IJCS | Volume 32, Nº2, May/June 2019

221 Lobato et al. Patients undergoing cagb in Pará, Brazil Int J Cardiovasc Sci. 2019;32(3)217-226 Original Article Table 3 - Complications of myocardial revascularization surgery during hospitalization at Fundação Hospital de Clínicas Gaspar Vianna between 2013 and 2014 Complications N % 95%CI Lower limit Upper limit Infection 94 52.5 45.2 59.8 Hospitalized, waiting for surgery 29 16.2 10.6 21.8 Postoperative 85 47.5 40.2 54.7 Bleeding 67 37.4 30.3 44.9 Blood transfusion 67 37.4 30.3 45.0 Complex arrhythmias 39 21.8 16.0 28.6 ARI requiring hemodialysis 8 4.5 1.9 8.6 ARI without dialysis 1 0.6 0.1 3.1 Stroke/acute ischemic attack 5 2.8 0.9 6.4 Need for new surgery 1 0.6 0.1 3.1 Others 1 0.7 0.1 3.7 ARI: acute renal injury. Expected benefits may be significantly reduced by factors related to the surgical procedure itself, to the center where the surgery was performed, and to the patient. In our study, surgical mortality was high (11.1%), higher than national mortality (6.2%) and much higher than that reported in European and American countries (2.13% and 4.4%, respectively). 15,16 In the northern region of Brazil, global mortality between 2005 and 2007 was 7.24%. 11 Studies conducted in other regions showed a wide variation in mortality rates, ranging from low rates as 1.7%, observed in a private hospital in Pernambuco to 14.2% in a hospital renowned for the cardiology service provided, located in the south of Brazil. 17,18 In another study carried out at this institution from January 2008 and December 2011, involving 233 patients, a mortality rate of 5.4% 19 was reported. Nevertheless, intraoperative and immediate (first 24 hours after surgery) postoperative deaths were excluded from the study, different from our study that considered all deaths for analyses. Such wide variation in mortality may be explained by differences in healthcare services provided in each institution. FHCG is a referral center for emergencies in cardiology in the northern region of Brazil to which highly complex patients are referred, as exemplified in our study group. All patients undergoing surgery had been admitted for acute coronary syndrome (ST segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction or unstable angina), which may have contributed to high preoperative mortality. The lack of scores for predicting preoperative mortality at FHCGV, such as EuroScore or STS, which are widely used inmany countries andwere validated in some centers in Brazil, 18,20 does not allow the comparison between our study group and patients fromother centers. Another explanation for the different results may be the type of health care provided; lower mortality rates were observed in private than public centers. In general, people have lower access to primary health care and centers specialized in highly complex cases. Also, higher availability and more effective use of financial resources are seen in private centers than in public ones. Although postoperative mortality rate seemed to be positively associated with age, particularly considering patients older than 80 years, the number of patients at this age range was considerably small, so that a definite conclusion cannot bemade. Rocha et al., 21 reported higher mortality and postoperative complications such as need for new surgery, respiratory complications, mediastinitis, stroke, acute kidney failure, sepsis, atrial fibrillation and