Coronary artery bypass surgery on small patients
1San Francisco Heart Institute, 1900 Sullivan Avenue, Daly City, CA, 94015, USA.
Insights
Smaller patients undergoing coronary artery bypass graft surgery face higher risks, including more complications and a greater death rate. However, most smaller patients still achieve successful outcomes after this cardiac surgery.
Area of Science:
- Cardiovascular Surgery
- Patient Outcomes Research
Background:
- Limited research exists on outcomes for smaller patients undergoing coronary artery bypass graft (CABG) surgery.
- Defining 'smaller patients' is crucial for understanding specific surgical risks.
Purpose of the Study:
- To evaluate the outcomes of cardiac surgery in smaller patients defined by body surface area.
- To identify differences in complications and mortality between smaller and normal-sized patients post-CABG.
Main Methods:
- A consecutive series of 4,358 patients undergoing bypass surgery was analyzed.
- Patients were classified as 'small' based on specific body surface area thresholds (males ≤1.6 m², females ≤1.5 m²).
- Outcomes including complications, re-operation, mortality, and length of stay were compared between groups.
Main Results:
- Smaller patients (5.6% of cohort) were more likely to be women, older, of Asian ethnicity, and less likely to have prior cardiac surgery.
- Smaller patients received arterial conduits less frequently and experienced higher rates of prolonged ventilator support, acute renal failure, transfusions, re-operation for bleeding, and mortality (5.7% vs. 2.6%).
- Small body surface area was not an independent predictor of death in multivariate analysis, though overall outcomes were poorer.
Conclusions:
- Smaller patients undergoing CABG surgery exhibit poorer outcomes compared to normal-sized patients.
- Despite increased risks, a significant majority (90%) of smaller patients experience event-free surgeries.
- Surgeons should provide closer monitoring for smaller patients, anticipating increased risks and healthcare costs.
Abstract:
Little research exists on the outcome of smaller patients who undergo coronary artery bypass graft surgery. The purpose of this study was to evaluate the outcomes of cardiac surgery in smaller patients (males with body surface area of 1.6 square meters or less, and women with 1.5 meters or less). A consecutive series of 4,358 patients undergoing bypass surgery was evaluated. Of these, 246 (5.6%) were classified as small patients. Smaller patients were more likely to be women, older and of Asian ethnicity. They were less likely to have undergone a prior cardiac surgery. Smaller patients were less likely to receive an arterial conduit (74% versus 99%; p<0.00001). Rates of post-surgery complications differed between small and normal size patients, with smaller patients more likely to require prolonged ventilator support (p <0.05), more likely to have acute renal failure (p<0.0001), more transfusions and re-operation for bleeding (p<0.05), higher death rate (5.7% versus 2.6%; p<0.01) and longer length of hospital stay (11.4 versus 8.3 days; p<0.00001). In multivariate analyses evaluating factors related to death, emergent surgery, poor ejection fraction and older patient age were independently related to mortality. Small body surface area was not an independent predictor. The results of this study indicate that smaller patients do have poorer outcomes associated with coronary artery bypass surgery. However, 90% of the smaller patients did have an event-free surgery. Surgeons may need to monitor these patients more closely and anticipate the increased risk and cost that is associated with this group.
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