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Association Between Chronic Liver Disease and Adverse In-Hospital Outcomes in Patients Undergoing CABG: A Propensity
Bekure B Siraw1, Parth Patel1, Abdulrahim Y Mehadi2
1Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, Illinois.
Insights
Patients with chronic liver disease (CLD) undergoing coronary artery bypass graft (CABG) surgery face significantly higher in-hospital mortality and complications, especially those with cirrhosis. Tailored care is crucial for this high-risk group.
Area of Science:
- Cardiovascular Surgery
- Hepatology
- Critical Care Medicine
Background:
- Coronary artery bypass graft (CABG) surgery, despite declining rates, still carries significant risks.
- Advancements in medicine increase survival for patients with chronic liver disease (CLD), leading to more frequent consideration for CABG.
- CLD patients undergoing CABG face elevated perioperative risks, necessitating further investigation into associated outcomes.
Purpose of the Study:
- To investigate the association between chronic liver disease (CLD) and in-hospital outcomes in patients undergoing coronary artery bypass graft (CABG) surgery.
- To compare outcomes between CLD patients (with and without cirrhosis) and non-CLD patients undergoing CABG.
Main Methods:
- Retrospective analysis of the National Inpatient Sample database (2016-2020).
- Included 7,945 CLD patients who underwent CABG, propensity score-matched with an equal number of non-CLD patients.
- Utilized International Classification of Diseases, Tenth Revision codes for data extraction and multivariable logistic/linear regression for outcome assessment (mortality, complications, length of stay).
Main Results:
- Overall in-hospital mortality was 5.5% (2.8% non-CLD, 5.9% CLD without cirrhosis, 8.6% CLD with cirrhosis).
- CLD with cirrhosis significantly increased odds of mortality (aOR=4.21) and length of stay (β=1.03).
- CLD patients, particularly those with cirrhosis, experienced higher rates of cardiac complications, thromboembolic events, gastrointestinal bleeding, acute kidney injury, pneumonia, and sepsis.
Conclusions:
- Chronic liver disease substantially increases adverse in-hospital outcomes following coronary artery bypass graft surgery.
- Cirrhosis in CLD patients undergoing CABG is a strong predictor of mortality and prolonged hospital stay.
- Emphasizes the critical need for specialized preoperative evaluations and postoperative management strategies for CLD patients undergoing CABG.
Abstract:
Despite a 30% decrease in the rate over the last decade, coronary artery bypass graft (CABG) surgery remains a common major surgical procedure with significant morbidity and mortality. Chronic liver disease (CLD) patients, with increased survival rates because of medical advancements, are now frequently being considered for CABG, bearing higher perioperative risks. This study investigates the association between CLD and in-hospital outcomes in CABG patients using retrospective data from the National Inpatient Sample database (2016 to 2020) including 7,945 CLD patients who underwent CABG that were propensity score-matched with an equivalent number of patients without CLD who underwent CABG. Clinical variables were extracted using corresponding International Classification of Diseases, Tenth Revision codes, and multivariable logistic and linear regression models were used to assess in-hospital mortality, complications, and length of stay. The overall mortality rate was 5.5% (8.6% in the CLD group with cirrhosis, 5.9% CLD group without cirrhosis, and 2.8% in the non-CLD group, p <0.001). CLD with cirrhosis was associated with higher odds of mortality (adjusted odds ratio = 4.21, 95% confidence interval 3.61 to 4.94) and length of stay (β = 1.03, 95% confidence interval 1.01 to 1.05). CLD patients with cirrhosis demonstrated higher odds of perioperative cardiac complications (cardiac arrest, ventricular arrhythmias, tamponade, and shock), thromboembolic events, gastrointestinal bleeding, bowel ischemia, acute kidney injury, pneumonia, and sepsis. This study reveals a substantial impact of CLD on adverse outcomes in CABG patients, emphasizing the need for tailored preoperative assessments and postoperative care.
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