HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ani C. Anyanwu Tom Treasure Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Anyanwu, A. C. Articles by Treasure, T. Search for Related Content PubMed PubMed Citation Articles by Anyanwu, A. C. Articles by Treasure, T. Related Collections Education Coronary disease Valve disease Professional affairs

J Thorac Cardiovasc Surg 2002;123:16-20
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Unrealistic expectations arising from mortality data reported in the cardiothoracic journals

From the St George's Hospital^a and Guy's Hospital,^b London, United Kingdom.

Received for publication May 15, 2001. Accepted for publication June 13, 2001. Address for reprints: Tom Treasure, MD, MS, FRCS, Cardiothoracic Unit, Guy's Hospital, London SE1 9RT, United Kingdom (E-mail tom.treasure{at}medix-uk.com).

Background: This study was undertaken to ascertain whether mortality data in the cardiac surgical literature mirror data reported in national databases.
Methods: This was a review of articles with 50 or more subjects reporting single-center mortality data for coronary artery bypass or aortic or mitral valve replacement published in the three major cardiothoracic surgical journals from 1997 through 2000. Mortality data and trends were examined.
Results: One hundred sixty-nine articles were found (coronary artery bypass, n = 119; aortic valve replacement, n = 34; mitral valve replacement, n = 16). Articles were predominantly case series (N = 95), with smaller numbers of comparative retrospective studies (n = 34), randomized trials (n = 29), and prospective noncomparative studies (n = 11). The median mortality figures for these studies were 1.5% (interquartile range, 0.3%-2.6%) for coronary artery bypass, 3.4% (interquartile range, 2.0%-5.3%) for aortic valve replacement, and 4.7% (interquartile range, 2.1%-6.9%) for mitral valve replacement. In contrast, the national registry mortality figures were 2.9%, 4.0%, and 6.0%, respectively, in the United States and 2.6%, 4.5% and 6.3%, respectively, in the United Kingdom. Coronary bypass studies with samples smaller than 100 patients reported lower mortality figures (median 0%) than did those with more than 100 patients (1.8%). Exploration with graphical plots suggested a bias toward reporting and publication of studies with below average mortality.
Conclusions: Particularly for coronary artery bypass, published data tend to underrepresent the risk of death as seen in most centers. Outcomes and magnitudes of effects as reported in these research studies may not be replicable to the same degree in most centers. In particular, extreme caution should be taken in extrapolating results from studies with fewer than 100 patients to larger surgical populations.

This article has been cited by other articles:

				C. Olsson, N. Eriksson, E. Stahle, and S. Thelin Surgical and long-term mortality in 2634 consecutive patients operated on the proximal thoracic aorta Eur. J. Cardiothorac. Surg., June 1, 2007; 31(6): 963 - 969. [Abstract] [Full Text] [PDF]

				A. Parolari, F. Alamanni, A. Cannata, M. Naliato, L. Bonati, P. Rubini, F. Veglia, E. Tremoli, and P. Biglioli Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials Ann. Thorac. Surg., July 1, 2003; 76(1): 37 - 40. [Abstract] [Full Text] [PDF]

				G. L. Grunkemeier and Y. Wu "Our complication rates are lower than theirs": Statistical critique of heart valve comparisons J. Thorac. Cardiovasc. Surg., February 1, 2003; 125(2): 290 - 300. [Abstract] [Full Text] [PDF]

				J. Arya, H. Wolford, and A. H. Harken Evidence-Based Science: A Worthwhile Mode of Surgical Inquiry Arch Surg, November 1, 2002; 137(11): 1301 - 1303. [Full Text] [PDF]