Article Text

Download PDFPDF

Original research
Death in low-risk cardiac surgery revisited
  1. Katarina Lidén1,
  2. Torbjörn Ivert1,2 and
  3. Ulrik Sartipy1,2
  1. 1Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
  2. 2Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Ulrik Sartipy; Ulrik.Sartipy{at}


Background A systematic review of low-risk death has been shown successful in identifying system weaknesses. The aim was to analyse early mortality in low-risk patients undergoing cardiac surgery and to determine the cause of death, classify if they were unavoidable or potentially preventable as a result of technical or system errors.

Methods We included all low-risk patients who underwent cardiac surgery at our institution from 1 September 2009 to 31 August 2019. In patients operated between 2009 and 2011, we defined low risk as an additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) I less than or equal to 3, and from 2012 and onwards as a EuroSCORE II less than or equal to 1.5. The medical records for the patients who died within 30 days of surgery were thoroughly examined and the cause of death was classified as cardiac or non-cardiac. Furthermore, deaths were categorised as not preventable, preventable (technical error) or preventable (system error).

Results During the study period 3103 low-risk patients underwent surgery, and 11 patients died within 30 days of the operation (0.35%). Six of these (55%) were classified as preventable and five non-preventable. Four of the preventable deaths were classified as technical errors and two were due to system errors.

Conclusions A repeated systematic review of deaths in patients with a low preoperative risk showed that a majority of deaths were preventable, and therefore potentially avoidable. Similar to the previous assessment at our unit, mortality was very low and failure to communicate remains a modifiable factor that should be addressed.

  • cardiac surgery
  • quality of care and outcomes
  • surgery-coronary bypass
  • surgery-valve

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors US and TI contributed to the conception and study design. KL performed data collection and drafted the first version of the manuscript. All authors contributed to data analysis and interpretation. TI and US critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript to be submitted. US is the guarantor of this work and, as such, had full access to all data in the study and takes responsibility for the integrity of data and accuracy of the analysis.

  • Funding This work was supported by the Swedish Heart-Lung Foundation (grant numbers 20160522, 20160525 and 20180400 to US); the Åke Wiberg Foundation (grant number M18-0016 to US); the Karolinska Institutet Foundations and Funds (grant number 2018-01784 to US); and the regional ALF agreement between Stockholm County Council and Karolinska Institutet (grant number 20180114 to US).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Swedish Ethical Review Authority (Dnr: 2019-04316).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.