Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Jan 1997
Randomized Controlled Trial Clinical TrialPreconditioning the human heart.
The phenomenon of ischaemic preconditioning protects the myocardium by limiting infarct size in animal models of ischaemia and reperfusion. Ischaemic preconditioning may be induced by short periods of ischaemia and reperfusion. We investigated whether the human heart can be ischaemically preconditioned during coronary artery bypass grafting (CABG). ⋯ In addition, more patients in the preconditioned group had troponin T levels lower than 0.5 milligram at 72 h than in the control group (10 vs 3 patients). Both groups of patients received the same number of grafts, and underwent the same length of ischaemia during the procedure. We conclude that in patients undergoing CABG surgery, ischaemic preconditioning may reduce myocardial injury as shown by the favourable changes in myocardial ATP, and serum troponin T levels.
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Ann R Coll Surg Engl · Jan 1997
Does hospital mortality rate reflect quality of care on a surgical unit?
All deaths occurring in 1 year in the surgical unit of a district general hospital were analysed to determine to what extent crude mortality rates reflect the quality of care. There were 166 deaths, 70% of patients were aged 75 years and older, and 87.3% were emergency admissions. ⋯ Factors such as the nature of the catchment area served, the proportion of emergency versus elective admissions, the numbers of complex operations performed and the availability of convalescent or hospice facilities are a greater influence on surgical mortality rates than variations in the standard of surgical care. The use of crude hospital mortality rates to compare the quality of care given by surgical units should be discontinued as it is unreliable and misleading.