Death after heart surgery overwhelmingly determined by patient risk factors


A study published in Anaesthesia has shown for the first time that the major contributing factors to patient death after heart surgery are their risk factors—underlying fitness and the presence of co-existing disease—accounting for 96% of the risk attributed to surgery. The research quantified the contributions made by the anaesthetist to outcomes following cardiac surgery in a large, multi-centre, UK-wide study.

On behalf of the Association of Cardiothoracic Anaesthetists (ACTA), the study analysed the survival after cardiac surgery of 110,000 patients over 10 years, in 10 UK centres.

The study showed a small amount of variability in surgical practice, which accounted for 4% of the risk of death. However, once these risks were taken into account, there was no variability in anaesthetic practice amongst the 190 consultant anaesthetists studied, and the individual anaesthetist did not contribute to patient death following surgery.

According to the Association of Anaesthetists of Great Britain and Ireland (AAGBI), the implication of this research is that the many years of training and experience gained in the UK health system ensures that practice is uniform and does not unduly put patients at risk.

Together with the results of cardiac surgery in the UK, an AAGBI press release claims that the findings of this study will be reassuring to patients and their families. According to the study, resources and research should now be targeted at improving the fitness of patients who need to undergo cardiac surgery.

This study is accompanied by an editorial that describes this study as one of the most important pieces of research in cardiac anaesthesia published in the last 30 years. It asks and answers the question: do anaesthetists contribute any harm to patients undergoing cardiac surgery as measured by mortality? The editorial reports that this is not the case.