Factors affecting postoperative morbidity and mortality in isolated coronary artery bypass graft surgery

Area of Science:

• Cardiovascular Surgery
• Medical Statistics
• Patient Outcomes Research

Background:

• Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
• Identifying mortality predictors is crucial for optimizing patient selection and perioperative management.
• Understanding risk factors aids in improving surgical outcomes and patient survival rates.

Purpose of the Study:

• To investigate predictors of mortality before and after isolated coronary artery bypass grafting (CABG).
• To develop and validate risk models for operative mortality.
• To identify modifiable and non-modifiable factors influencing patient outcomes post-CABG.

Main Methods:

• Analysis of single-institutional data from 8890 patients undergoing isolated CABG.
• Utilized univariate and multivariate analyses to assess risk factors and outcomes.
• Developed two risk models: preoperative (model 1) and pre-, intra-, and postoperative (model 2).

Main Results:

• Operative mortality was 0.6% (55 patients).
• Preoperative predictors included diabetes, hypertension, previous CABG, angina, arrhythmia, CCS grades III-IV, low ejection fraction (EF ≤30%), three-vessel disease, and left main disease.
• Postoperative predictors for in-hospital mortality included diabetes, hypertension, angina, CCS grades III-IV, low EF, absence of internal mammary artery (IMA) use, prolonged cardiopulmonary bypass (CPB) time, and prolonged ICU stay.

Conclusions:

• Diabetes, hypertension, angina, low ejection fraction, and prolonged ICU stay are significant prognostic factors for in-hospital mortality after CABG.
• The use of internal mammary artery (IMA) and shorter cardiopulmonary bypass (CPB) times are associated with better outcomes.
• These findings can inform clinical decision-making and enhance postoperative care strategies to reduce mortality.