Trends in cardiac surgery in the Maltese population 1992-1997

Abstract

Prior to April 1995, patients in Malta requiring cardiac surgery were either referred to the United Kingdom or treated by a visiting cardio-thoracic team. The objective of this study was to examine trends in cardiac surgery between 1 st April 1992 and 31st March 1997, taking into consideration the transition to resident surgery which occurred in 1995. Analysis of data on sex, age, time from coronary angiogram to surgery and perioperative mortality was performed for all patients (n=1356) aged over 24 years who underwent cardiac surgery. Between 1992 and 1997 the number of coronary artery bypass grafts (CABG) increased by 50% and age sex standardised rates rose from 498 to 740 per million population per annum. The incidence of CABG in men was 5.5 times that in women. The largest number of CABGs were performed in men aged 55-64 and in women aged 65-74 years. Rates of intervention increased more rapidly for older age groups. Women undergoing CABG were 4 years older than men. The mean age for women increased by 3.5 years (62.7 - 66.2) whilst that for men remained unchanged (60.9) throughout this period. Mean waiting time rose to 128.34 days in 1996-97. The percentage of patients waiting over one year rose from 0.5% in 1992-93 to 7.7% in 1996-97. Perioperative mortality for CABG declined from 3.3 % to 1.8%. On average, 112.5 valve replacements per million population per year were performed with no change in trends. Waiting times have grown because projected output has outstripped resources.