Determination of factors related to perioperative mortality in cardiovascular surgery

Objective: The mortality rate in cardiovascular surgery procedures varies with different centers around the globe. Identification of risk factors for perioperative mortality and establishment of protocols for this may increase survival in patients. In this study, we investigated the mortality rates
and corresponding risk factors in cardiovascular surgery.
Material and Methods: A retrospective cohort study was performed in the patients who were admitted to the Cardiovascular Surgery Clinic and died in the perioperative period.
Results: A total of 4037 patients were admitted to the Cardiovascular Surgery Service between January 1, 2013 and December 31, 2016, during four years. In patients treated in intensive care unit, open heart surgery for 567 patients and peripheral vascular disease surgery for 525 patients were planned. Thirty patients who had open heart surgery and 14 patients who had peripheral vascular disease died in perioperative period at the intensive care unit. The general mortality rate in the Cardiovascular Surgery Clinic during this 4-year period was found as 1.1%. The mortality rate of open heart surgery was 5.1% whereas that of peripheral vascular surgery was 2.7%. Hypertension, chronic kidney disease and diabetes mellitus were detected as the most common accompanying systemic diseases. Ejection fraction (EF) was found as 48.4±13.7, Euroscore Additive as 10.0±4.2, cross-clamp time as 125.1±51.9 minutes and cardiopulmonary bypass (CPB) duration as 192.0±81.1 minutes in patients who were lost during open heart surgeries. The APACHE II scores of the patients who were scheduled for peripheral vascular disease and were lost in the perioperative period were detected as 26.1±8.5.
Conclusion: The mortality rate of open heart surgery in our clinic, when compared within the global scale is between developed and emerging countries. Presence of preoperative systemic diseases in cardiovascular surgery patients is significantly correlated with the mortality rate.

Kalp ve damar cerrahisinde perioperatif mortalite ile iliþkili faktörlerin belirlenmesi

Amaç: Kalp ve damar cerrahisi prosedürleri dünya üzerinde deðiþik merkezlerde farklý mortalite oranlarý gösterir. Perioperatif mortaliteye neden olan risk faktörlerinin belirlenmesi ve buna yönelik protokollerin oluþturulmasý hastalarda saðkalýmý arttýrabilir. Biz bu araþtýrmada kalp ve damar cerrahisi mortalite oranlarýný ve risk faktörlerini araþtýrmayý planladýk.
Gereç ve Yöntemler: Kalp ve Damar Cerrahisi Kliniði’ne yatan ve perioperatif dönemde ölen hastalarda retrospektif kohort çalýþmasý yapýldý.
Bulgular: Kalp ve Damar Cerrahi Servisi’ne 1 Ocak 2013 ile 31 Aralýk 2016 tarihleri arasýnda dört yýl süresince toplam 4037 hasta yatýrýldý. Yoðun bakým ünitesinde tedavi gören hastalar içerisinde 567 hastaya açýk kalp cerrahisi ve 525 hastaya periferik damar hastalýðý cerrahisi planlandý. Açýk kalp cerrahisi geçirenlerden 30 hasta, periferik damar hastalýðý olanlardan 14 hasta perioperatif dönemde yoðun bakým ünitesinde kaybedildi. Kalp ve Damar Cerrahisi Kliniði’nin dört yýllýk toplam mortalite oraný %1.1 olarak bulundu. Açýk kalp cerrahisi geçirenlerin mortalite oraný %5.1 iken periferik damar cerrahisinde %2.7 olarak bulundu. Hipertansiyon, kronik böbrek hastalýðý, ve diyabetes mellitusun en
sýk eþlik eden sistemik hastalýklar olduðu tespit edildi. Açýk kalp cerrahisi geçirip sonrasýnda kaybedilen hastalarda ejeksiyon fraksiyonu (EF) %48.4±13.7, Euroscore Additive 10.0±4.2, kros klemp süresi 125.1±51.9 dakika ve kardiyopulmoner bypass (KPB) süresi 192.0±81.1 dakika olarak bulundu. Periferik damar hastalýðý için prosedür planlanan ve perioperatif dönemde kaybedilen hastalarýn APACHE II
skorlarýnýn 26.1±8.5 olduðu tespit edildi.
Sonuç: Kliniðimizin açýk kalp cerrahisi mortalite oraný, geliþmiþ ülkeler ile geliþmekte olan ülkelerin oranlarý arasýndadýr. Kalp ve damar cerrahisi hastalarýnda preoperatif sistemik hastalýklarýn varlýðý mortalite oranýyla doðrudan iliþkilidir.