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Resternotomy Coronary Artery Bypass 1999-2018: Insights From The Society of Thoracic Surgeons Adult Cardiac Surgery
Nadav Rappoport1, Gal Aviel2, David M Shahian3
1Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Insights
The risk associated with resternotomy coronary artery bypass grafting (CABG) has significantly decreased over two decades. However, resternotomy CABG after a previous CABG remains a higher-risk procedure compared to non-CABG reoperations.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Surgical Risk Assessment
Background:
- Quantifying the evolving risk of resternotomy coronary artery bypass grafting (CABG) is crucial for surgical decision-making.
- Understanding trends in resternotomy CABG outcomes over the past two decades is essential for patient care.
- The Society of Thoracic Surgeons Adult Cardiac Surgery Database provides a robust platform for analyzing large-scale surgical outcomes.
Purpose of the Study:
- To quantify the risk trend of resternotomy coronary artery bypass grafting (CABG) over the past 20 years.
- To compare the in-hospital mortality and overall morbidity between resternotomy CABG and first-time CABG patients.
- To analyze the impact of prior cardiac surgery history on resternotomy CABG outcomes.
Main Methods:
- A retrospective analysis of 194,804 resternotomy CABG patients and 1,445,894 first-time CABG patients from 1999-2018.
- Utilized The Society of Thoracic Surgeons Adult Cardiac Surgery Database for patient data.
- Employed multiple logistic regression and propensity score matching to adjust for confounding factors and analyze risk trends.
Main Results:
- Resternotomy CABG case volume declined by 68% from 1999 to 2018.
- After propensity matching, in-hospital mortality (3.5% vs 2.3%) and morbidity (40.7% vs 40.3%) were similar between resternotomy and first-time CABG.
- Mortality was higher for resternotomy CABG after prior CABG (4.3%) compared to non-CABG (2.4%), though morbidity was similar.
- Risk-adjusted odds ratios for mortality and morbidity after resternotomy CABG significantly declined over the study period (P < .001).
Conclusions:
- The risk associated with resternotomy CABG has substantially decreased over the past two decades.
- Resternotomy CABG following a previous CABG procedure carries a higher risk than resternotomy CABG after a non-CABG operation.
- Ongoing monitoring and risk stratification are important for optimizing outcomes in resternotomy CABG patients.
Background:
We sought to quantify the risk trend of resternotomy coronary artery bypass grafting (CABG) over the past 2 decades.
Methods:
We compared the outcomes of 194 804 consecutive resternotomy CABG patients and 1 445 894 randomly selected first-time CABG patients (50% of total) reported to The Society of Thoracic Surgeons Adult Cardiac Surgery Database between 1999 and 2018. Primary outcomes were in-hospital mortality and overall morbidity. Using multiple logistic regression for each outcome for each year, we computed the annual trends of risk-adjusted odds ratios for the primary outcomes in the entire cohort and in 194 776 propensity-matched pairs.
Results:
The annual resternotomy CABG case volume from participating centers declined by 68%, from a median of 25 (range, 14-44) to a median of 8 (range, 4-15). Compared with first-time CABG, resternotomy CABG patients were consistently older, with higher proportions of comorbidities. After propensity matching, primary outcomes of resternotomy and first-time CABG were similar (mortality: 3.5% vs 2.3%, standardized difference [SDiff], 7.5%; morbidity: 40.7% vs 40.3%, SDiff, 0.9%). Mortality of resternotomy CABG performed after prior CABG was higher than that after prior non-CABG (4.3% vs 2.4%; SDiff, 10.8). Morbidity was similar between these subgroups (41.0% vs 39.1%; SDiff, 2.9). The adjusted odds ratio for mortality after resternotomy CABG declined from 1.93 (95% CI, 1.73-2.16) to 1.22 (95% CI, 0.92-1.62), and that of morbidity declined from 1.13 (95% CI, 1.08-1.18) to 0.91 (95% CI, 0.87-0.95), P < .001 for both.
Conclusions:
The risk of resternotomy CABG has decreased substantially over time. Resternotomy CABG performed after a prior CABG is higher risk compared with that performed after a non-CABG operation.
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