The new cardiac surgery patient: defying previous expectations.
Bibliographic record
Abstract
BACKGROUND: Studies conducted before 1999 of patients who had coronary artery bypass graft surgery (CABG) have shown a tendency toward increasing preoperative risk factors. This study examines whether this trend of increasing risk in patients who have cardiac surgery has continued since 1999 and whether its effect on mortality and morbidity has changed. METHODS: We prospectively collected data for 2754 patients who had cardiac surgery, divided them into 4 cohorts based on the year of operation (2000-2003) and analyzed the data according to 56 predefined preoperative, operative and postoperative variables. RESULTS: There were no significant changes in most preoperative risk factors over time, except for significant decreases in the proportion of elective (p = 0.016) and emergency/salvage operations (p < 0.001) and increases in urgent procedures and in the number of patients with congestive heart failure (CHF) (p < 0.001). The proportion of CABG procedures decreased significantly, whereas the proportion of valve, CABG plus valve, and non-CABG surgeries increased. A significant increase in multiarterial graft use and a decrease in off-pump coronary artery bypass procedures were observed. Postoperative complication rates did not change during the 4 years except for a significant decrease in wound infections. No significant changes in overall mortality and mortality across types of procedure were observed. Median observed/expected ratios for expected length of stay in hospital and risk of mortality did not change significantly over time. CONCLUSION: Patients' risk factors, except for CHF, did not change from 2000 to 2003. Despite more complicated procedures, the postoperative complication rates did not change except for a decrease in wound infections. These results suggest that the assumption of an inexorably increasing patient risk profile should be re-evaluated.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".