Mortality and complications of coronary artery bypass grafting in Rio de Janeiro, from 1999 to 2003.

BACKGROUND

Coronary artery bypass grafting (CABG) is a consolidated procedure for the treatment of ischemic heart diseases (IHDs), which requires continuous assessment.

OBJECTIVE

To assess the quality of CABG surgery by reviewing patients' clinical characteristics, mortality rates up to one year after hospital discharge, primary causes of death and postoperative complications, at four public hospitals in Rio de Janeiro from 1999 to 2003.

METHODS

CABG patient charts were randomly selected. A retrospective review was conducted to collect data on clinical characteristics, complications and deaths from patient medical charts and statements of death (SDs). Mortality rates were estimated for the hospitalization period and for up to one year after hospital discharge.

RESULTS

The prevalence of preoperative patient characteristics were: women: 31.9%; arterial hypertension: 90.7%; dyslipidemia: 67.4%; diabetes: 37.2%; current smoking status: 22.9%; obesity: 18.3%; chronic obstructive pulmonary disease: 8.2%; prior stroke: 5.8%; extracardiac artery disease: 12.7%; elevation of creatinine levels: 4.1%; critical preoperative status: 3.7%; recent acute myocardial infarction: 23.5%; unstable angina: 40.8%; acute coronary syndrome: 50.0%; prior CABG: 2.4%; left ventricular dysfunction: 27.3%; left main coronary artery lesion: 3.9%; and associated with lesion in another system: 19.8%. In-hospital mortality rates ranged from 7.0% to 14.3%, and up to one year after hospital discharge from 8.5% to 20.2%. Ischemic heart disease (IHD) accounted for more than 80% of the deaths, and the most frequent complications after surgery were hemorrhage or post-procedural low cardiac output. Sixty percent of the patients who died had five or more complications, whereas 40% of those who survived had none.

CONCLUSION

Mortality and complication rates were high. Even among those patients who survived, complications were more frequent than expected.