Determinants of mortality after cardiac surgery : results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10 525 Patients
Identifieur interne : 000D06 ( PascalFrancis/Checkpoint ); précédent : 000D05; suivant : 000D07Determinants of mortality after cardiac surgery : results of the Registry of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK) on 10 525 Patients
Auteurs : A. Vogt [Allemagne] ; E. Grube [Allemagne] ; H. G. Glunz [Allemagne] ; K. E. Hauptmann [Allemagne] ; U. Sechtem [Allemagne] ; W. M Urer [Allemagne] ; U. Tebbe [Allemagne] ; K. W. Heinrich [Allemagne] ; H.-J. Engel [Allemagne] ; W. Kettner [Allemagne] ; W. Krawietz [Allemagne] ; K.-L. Neuhaus [Allemagne]Source :
- European heart journal [ 0195-668X ] ; 2000.
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- Pascal (Inist)
- Wicri :
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 10 000 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 10 525 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.
Affiliations:
- Allemagne
- Bade-Wurtemberg, Bavière, Brême (Land), District de Haute-Franconie, District de Kassel, District de Stuttgart, Hesse (Land), Rhénanie-Palatinat, Saxe-Anhalt
- Bayreuth, Brême, Cassel (Hesse), Kaiserslautern, Magdebourg, Stuttgart
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Pascal:00-0082974Le document en format XML
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<author><name sortKey="M Urer, W" sort="M Urer, W" uniqKey="M Urer W" first="W." last="M Urer">W. M Urer</name>
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<author><name sortKey="Engel, H J" sort="Engel, H J" uniqKey="Engel H" first="H.-J." last="Engel">H.-J. Engel</name>
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<author><name sortKey="Kettner, W" sort="Kettner, W" uniqKey="Kettner W" first="W." last="Kettner">W. Kettner</name>
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<author><name sortKey="Krawietz, W" sort="Krawietz, W" uniqKey="Krawietz W" first="W." last="Krawietz">W. Krawietz</name>
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<wicri:noRegion>Rosenheim</wicri:noRegion>
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<author><name sortKey="Neuhaus, K L" sort="Neuhaus, K L" uniqKey="Neuhaus K" first="K.-L." last="Neuhaus">K.-L. Neuhaus</name>
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<sZ>1 aut.</sZ>
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<series><title level="j" type="main">European heart journal</title>
<title level="j" type="abbreviated">Eur. heart j.</title>
<idno type="ISSN">0195-668X</idno>
<imprint><date when="2000">2000</date>
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<seriesStmt><title level="j" type="main">European heart journal</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Follow up study</term>
<term>Heart</term>
<term>Human</term>
<term>Mortality</term>
<term>Prognosis</term>
<term>Surgery</term>
<term>Treatment</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Chirurgie</term>
<term>Coeur</term>
<term>Etude longitudinale</term>
<term>Traitement</term>
<term>Pronostic</term>
<term>Mortalité</term>
<term>Homme</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term>
<term>Mortalité</term>
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<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 10 000 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 10 525 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>
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</fA14>
<fA14 i1="02"><s1>Krankenhaus Siegburg GmbH, Medizinische Klinik</s1>
<s2>Siegburg</s2>
<s3>DEU</s3>
<sZ>2 aut.</sZ>
</fA14>
<fA14 i1="03"><s1>Klinikum Westpfalz</s1>
<s2>Kaiserslautern</s2>
<s3>DEU</s3>
<sZ>3 aut.</sZ>
</fA14>
<fA14 i1="04"><s1>Krankenhaus der Barmherzigen Brüder</s1>
<s2>Trier</s2>
<s3>DEU</s3>
<sZ>4 aut.</sZ>
</fA14>
<fA14 i1="05"><s1>Robert-Bosch-Krankenhaus</s1>
<s2>Stuttgart</s2>
<s3>DEU</s3>
<sZ>5 aut.</sZ>
</fA14>
<fA14 i1="06"><s1>Klinikum Bayreuth</s1>
<s2>Bayreuth</s2>
<s3>DEU</s3>
<sZ>6 aut.</sZ>
</fA14>
<fA14 i1="07"><s1>Medizinische Klinik II, Klinikum Lippe-Detmold</s1>
<s2>Detmold</s2>
<s3>DEU</s3>
<sZ>7 aut.</sZ>
</fA14>
<fA14 i1="08"><s1>Herzzentrum KWK</s1>
<s2>Duisburg</s2>
<s3>DEU</s3>
<sZ>8 aut.</sZ>
</fA14>
<fA14 i1="09"><s1>Zentral-Krankenhaus Links der Weser</s1>
<s2>Bremen</s2>
<s3>DEU</s3>
<sZ>9 aut.</sZ>
</fA14>
<fA14 i1="10"><s1>Klinik für Inner Medizin, Krankenhaus Altstadt</s1>
<s2>Magdeburg</s2>
<s3>DEU</s3>
<sZ>10 aut.</sZ>
</fA14>
<fA14 i1="11"><s1>Medizinische Klinik I, Klinikum Rosenheim</s1>
<s2>Rosenheim</s2>
<s3>DEU</s3>
<sZ>11 aut.</sZ>
</fA14>
<fA17 i1="01" i2="1"><s1>Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK)</s1>
<s3>DEU</s3>
</fA17>
<fA20><s1>28-32</s1>
</fA20>
<fA21><s1>2000</s1>
</fA21>
<fA23 i1="01"><s0>ENG</s0>
</fA23>
<fA43 i1="01"><s1>INIST</s1>
<s2>18785</s2>
<s5>354000081531820080</s5>
</fA43>
<fA44><s0>0000</s0>
<s1>© 2000 INIST-CNRS. All rights reserved.</s1>
</fA44>
<fA45><s0>7 ref.</s0>
</fA45>
<fA47 i1="01" i2="1"><s0>00-0082974</s0>
</fA47>
<fA60><s1>P</s1>
</fA60>
<fA61><s0>A</s0>
</fA61>
<fA64 i1="01" i2="1"><s0>European heart journal</s0>
</fA64>
<fA66 i1="01"><s0>GBR</s0>
</fA66>
<fC01 i1="01" l="ENG"><s0>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 10 000 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 10 525 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.</s0>
</fC01>
<fC02 i1="01" i2="X"><s0>002B25E</s0>
</fC02>
<fC03 i1="01" i2="X" l="FRE"><s0>Chirurgie</s0>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="ENG"><s0>Surgery</s0>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="SPA"><s0>Cirugía</s0>
<s5>01</s5>
</fC03>
<fC03 i1="02" i2="X" l="FRE"><s0>Coeur</s0>
<s5>02</s5>
</fC03>
<fC03 i1="02" i2="X" l="ENG"><s0>Heart</s0>
<s5>02</s5>
</fC03>
<fC03 i1="02" i2="X" l="SPA"><s0>Corazón</s0>
<s5>02</s5>
</fC03>
<fC03 i1="03" i2="X" l="FRE"><s0>Etude longitudinale</s0>
<s5>16</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>Follow up study</s0>
<s5>16</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA"><s0>Estudio longitudinal</s0>
<s5>16</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Traitement</s0>
<s5>17</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Treatment</s0>
<s5>17</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Tratamiento</s0>
<s5>17</s5>
</fC03>
<fC03 i1="05" i2="X" l="FRE"><s0>Pronostic</s0>
<s5>18</s5>
</fC03>
<fC03 i1="05" i2="X" l="ENG"><s0>Prognosis</s0>
<s5>18</s5>
</fC03>
<fC03 i1="05" i2="X" l="SPA"><s0>Pronóstico</s0>
<s5>18</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE"><s0>Mortalité</s0>
<s5>19</s5>
</fC03>
<fC03 i1="06" i2="X" l="ENG"><s0>Mortality</s0>
<s5>19</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA"><s0>Mortalidad</s0>
<s5>19</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE"><s0>Homme</s0>
<s5>20</s5>
</fC03>
<fC03 i1="07" i2="X" l="ENG"><s0>Human</s0>
<s5>20</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA"><s0>Hombre</s0>
<s5>20</s5>
</fC03>
<fN21><s1>059</s1>
</fN21>
</pA>
</standard>
</inist>
<affiliations><list><country><li>Allemagne</li>
</country>
<region><li>Bade-Wurtemberg</li>
<li>Bavière</li>
<li>Brême (Land)</li>
<li>District de Haute-Franconie</li>
<li>District de Kassel</li>
<li>District de Stuttgart</li>
<li>Hesse (Land)</li>
<li>Rhénanie-Palatinat</li>
<li>Saxe-Anhalt</li>
</region>
<settlement><li>Bayreuth</li>
<li>Brême</li>
<li>Cassel (Hesse)</li>
<li>Kaiserslautern</li>
<li>Magdebourg</li>
<li>Stuttgart</li>
</settlement>
</list>
<tree><country name="Allemagne"><region name="Hesse (Land)"><name sortKey="Vogt, A" sort="Vogt, A" uniqKey="Vogt A" first="A." last="Vogt">A. Vogt</name>
</region>
<name sortKey="Engel, H J" sort="Engel, H J" uniqKey="Engel H" first="H.-J." last="Engel">H.-J. Engel</name>
<name sortKey="Glunz, H G" sort="Glunz, H G" uniqKey="Glunz H" first="H. G." last="Glunz">H. G. Glunz</name>
<name sortKey="Grube, E" sort="Grube, E" uniqKey="Grube E" first="E." last="Grube">E. Grube</name>
<name sortKey="Hauptmann, K E" sort="Hauptmann, K E" uniqKey="Hauptmann K" first="K. E." last="Hauptmann">K. E. Hauptmann</name>
<name sortKey="Heinrich, K W" sort="Heinrich, K W" uniqKey="Heinrich K" first="K. W." last="Heinrich">K. W. Heinrich</name>
<name sortKey="Kettner, W" sort="Kettner, W" uniqKey="Kettner W" first="W." last="Kettner">W. Kettner</name>
<name sortKey="Krawietz, W" sort="Krawietz, W" uniqKey="Krawietz W" first="W." last="Krawietz">W. Krawietz</name>
<name sortKey="M Urer, W" sort="M Urer, W" uniqKey="M Urer W" first="W." last="M Urer">W. M Urer</name>
<name sortKey="Neuhaus, K L" sort="Neuhaus, K L" uniqKey="Neuhaus K" first="K.-L." last="Neuhaus">K.-L. Neuhaus</name>
<name sortKey="Sechtem, U" sort="Sechtem, U" uniqKey="Sechtem U" first="U." last="Sechtem">U. Sechtem</name>
<name sortKey="Tebbe, U" sort="Tebbe, U" uniqKey="Tebbe U" first="U." last="Tebbe">U. Tebbe</name>
</country>
</tree>
</affiliations>
</record>
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