1019-25 A Comparison of Preoperative Risk Factors for Early and Late Hospital Death in Cardiac Surgeries

Abstract

Influence of preoperative risk factors on hospital mortality in cardiac surgeries has been investigated, but no one has identified differences in risk factors on early (postop day ≤ 2) and late death (postop day ≤ 3). To explore proper preventive strategies for each death, data were reviewed in 4351 adult patients who underwent cardiac surgery between 1/1/90 and 6/30/94. There were 93 (2.14%) early deaths and 171 (4.02%) late deaths in this series. Patients who died are older (early: 67.8 vs. 64.2, p = 0.002; late: 71.1 vs. 63.9, p < 0.001) Proportion of females is higher in late deaths (41.5% vs. 29.7%. p = 0.001). but not in early deaths (32.3% vs. 30.2%, p = 0.6). The early and late mortality are 1.65% and 2.78% for isolated CABGs (n = 3037). 1.82% and 4.0% for isolated valves (n = 713), 3.79% and 9.61% for CABG + valve (n = 422), 7.82% and 12.73% for others (n = 179). To adjust influence of preoperative risk factors on each type of death. stepwise logistic regression was applied.Early DeathLate DeathRisk FactorOdds RatiopRisk FactorOdds RatiopCardiac arrest5.98<0.001Cardiogenic shock6.93<0.001Refuse blood5.84<0.001Renal disease5.50<0.001Age≥ 85 years5.010.008CV disease4.08<0.001Emergency3.67<0.001MI <30 days3.360.004Re-operation2.85<0.001Cardiac arrest3.31<0.001Rheumatic dis.2.790.001Respiratory dis3.19<0.001Preop EF <35%2.71<0.001Liver disease3.040.051Hypotension2.260.009Age ≥ 75 years2.80<0.001MI < 10 days2.100.005Rheumatic dis2.190.002IABP support1.920.042Emergency1.560.035Age 65–64 years1.770.017Heart Failure1.480.050Diabetes1.470.055Chronic Isch. HD0.37<0.001 (1) Acute cardiac factors dominate early mortality. (2) Chronic organ system function is more important in late deaths than in early deaths. (3) Risk adjusted mortality does not differ significantly in genders.