Original Articles
Trends during 25 years of coronary artery bypass operation at St. Luke’s Medical Center in Milwaukee, Wisconsin

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Abstract

Background. Most studies of changes in coronary artery bypass graft (CABG) operations are from major academic institutions. The present study evaluated changes in CABG operations since 1968 in a community hospital.

Methods. The data were from the St. Luke’s Medical Center Cardiovascular Data Registry in Milwaukee, Wisconsin. Mortality rates, risk factors, overall patient risk, and surgical procedures were compared from 1968 to 1994.

Results. There was a dramatic decrease in 30-day mortality rates from 1968 to 1972. After 1976, mortality rates increased because of higher risk patients, but the mortality rate, adjusted for patient risk, continued to decline. Both internal mammary arteries and sequential grafts were widely used by 1972, followed by a decline in use until 1980, and then a steep increase in use from 1980 to the present.

Conclusions. This study provided evidence from a community hospital that the skills of the surgical teams improved first dramatically then gradually. The pattern of adapting new surgical techniques suggested that these techniques were critically evaluated for several years after they were introduced.

Section snippets

Material and methods

The data were obtained from the St. Luke’s Medical Center Cardiovascular Data Registry in Milwaukee, Wisconsin. The registry was established in June 1971 and includes CABG operations from March 1968 to October 1994. Data for the registry were obtained from five sources: (1) surgical data entry forms, (2) cardiac catheterization data entry forms, (3) computerized hospital records, (4) annual follow-up questionnaires mailed to patients and their families, and (5) medical record abstraction. The

Results

The clinical and operative characteristics of the patients are shown in Table 1. The data are compared for three time intervals to show trends. There were highly significant increases over time in the percentage of patients who are older than age 70, female, and hypertensive. There were also more operations on patients who had a recent myocardial infarction, or had left main disease, urgent operations, reoperations, and procedures that included a valve operation. There was only a minimal

Comment

The data analyzed in this study were used to track changes in CABG operations over more than two decades in patients under the care of 3 cardiologists in a private practice. Several changes were apparent over this time period. The most dramatic was the decrease in short-term mortality rates during the first 3 years of the operations, which reflected the learning curve for the operative team. After this period mortality rates increased, but this increase was due to higher risk for patients in

Acknowledgements

This work was supported in part by a generous grant from the Ladish Company Foundation, John H. Ladish Trustee, and the St. Luke’s Medical Center Research Foundation. The data for the study was provided by Jacob Assa of Cardiovascular Computer Systems Ltd. Suzanne Bentler, MS provided technical assistance.

We appreciate the contributions of all of the coronary bypass surgeons affiliated with the St. Luke’s Medical Center Cardiovascular Data Registry. We dedicate this paper to the memory of two

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