The costs of coronary artery surgery to the community.

The possible benefits obtained both for the community and patients following coronary artery bypass grafting (CABG) have been examined in 4001 patients (mean age 54 years, 14.8% female) who underwent CABG from 1971 to 1982 in the Cardiothoracic Surgical Unit of the Royal Adelaide Hospital. Assessment followed a fixed response format questionnaire sent to all patients with a total follow-up of 98.8%. The hospital mortality was 1.4% for the 10 year period with a fall from 4% in 1973 to 0.9% in 1981. Shifts in employment were assessed in survivors. At follow up, 548 patients who were previously employed had ceased full-time or part-time employment. This decrease in employment was attributed mainly to age. Analysis of retirement curves for the general male population and male patients showed a similar pattern but downward translation of 4% for the pre-operative group. A similar downward shift occurred following surgery. For female patients, performance of home duties improved from 159 patients on full home duties pre-operatively to 292 post-operatively. Visits to the doctor dropped in 50% of surviving patients. CABG has a low mortality. The community benefits by helping to maintain productivity and decreased cost for ongoing medical care.

Cardiac surgery relative to population: pattern of cardiac surgery in South Australia, 1949--75.

The total work load of the sole cardiac surgery unit in South Australia has been analysed by means of a computer-based data retrieval system. The review covers the period 1949--75 inclusive. This study analyses the case-loads year by year, in total, and in different diagnostic categories, and has allowed conclusions to be drawn about surgical needs relative to population figures. From these figures future trends in requirements for cardiac surgical facilities have been deduced. There are many lessons to be learnt by maintaining an easily recoverable set of data for all the surgery performed in any cardiac surgery unit. This type of analysis makes it possible to maintain surveillance of demands on resources and of the results of the surgery performed. Because of the structure and situation of the community of South Australia and the fact that it is served by a single open heart unit, the pattern of this series may truly represent the optimum cardiac surgery case-load for any modern westernised community of comparable size.

Coronary artery surgery in South Australia: second report.

This is the second report on the results of coronary artery grafting in South Australia. Symptomatic relief after grafting has continued at a high level (at five years, the conditions of 90.3% of surviving patients are improved as assessed by their cardiologists), and, in patients with significant symptoms, the operation can be recommended with a high degree of safety on these grounds alone. In addition, an attempt has been made to ascertain whether grafting alters longevity and, although more information is required on this point, the initial results are most encouraging with the five-year survival rate for operated patients being 92%, a figure which compares favourably with any large, medically treated group of patients. The operative mortality rate has continued to fall and is 2.2% for the entire series.

Surgery for left main coronary artery disease.

The early and late results of the first 103 patients with left main coronary obstruction submitted to bypass grafting in South Australia are presented. A satisfactory hospital mortality of 2.9% and a surprisingly low late mortality of 2.9% (at an average follow-up time of 30 months), were obtained, and these figures, when taken in conjunction with a symptomatic relief rate of 83% at 24 months, have encouraged us to continue to recommend coronary artery grafting as the treatment of choice of left main stem disease.

Coronary artery surgery in South Australia 1970-1976.

The South Australian population of approximately 1,245,000 is 9.2% of the total Australian population. The Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospital is the only one such unit in the State which is equipped for open heart surgery, and coronary artery grafting was first undertaken there in December, 1970. From that time until the end of December, 1976, 701 patients underwent coronary artery grafting with an overall hospital mortality of 3.0%, and a late mortality of 3.2%. The principal indication for operation was incapacitating angina, and of the 628 patients who have been followed-up after operation for a minimum period of six months, 78.6% were judged by their cardiologist to be completely relieved of this symptom. A further 8.9% of patients were considered to be significantly improved. Coronary artery surgery has rapidly assumed a dominant role in our Unit so that, in 1976, of the 435 open heart operations which were performed, 267 (61%) were procedures which necessitated coronary artery grafting. The rate of increase has slowed considerably over the past 18 months, and it is expected that, with current operative indications, the proportion of coronary artery cases will not rise much above 60% of the open heart work load of the Unit.

Twelve years of coronary artery surgery in South Australia.

Twelve years' results of coronary artery bypass surgery in South Australia have been reviewed. The preoperative assessment parameters and operative profiles of 4001 patients who underwent isolated coronary artery grafting between 1970 and 1982 have been examined. In addition, all surviving patients received a follow-up questionnaire; only 48 patients have remained untraced. Survival curves for the patient group have been calculated and compared with those for the Australian population. The risk factors which influenced long-term survival have been identified. Surviving patients described their anginal symptoms as diminished in 93% of cases at the time of review. When recurrent angina was described, 58% of patients experienced it within 12 months of the operation. Postoperative activity was improved in 71% of patients; 8% described a deterioration. A second operation was performed in 2.1% of patients. This study provides a comprehensive review of the efficacy of coronary artery bypass surgery both in the short and in the medium term.