Death in low-risk cardiac surgery: Stockholm experience

Abstract

In cardiac surgery, perioperative death in low-risk patients is uncommon, but does occur. Reports on the incidence, cause and circumstances of death in this population are rare. We analyzed the early mortality and cause of death in patients with an additive EuroSCORE≤3 who underwent cardiac surgery between 2001 and August 2009 in Stockholm. We also investigated if death could be considered preventable, and in that case, if it was due to a technical or a system error. Among 3924 low-risk patients, 15 died within 30 days of surgery, and early mortality was 0.38%. Cause of death was mostly cardiac related (11 of 15). Death occurred after hospital discharge in three patients, and was classified as non-preventable in 13 patients. In the remaining two patients, the circumstances leading to death were categorized as due to a system error. A systematic and structured analysis of the circumstances resulting in death in low-risk patients, in addition to traditional morbidity and mortality conferences, have the potential to identify problems and offer improvements in the quality of care.

Analysis of mortality in low-risk patients undergoing coronary artery bypass grafting : cardiovascular topic

“…Although the reasons for mortality have been extensively studied in high-risk patients,8,9 only a few reports have analysed the reasons for and possible preventive strategies of mortality in low-risk patients undergoing coronary artery bypass grafting (CABG) 10,11. Drawing on the FIASCO study,10 we reviewed the mortality in our own low-risk CABG patient population in order to identify whether death could be considered preventable, and if so, whether it was due to a technical or system error.…”

A new heart surgery clinic: Open Heart Surgery Outcomes at Karabuk Training and Research Hospital: Assessment of the first year

“…In the literature, rates of early mortality within 30 days vary from 1.1% to 9% in heart surgery [11][12][13][14]. Factors increasing the rate of early morbidity and mortality include severe left ventricular dysfunction, previous MI, serious ischemic mitral regurgitation, renal failure and chronic pulmonary disease.…”

Mortality in low- and very low-risk patients undergoing cardiac surgery: Evaluation according to the EuroSCORE II as a new standard

“…Perioperative death in low-risk patients is uncommon and had not been thoroughly studied until recently [3][4][5][6][7]. Previous studies defined low--risk with a logistic EuroSCORE ≤ 2 or an additive EuroSCORE ≤ 3, and investigated whether death could be considered preventable due to a technical or system error.…”

“…Although the observed in-hospital mortality in very low-risk patients was 0.93%, the expected risk based on the EuroSCORE II was even lower (0.70), and this difference could reach statistical significance in a larger sample. Table 3 summarizes the findings of different studies analyzing death in low-risk patients and virtually 3 of them (from United Kingdom [3,4] and Sweden [5]) showed mortality rates well below 1%. The remaining 2 studies from Turkey reported similar results to ours, though they only included coronary artery bypass grafting that has a well-known lower risk of operative mortality than other types of open heart surgery [6,7].…”

“…To date, only a few reports have analyzed the outcomes in low-risk patients, and in every case risk has been calculated based on a logistic Euro-SCORE ≤ 2 [3][4][5][6][7]. Since this original EuroSCORE overestimates operative risk [8], we developed this study to prospectively evaluate the immediate results of cardiac surgery in patients with an expected mortality risk ≤ 2% according to the EuroSCORE II as a new gold-standard.…”