Related Experiment Video
Updated: Dec 2, 2025
Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Wound complications and 30-day readmissions after single and bilateral internal mammary grafting: Analysis of the
Sameer Hirji1, Rohan Shah1, Shawn Shah2
1Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Insights
Bilateral internal mammary artery (BIMA) grafting does not independently predict 30-day readmissions after coronary artery bypass graft (CABG) surgery. Cardiovascular issues are the main reason for readmissions in both BIMA and single internal mammary artery (SIMA) patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Outcomes Research
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure.
- The choice between bilateral internal mammary artery (BIMA) and single internal mammary artery (SIMA) grafting is debated.
- Understanding postoperative outcomes and readmission rates is crucial for patient care.
Purpose of the Study:
- To compare postoperative outcomes between BIMA and SIMA grafting during CABG.
- To evaluate 30-day readmission rates, including those related to sternal wound infections.
- To identify predictors of 30-day readmission after CABG.
Main Methods:
- Utilized the 2013-2014 National Readmission Database.
- Included adult patients who underwent CABG with SIMA (n=279,891) or BIMA (n=11,651).
- Employed propensity matching and multivariable Cox proportional hazards analysis.
Main Results:
- No significant differences in index hospitalization outcomes, except higher costs for BIMA.
- Comparable wound infection rates (1.1% BIMA vs. 1.2% SIMA).
- Elevated overall 30-day readmissions in SIMA patients (9.5% vs. 8.8%), driven by cardiovascular causes. Higher infection-related readmissions for BIMA (20.4% vs. 15.9%).
Conclusions:
- Bilateral internal mammary artery (BIMA) grafting is not an independent predictor of all-cause 30-day readmissions.
- Cardiovascular causes are the primary driver of 30-day readmissions for both SIMA and BIMA patients.
- Sternal wound infections during index hospitalization did not predict all-cause 30-day readmission in BIMA patients.
Background:
This study compares the postoperative outcomes, 30-day readmission rates, and incidence of sternal wound infection-related readmissions between patients receiving bilateral internal mammary arteries (BIMA) and single internal mammary artery (SIMA) grafting during coronary artery bypass graft (CABG) surgery.
Methods:
We utilized the weighted 2013-2014 National Readmission Database claims to identify all US adult patients who underwent CABG utilizing SIMA (n = 279,891) or BIMA (n = 11,651). Thirty-day overall and wound-related readmissions, in-hospital outcomes, costs, lengths of stay (LOS) at readmissions were compared between the two groups. Predictors of 30-day readmission were assessed using multivariable Cox proportional hazards analysis.
Results:
After propensity matching (n = 10,339 pairs), there were no significant differences between the two groups during the index hospitalization, except for higher total hospital costs in the BIMA group (p = .02). The incidence of wound infections was also comparable between BIMA and SIMA (1.1% vs. 1.2%; p = .50). At 30-days, the overall readmission rate was elevated in SIMA patients (9.5% vs. 8.8%; p < .01), primarily impacted by cardiovascular causes. While the proportion of 30-day readmissions due to infections was significantly higher among BIMA versus SIMA patients (20.4% vs. 15.9%; p < .01), wound infections during the index hospitalization did not predict all-cause 30-day readmission among BIMA patients (p = .24) in the risk-adjusted analysis. Among the readmitted patients, LOS (6.4 vs. 6.2 days), costs ($14,440 vs. $16,461), and in-hospital mortality (2.4% vs. 1.7%) were comparable between the two groups (all p > .05).
Conclusions:
BIMA grafting is not an independent predictor of all-cause 30-day readmissions. Cardiovascular causes remain the primary driver of 30-day readmissions among SIMA and BIMA patients after CABG.
Related Concept Videos
01:26Aneurysm III: Interprofessional Care
01:23Peripheral Artery Disease V: Postoperative Nursing Management