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Determinants of hospital mortality after coronary artery bypass grafting
A Michalopoulos1, G Tzelepis, U Dafni
1Cardiothoracic ICU, Onassis Cardiac Surgery Center, Athens, Greece. amichalopoulos@hol.gr
Insights
Predicting hospital mortality after coronary artery bypass graft (CABG) surgery is improved by analyzing simple postoperative factors. The number of inotropic agents and blood transfusions administered on postoperative day 1 are key predictors of mortality.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Outcomes Research
Background:
- Elective coronary artery bypass graft (CABG) surgery carries a risk of hospital mortality.
- Identifying predictors of mortality is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the causes of death following elective CABG surgery.
- To identify predictors of hospital mortality after elective CABG.
Main Methods:
- A prospective case-control study was conducted at a tertiary teaching hospital.
- Preoperative, operative, and immediate postoperative variables were collected from patients undergoing elective CABG.
- Logistic regression analysis was used to identify predictors of mortality.
Main Results:
- Of 2,014 patients, 1.3% died during hospitalization. Main causes included cardiogenic shock, brain death/stroke, and septic shock.
- Univariate analysis identified age, ejection fraction, bypass/cross-clamp times, blood transfusions, inotropes, hypertension, IABP use, and shock as significant factors.
- Logistic regression revealed that the number of inotropes and blood units transfused on postoperative day 1 were the strongest predictors of outcome (91.7% positive predictive value).
Conclusions:
- Simple variable analysis improves prediction of hospital mortality in elective CABG patients.
- The number of inotropic agents and blood transfusions in the immediate postoperative period are the most important independent predictors of hospital mortality.
Objectives:
To examine causes of death and to find predictors of hospital mortality after elective coronary artery bypass graft (CABG) surgery.
Design:
Case-control study.
Setting:
Tertiary teaching hospital.
Methods:
We prospectively collected various preoperative, operative, and immediate postoperative variables in a cohort of patients undergoing elective CABG surgery.
Results:
Of the 2,014 consecutive patients (mean [+/- SD] age of 61.3+/-6.7 years old) undergoing elective CABG over a 2-year period, 27 patients (1.3%) died during their hospitalization. The main causes of death (either isolated or in combination) were cardiogenic shock (n = 13), brain death or stroke (n = 7), septic shock (n = 4), ARDS (n = 2), and pulmonary embolism (n = 1). A univariate statistical analysis revealed factors that significantly correlate with outcome: patient age, preoperative left ventricular ejection fraction, bypass time, aortic cross-clamp time, number of blood units transfused, number of inotropic agents administered in the operating room during the first postoperative day (POD), history of arterial hypertension, intra-aortic balloon pump usage, and perioperative development of shock. A logistic regression analysis showed that the combination of the number of inotropes and the number of blood units administered in the operating room during POD 1 was the most important determinant of outcome, with an overall positive predictive value of 91.7%.
Conclusions:
We conclude that the analysis of simple variables enhances our ability to accurately predict hospital mortality in patients undergoing elective CABG surgery. The number of inotropic agents and blood transfusions administered during the immediate postoperative period is the most important independent predictor of hospital mortality.