Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery. The Working Group Panel on the Cooperative CABG Database Project

Duke University Medical Center, Durham, North Carolina 27710, USA.

OBJECTIVES: The purpose of this consensus effort was to define and prioritize the importance of a set of clinical variables useful for monitoring and improving the short-term mortality of patients undergoing coronary artery bypass graft surgery (CABG). BACKGROUND: Despite widespread use of data bases to monitor the outcome of patients undergoing CABG, no consistent set of clinical variables has been defined for risk adjustment of observed outcomes for baseline differences in disease severity among patients. METHODS: Experts with a background in epidemiology, biostatistics and clinical care with an interest in assessing outcomes of CABG derived from previous work with professional societies, government or academic institutions volunteered to participate in this unsponsored consensus process. Two meetings of this ad hoc working group were required to define and prioritize clinical variables into core, level 1 or level 2 groupings to reflect their importance for relating to short-term mortality after CABG. Definitions of these 44 variables were simple and specific to enhance objectivity of the 7 core, 13 level 1 and 24 level 2 variables. Core and level 1 variables were evaluated using data from five existing data bases, and core variables only were examined in an additional two data bases to confirm the consensus opinion of the relative prognostic power of each variable. RESULTS: Multivariable logistic regression models of the seven core variables showed all to be predictive of bypass surgery mortality in some of the seven existing data sets. Variables relating to acuteness, age and previous operation proved to be the most important in all data sets tested. Variables describing coronary anatomy appeared to be least significant. Models including both the 7 core and 13 level 1 variables in five of the seven data sets showed the core variables to reflect 45% to 83% of the predictive information. However, some level 1 variables were stronger than some core variables in some data sets. CONCLUSIONS: A relatively small number of clinical variables provide a large amount of prognostic information in patients undergoing CABG.

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				N. Sadeghi, S. Sadeghi, Z. A. Mood, and A. Karimi Determinants of operative mortality following primary coronary artery bypass surgery Eur J Cardiothorac Surg, February 1, 2002; 21(2): 187 - 192. [Abstract] [Full Text] [PDF]

				J. S. Rumsfeld, D. J. Magid, M. O'Brien, M. McCarthy Jr, S. MaWhinney, A. L. W. Shroyer, T. E. Moritz, W. G. Henderson, G. K. Sethi, F. L. Grover, et al. Changes in health-related quality of life following coronary artery bypass graft surgery Ann. Thorac. Surg., December 1, 2001; 72(6): 2026 - 2032. [Abstract] [Full Text] [PDF]

				S. C. Gardner, G. K. Grunwald, J. S. Rumsfeld, T. Mackenzie, D. Gao, J. B. Perlin, G. McDonald, and A. L. W. Shroyer Risk factors for intermediate-term survival after coronary artery bypass grafting Ann. Thorac. Surg., December 1, 2001; 72(6): 2033 - 2037. [Abstract] [Full Text] [PDF]

				D. M. Shahian, S.-L. Normand, D. F. Torchiana, S. M. Lewis, J. O. Pastore, R. E. Kuntz, and P. I. Dreyer Cardiac surgery report cards: comprehensive review and statistical critique Ann. Thorac. Surg., December 1, 2001; 72(6): 2155 - 2168. [Abstract] [Full Text] [PDF]

				F. Hernandez, W. E. Cohn, Y. R. Baribeau, J. F. Tryzelaar, D. C. Charlesworth, R. A. Clough, J. D. Klemperer, J. R. Morton, B. M. Westbrook, E. M. Olmstead, et al. In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multicenter experience Ann. Thorac. Surg., November 1, 2001; 72(5): 1528 - 1534. [Abstract] [Full Text] [PDF]

				N. W. Niles, P. D. McGrath, D. Malenka, H. Quinton, D. Wennberg, S. J. Shubrooks, J. F. Tryzelaar, R. Clough, M. J. Hearne, F. Hernandez Jr, et al. Survival of patients with diabetes and multivessel coronary artery disease after surgical or percutaneous coronary revascularization: results of a large regional prospective study J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1008 - 1015. [Abstract] [Full Text] [PDF]

				B. J. Harlan Statewide reporting of coronary artery surgery results: A view from California J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 409 - 417. [Full Text] [PDF]

				D. J. O'Rourke, D. J. Malenka, E. M. Olmstead, H. B. Quinton, J. H. Sanders Jr, S. J. Lahey, M. Norotsky, R. D. Quinn, Y. R. Baribeau, F. Hernandez Jr, et al. Improved in-hospital mortality in women undergoing coronary artery bypass grafting Ann. Thorac. Surg., February 1, 2001; 71(2): 507 - 511. [Abstract] [Full Text] [PDF]

				G. J. Avery II, S. J. Ley, J. D. Hill, J. J. Hershon, and S. E. Dick Cardiac surgery in the octogenarian: evaluation of risk, cost, and outcome Ann. Thorac. Surg., February 1, 2001; 71(2): 591 - 596. [Abstract] [Full Text] [PDF]

				A. Rodriguez, V. Bernardi, J. Navia, J. Baldi, L. Grinfeld, J. Martinez, D. Vogel, R. Grinfeld, A. Delacasa, M. Garrido, et al. Argentine randomized study: coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple-vessel disease (ERACI II): 30-day and one-year follow-up results J. Am. Coll. Cardiol., January 1, 2001; 37(1): 51 - 58. [Abstract] [Full Text] [PDF]

				J. Y. Liu, N. J. O. Birkmeyer, J. H. Sanders, J. R. Morton, H. F. Henriques, S. J. Lahey, R. W. Dow, C. Maloney, A. W. DiScipio, R. Clough, et al. Risks of Morbidity and Mortality in Dialysis Patients Undergoing Coronary Artery Bypass Surgery Circulation, December 12, 2000; 102(24): 2973 - 2977. [Abstract] [Full Text] [PDF]

				D. Abramov, M. G. Tamariz, J. Y. Sever, G. T. Christakis, G. Bhatnagar, A. L. Heenan, B. S. Goldman, and S. E. Fremes The influence of gender on the outcome of coronary artery bypass surgery Ann. Thorac. Surg., September 1, 2000; 70(3): 800 - 805. [Abstract] [Full Text] [PDF]