Coronary Artery Bypass Graft Surgery
VARIABLES USED TO ADJUST FOR
Peripheral vascular disease(PVD): PVD a)
cerebrovascular disease: prior CVA, prior TIA, prior carotid surgery,
carotid stenosis by history or radiographic studies, or carotid bruit;
as b) lower extremity (LE) disease: claudication, amputation, prior lower
extremity bypass, absent pedal pulses or lower extremity ulcers.
Diabetes: Documented in medical record or patient history.
Diabetes with no sequelae: Diabetes without sequelae described as follows.
Diabetes with sequelae: Diabetes with renal disease, retinopathy, peripheral
neuropathy, gastroparesis, or peripheral circulatory disease.
Renal failure prior to surgery: On peritoneal or hemo-dialysis.
Pre-op creatinine: Last pre-operative creatinine measurement
taken before procedure. Documented in medical record or patient history.
Chronic obstructive pulmonary disease: COPD, or asthma
requiring inhalers, theophyllines/aminophyllines, or steroids.
White blood cell (WBC): Last pre-operative measurement
of WBC taken before procedure.
Priority at Surgery: Emergent: Medical
factors relating to the patient's cardiac disease dictate that surgery
should be performed within hours to avoid unnecessary morbidity or death.
Examples: failed PTCA with acute coronary insufficiency and/or hemodynamic
instability, similar situation in absence of PTCA. This case should take
precedence in time over an elective case, open a new room, or be done
at night, if necessary. Urgent: Medical factors
require patient to stay in hospital to have operation before discharge.
The risk of immediate morbidity and death are not present. Examples: threatening
pathologic anatomy such as high grade Left Main Coronary Disease, particularly
with moderately severe symptoms or history of life threatening arrhythmia
(VF) related to ischemia. May have intra-aortic balloon pump (IABP) or
intravenous (IV) nitroglycerin (NTG) as part of treatment program. This
case might be done in the next available surgical slot but would not necessarily
take precedence over an elective case and could possibly wait for several
days. Non-urgent: Medical factors indicate the
need for operation but the clinical picture allows discharge from the
hospital with readmission at a later date for more elective surgery. Little
risk of incurring morbidity or death outside of the hospital with good
medical management and restricted physical activities.
Preoperative ejection fraction: Most recent prior to
CABG, including during the current hospitalization.
Recent MI (≤7 days): The development of a) new
Q waves on EKG, or b) new ST-T changes with a significant rise (defined
locally) in CPK with positive (defined locally) isoenzymes.
Left main artery stenosis: If a range is specified on
angiography report give an integer midpoint of the range.
Mortality: Death during index hospitalization.
Cerebrovascular Accident:Diagnosis documented
by MD and defined by the following: new focal neurological deficit which
appears and is still at least partially evident more than 24 hours after
its onset, occurring during or following the CABG procedure and established
prior to discharge.
Return or Operating Room for Bleeding: Performance
of a median sternotomy to assess bleeding after initial departure from
Mediastinitis/sternal Dehiscence: Mediastinitis [two
of the following with no other recognized cause: (a) Organisms and
blood cells seen on gram stain aspirated fluid; (b) Positive deep
culture; (c) Radiographic evidence of infection] or sternal dehiscence
Post-operative Renal Failure or Insufficiency: A
new peritoneal or hemo-dialysis that occurred after the procedure or
an increase in
serum creatinine to >2.0 and two times the most recent pre-operative
is used to calculate the predicted risk of mortality associated
procedure for each patient in the registry. Using this risk information
from the model, a risk profile for the entire NNE region can be created.
Direct standardization (or adjustment) methods allow us to approximate
what the center outcome rates would be if all centers operated on
patients with the same risk profile as the entire region. This method
uses a center's actual mortality rates within categories of risk
but applies them to a standardized risk profile. In this way, institution
rates can be compared without the confounding effects of varying