Healthcare

Biography

Biography: Carl Johan Jakobsen

Abstract

The short time outcomes from cardiac surgery has changed dramatically during the last decades. Despite an increasing elderly population and more complex surgery the 30-day mortality has in many institutions been halved the last 10 years, but the one-year mortality remains. Risk prediction systems like the EuroSCORE is a valuable tool in control of the quality of cardiac surgery, but the validity of the risk score for the individual patient may be questioned. Further most scoring systems only take the patients preoperative state and the intended surgery into consideration, and hardly handle the procedure and perioperative complicating factors. Thus we have very poor tools to predict the longer term mortality. The presentation is based on cohort studies of more than 25.000 patients handling and evaluating different factors in an attempt to isolate factors with independent impact on postoperative complications and survival. The studies demonstrate that both co-morbidity and age has great impact on 30-day mortality. In longer time outcomes the impact of co-morbidity seems less, while the impact of age increases together with perioperative intervention I.e. use of inotropes and vasoconstrictors, use of haemostatic drugs and blood transfusion. Except that age in elderly people has an important role in survival the unequal developments in short and longer term mortality are not readily explained.