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Published on: March 27, 2018
Association of postoperative complications and outcomes following coronary artery bypass grafting
Oliver K Jawitz1, Brian C Gulack2, J Matthew Brennan3
1Department of Surgery, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC.
Insights
Postoperative complications after coronary artery bypass grafting (CABG) increase long-term mortality and rehospitalization risks. These risks persist for up to seven years, highlighting the need for complication avoidance strategies.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Outcomes Research
Background:
- Long-term effects of postoperative complications following coronary artery bypass grafting (CABG) remain largely unknown.
- Understanding these long-term outcomes is crucial for improving patient care and resource allocation.
Purpose of the Study:
- To evaluate the long-term associations between individual postoperative complications and mortality and rehospitalization after isolated CABG.
- To determine if these associations differ between early (0-90 days) and late (90 days to 7 years) periods.
Main Methods:
- Utilized Medicare-linked records from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2007-2012) for isolated CABG procedures.
- Employed Cox proportional-hazards models and cumulative incidence functions to assess associations with mortality and rehospitalization up to 7 years.
- Accounted for nonproportional hazards by analyzing early and late periods separately.
Main Results:
- A total of 294,533 patients undergoing isolated CABG were included, with 41% experiencing at least one complication.
- Common complications included new-onset atrial fibrillation (30.0%), prolonged ventilation (12.3%), and renal failure (4.5%).
- All six studied complications were significantly associated with increased long-term mortality and rehospitalization, with effects persisting beyond 90 days.
Conclusions:
- Postoperative complications following CABG are linked to increased risks of both early and late mortality and rehospitalization.
- The most significant impact of complications was observed within the initial 90 days post-surgery.
- Findings emphasize the necessity for developing strategies to prevent complications and refine cost-adjustment methodologies.
Background:
The long-term effects of postoperative complications following coronary artery bypass grafting (CABG) are unknown.
Methods:
Medicare-linked records from the Society of Thoracic Surgeons Adult Cardiac Surgery Database were queried for isolated CABG records from 2007 through 2012. Unadjusted and adjusted associations between individual postoperative complications and both mortality and all-cause rehospitalization were evaluated to 7 years using Cox proportional-hazards models and cumulative incidence functions. Because of nonproportional hazards, associations are presented as early (0 to 90 days) and late (90 days to 7 years).
Results:
Of the 294,533 isolated CABG patients who had records linked to Medicare for long-term follow-up (median age, 73 years; 30% female), 120,721 (41%) experienced at least 1 of the complications of interest, including new-onset atrial fibrillation (30.0%), prolonged ventilation (12.3%), renal failure (4.5%), reoperation (3.5%), stroke (1.9%), and sternal wound infection (0.4%). Each of the 6 postoperative complications was associated with a significantly increased risk of mortality and rehospitalization to 7 years despite adjustment for baseline characteristics and the presence of multiple complications. Although the predominant effect of postoperative complications was observed in the first 90 days, the increased risk-adjusted hazard for death and rehospitalization continued through 7 years.
Conclusions:
Postoperative complications are associated with an increased risk of both early and late mortality and all-cause rehospitalization, particularly during the "value" window within 90 days of CABG. These findings underscore the need to develop avoidance strategies as well as cost-adjustment methods for each of these complications.
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