Cardiac surgery in a small community: an eight-year experience.

ABSTRACT

Long-term results of 374 open-heart procedures performed over an eight-year period in a small community hospital are presented. Patients were followed up for an average of 49 months. The heart unit did not conform to the yearly volume of cases suggested by current national guidelines. Nonetheless, we obtained some interesting results. 1. The hospital mortality in nonemergency coronary artery bypass operations was 1.8%; in all types of bypass operation, 3.3%; and 5.1% for all types of cardiac operation. 2. The attrition rate was less than 1% per year for all types of patients with a total long-term survival of 92%. 3. Patients having coronary artery bypass had a yearly attrition rate of 0.66% and a total long-term survival of 94.2%. 4. The average hospital cost per patient having open-heart operation was $9,670 in 1978 and $11,073 in 1979. Case volume requirements for an open-heart-surgery unit in our area allowed an exception from the guidelines with emphasis on quality of results rather than quantity. This permitted comprehensive cardiac care especially for the poor and those with fixed incomes unable to afford the cost of traveling and associated expenses. Further similar reports may be valuable in the formulation of health policies for small communities that guarantee the health rights of all segments of the population.