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Risk of major elective operation after myocardial revascularization
J L Nielsen1, C P Page, C Mann
1Department of Surgery, University of Texas Health Science Center, San Antonio.
Insights
Patients with prior coronary artery bypass grafting (CABG) face similar surgical risks for major vascular operations compared to those without. Successful CABG does not appear to increase the risk of subsequent elective general and vascular surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Anesthesiology
Background:
- Increased surgical risk of ischemic myocardial disease is widely accepted.
- Amelioration of this risk after coronary artery bypass grafting (CABG) is poorly defined.
Purpose of the Study:
- To compare outcomes of major elective general and peripheral vascular operations in patients with prior CABG versus a matched cohort without prior CABG.
- To evaluate the impact of prior CABG on surgical risk and outcomes in major elective vascular procedures.
Main Methods:
- Retrospective comparison of 181 patients with prior CABG and an age-, gender-, and procedure-matched group without prior CABG (NOCABG).
- Analysis of mortality and morbidity rates between the two groups undergoing major elective general and peripheral vascular operations.
Main Results:
- Despite a perception of higher risk in CABG patients (more ASA class III, fewer ASA class I), mortality rates were not significantly different (1.1% CABG vs. 2.8% NOCABG).
- Morbidity rates were also similar between the groups (18.8% CABG vs. 18.5% NOCABG).
Conclusions:
- For patients with successful CABG, the risk of subsequent elective major general and vascular surgery is similar to that of a matched cohort without prior CABG.
- Mortality rates after elective operations in patients with a history of successful CABG are low.
Abstract:
Although an increased surgical risk of ischemic myocardial disease is widely accepted, amelioration of this risk after coronary artery bypass is poorly defined. We compared the outcomes of major elective general and peripheral vascular operations in 181 patients with prior coronary artery bypass grafting (CABG) with outcomes in an age-, gender-, and procedure-matched group without prior CABG (NOCABG). Despite the perception of a greater operative risk in the CABG patients (more CABG patients in American Society of Anesthesiologists [ASA] class III and fewer in ASA class I, p < 0.001), mortality (1.1% CABG versus 2.8% NOCABG) and morbidity (18.8% CABG versus 18.5% NOCABG) rates in the two groups were not significantly different. For patients who have undergone successful CABG, it appears that: (1) the risk of subsequent elective major general and vascular surgical operations is similar to that of an age-, gender-, and procedure-matched cohort, and (2) the mortality rate after elective operations is low.