0% (8820/137,267) in 2000 to 3.4% (5734/160,997) in 2009. The unadjusted operative mortality declined from 6.1%(542/8820) in 2000 to 4.6%(261/5734) in 2009 (P < .05). Patients now AR-13324 chemical structure more frequently present with left main disease (35.1% vs 25.7%; P < .05), myocardial infarction (60.9% vs 55.9%; P < .001), and heart failure (18.4% vs 14.2%; P < .001). Patients also now present more frequently for urgent or emergent surgery (51.6% vs 39%; P < .001) and after previous percutaneous coronary intervention (51% vs 35%; P < .001). They also have a greater incidence of other comorbidities such as increased weight (88 vs 84 kg; P < .001), diabetes (42.5% vs 31.7%; P < .001), hypertension (90.9% vs 73.4%;
P < .001), hypercholesterolemia (90.9% vs 73.4%; P < .001), renal failure (2.2% vs 0.7%; P < .001), and cerebrovascular disease (12.4% vs 8.5%; P < .001). Risk-adjusted mortality decreased from 6.0% to 4.6%, a relative risk reduction of 23.7% (P < .001). Risk-adjusted postoperative stroke decreased from 1.9% to 1.6% (P < .001).
Conclusions: Surgical coronary revascularization has click here evolved during the past decade, with reoperative coronary artery bypass grafting now uncommonly performed in contemporary practice. Despite treating patients with more complex coronary artery disease and greater
medical comorbidities, significant improvements have occurred in operative morbidity and mortality in this challenging population. (J Thorac Cardiovasc Surg 2013;145:364-72)”
“Objective: The aim of the present study was to review nationwide outcomes of surgical embolectomy for acute pulmonary embolism.
Methods: Adult patients undergoing surgical embolectomy for acute pulmonary embolism from 1999 to 2008 were identified in the weighted Nationwide Inpatient Sample. The primary endpoint was inpatient mortality. Multivariate logistic GNAT2 regression
analysis incorporating significant univariate predictors (P < .2) was conducted to identify independent predictors of inpatient mortality.
Results: There were 2709 eligible patients identified as undergoing surgical embolectomy for acute pulmonary embolism during the study period. The mean age was 57.0 +/- 16.0 years. Of the patients, 1242 (45.8%) were women. A total of 280 patients (10.3%) had undergone thrombolysis before surgical embolectomy. The overall inpatient mortality rate was 27.2%. On multivariate analysis, an increasing Charlson comorbidity index (odds ratio, 1.37; 95% confidence interval, 1.12-1.69; P = .003) significantly increased the odds of inpatient mortality. In addition, blacks were more than twofold more likely to die during hospitalization than whites (odds ratio, 2.29; 95% confidence interval, 1.18-4.46; P = .02). Although age, payment type, hospital location (urban versus rural), hospital embolectomy volume, and surgeon embolectomy volume were associated with inpatient mortality on univariate analysis (each P < .