Evolution of case-mix in heart surgery: from mortality risk to complication risk.

During the last two decades despite an increase of the average preoperative mortality risk of patients referred to heart surgery a decrease of hospital mortality has been observed in many surgical institutions. The ratio between the increase of risk and the decrease of mortality could be defined as the 'risk paradox' for coronary surgery. Meanwhile an increase of the incidence of postoperative complications is leading to a longer stay in intensive care that involves a remarkable cost increase per single hospitalisation and a disproportionally long-term use of reanimation beds in those patients who survive the operation but have comorbidities complicating the postoperative course.

Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients.

Objective: To assess risk factors for mortality in cardiac surgical adult patients as part of a study to develop a European System for Cardiac Operative Risk Evaluation (EuroSCORE).

Methods: From September to November 1995, information on risk factors and mortality was collected for 19030 consecutive adult patients undergoing cardiac surgery under cardiopulmonary bypass in 128 surgical centres in eight European states. Data were collected for 68 preoperative and 29 operative risk factors proven or believed to influence hospital mortality.

[Assessment of the quality of health care: heart surgery].

In the process of health planning and of the evaluation of health care, there is growing interest in assessing the quality of medical care. Traditionally, quality indexes are divided into three groups: structure, process and outcome. The first two indexes can be measured more easily and quickly, but outcome indexes are more appropriate care indicators for both health planners and patients.

Preoperative evaluation in non-cardiac surgery: cardiac risk assessment.

Nine hundred and ninety patients, ages 20 years or older, undergoing non-cardiac elective surgery were prospectively studied to identify high cardiac risk preoperative factors in a case-mix population and to assess cardiological risk. The prevalence of major cardiac complications was 2.3%, including 0.