><year>1999</year></date><date date-type="rev-recd"><day>22</day><month>3</month><year>1999</year></date></history><permissions><copyright-statement>The European Society of Cardiology</copyright-statement><copyright-year>2000</copyright-year></permissions><abstract xml:lang="en"><p><bold>Background</bold> Mortality from cardiac surgery is an essential indicator of quality and forms the basis of treatment strategy decisions in eligible patients. No contemporary complete data on unselected adult cardiac surgery patients are available in Germany.</p><p><bold>Methods and Results</bold> A registry was started in June 1997 of all patients referred to surgery from 85 cardiology centres in Germany. The registry was intended to include 10000 patients and this number was reached in March 1998. Follow-up of the patients was by simple questionnaire, reporting the date of surgery, major complications, and symptomatic improvement. If the questionnaire was not returned, a reminder letter was sent and, if necessary, further telephone investigations were performed. This resulted in 99·9% complete data. Of 10525 patients operated on, 3·91% had died by 30 days after surgery. The overall operative mortality was 4·57%, which included 69 patients who died after more than 30 days from complications related to surgery. By multivariate analysis, the following predictors of mortality were identified: previous surgery, emergency or complex operation; age >75 years, female gender, cardiac failure, angina CCS class IV, and three-vessel coronary disease. An integral part of the registry was a pre-operative prediction of surgical risk in five categories. This risk estimate revealed a surprisingly correct prediction of the mortality observed.</p><p><bold>Conclusions</bold> In a representative unselected group of cardiac surgery patients, operative mortality was 4·57%. Several procedural and clinical parameters were significantly correlated with mortality, but the risk increment by each of these factors was small. Unstructured clinical judgement reliably predicted the operative risk.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>Cardiac surgery, bypass surgery, mortality, quality control.</kwd></kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>28</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>Regular Article</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Determinants of mortality after cardiac surgery: results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10525 Patients</title></titleInfo><name type="personal"><namePart type="given">A</namePart><namePart type="family">Vogt</namePart><affiliation>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">E</namePart><namePart type="family">Grube</namePart><affiliation>Krankenhaus Siegburg GmbH, Medizinische Klinik, Siegburg</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H.G</namePart><namePart type="family">Glunz</namePart><affiliation>Klinikum Westpfalz, Kaiserslautern</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K.E</namePart><namePart type="family">Hauptmann</namePart><affiliation>Krankenhaus der Barmherzigen Brüder, Trier</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">U</namePart><namePart type="family">Sechtem</namePart><affiliation>Robert-Bosch-Krankenhaus, Stuttgart</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">W</namePart><namePart type="family">Mäurer</namePart><affiliation>Klinikum Bayreuth, Bayreuth</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">U</namePart><namePart type="family">Tebbe</namePart><affiliation>Medizinische Klinik II, Klinikum Lippe-Detmold, Detmold</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K.W</namePart><namePart type="family">Heinrich</namePart><affiliation>Herzzentrum KWK, Duisburg</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">H.-J</namePart><namePart type="family">Engel</namePart><affiliation>Zentral-Krankenhaus Links der Weser, Bremen</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">W</namePart><namePart type="family">Kettner</namePart><affiliation>Klinik für Inner Medizin, Krankenhaus Altstadt, Magdeburg</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">W</namePart><namePart type="family">Krawietz</namePart><affiliation>Medizinische Klinik I, Klinikum Rosenheim, Rosenheim, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">K.-L</namePart><namePart type="family">Neuhaus</namePart><affiliation>Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="other" displayLabel="other"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2000-01-01</dateIssued><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Background Mortality from cardiac surgery is an essential indicator of quality and forms the basis of treatment strategy decisions in eligible patients. No contemporary complete data on unselected adult cardiac surgery patients are available in Germany. Methods and Results A registry was started in June 1997 of all patients referred to surgery from 85 cardiology centres in Germany. The registry was intended to include 10000 patients and this number was reached in March 1998. Follow-up of the patients was by simple questionnaire, reporting the date of surgery, major complications, and symptomatic improvement. If the questionnaire was not returned, a reminder letter was sent and, if necessary, further telephone investigations were performed. This resulted in 99·9% complete data. Of 10525 patients operated on, 3·91% had died by 30 days after surgery. The overall operative mortality was 4·57%, which included 69 patients who died after more than 30 days from complications related to surgery. By multivariate analysis, the following predictors of mortality were identified: previous surgery, emergency or complex operation; age >75 years, female gender, cardiac failure, angina CCS class IV, and three-vessel coronary disease. An integral part of the registry was a pre-operative prediction of surgical risk in five categories. This risk estimate revealed a surprisingly correct prediction of the mortality observed. Conclusions In a representative unselected group of cardiac surgery patients, operative mortality was 4·57%. Several procedural and clinical parameters were significantly correlated with mortality, but the risk increment by each of these factors was small. Unstructured clinical judgement reliably predicted the operative risk.</abstract><subject lang="en"><genre>KWD</genre><topic>Cardiac surgery, bypass surgery, mortality, quality control.</topic></subject><relatedItem type="host"><titleInfo><title>European Heart Journal</title></titleInfo><titleInfo type="abbreviated"><title>Eur Heart J</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0195-668X</identifier><identifier type="eISSN">1522-9645</identifier><identifier type="PublisherID">eurheartj</identifier><identifier type="PublisherID-hwp">ehj</identifier><identifier type="PublisherID-nlm-ta">Eur Heart J</identifier><part><date>2000</date><detail type="volume"><caption>vol.</caption><number>21</number></detail><detail type="issue"><caption>no.</caption><number>1</number></detail><extent unit="pages"><start>28</start><end>32</end></extent></part></relatedItem><identifier type="istex">518228A7E04A2BF981EBC4B280FE117823755E1E</identifier><identifier type="DOI">10.1053/euhj.1999.1634</identifier><identifier type="local">0.99916342.28</identifier><accessCondition type="use and reproduction" contentType="copyright">The European Society of Cardiology</accessCondition><recordInfo><recordContentSource>OUP</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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