Division of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Division of Cardiac Surgery, University of Bristol and Bristol Royal Infirmary, Bristol, UK.
Eur J Cardiothorac Surg. 2022 Jan 24;61(2):449-456. doi: 10.1093/ejcts/ezab391.
The aim of this study was to review the UK national trends in activity and outcome in coronary artery bypass graft (CABG) over a 15-year period (2002-2016).
Validated data collected (2002-2016) and uploaded to National Institute for Cardiovascular Outcomes Research were used to generate summary data from the National Adult Cardiac Surgery Audit Database for the analysis. Logistic European System of Cardiac Operative Risk Evaluation was used for risk stratification with recalibration applied for governance. Data were analysed by financial year and presented as numerical, categorical, %, mean and standard deviation where appropriate. Mortality was recorded as death in hospital at any time after index CABG operation.
A total of 347 626 CABG procedures (282 883 isolated CABG, 61 109 CABG and valve and 4132 redo CABG) were recorded. Over this period annual activity reduced from 66.6% of workload to 41.7%. The mean age for isolated CABG was 65.7 years. The mean log European System of Cardiac Operative Risk Evaluation was 3.1, 5.9 and 23.2 for elective, urgent and emergency isolated CABG, respectively. There was a decline in the observed mortality for all procedures. Overall mortality for isolated CABG surgery is now 1.0% and only 0.6% for elective operations.
Quality of care and risk-adjusted mortality rates have consistently improved over the last 15 years despite the increasing risk profile of patients. There have been a consistent decline in overall case volumes and a three-fold increase in elderly cases.
本研究旨在回顾英国在 15 年间（2002-2016 年）冠状动脉旁路移植术（CABG）的活动和结果的国家趋势。
使用从国家成人心脏手术审核数据库中收集并上传到国家心血管结果研究所的经过验证的数据（2002-2016 年），以生成分析用的汇总数据。采用欧洲心脏手术风险评估系统进行风险分层，并对治理进行重新校准。按财政年度进行数据分析，并在适当情况下以数字、分类、%、平均值和标准差呈现。死亡率是指在指数 CABG 手术后任何时间在医院内死亡。
共记录了 347626 例 CABG 手术（282883 例单纯 CABG、61109 例 CABG 和瓣膜手术以及 4132 例再次 CABG）。在此期间，年活动量从工作量的 66.6%减少到 41.7%。单纯 CABG 的平均年龄为 65.7 岁。择期、紧急和急诊单纯 CABG 的平均欧洲心脏手术风险评估系统 log 分别为 3.1、5.9 和 23.2。所有手术的观察死亡率均有所下降。单纯 CABG 手术的总死亡率现为 1.0%，择期手术仅为 0.6%。
尽管患者的风险状况不断增加，但过去 15 年来，护理质量和风险调整后死亡率一直在持续提高。总体病例量持续下降，老年病例数增加了两倍。
