Preoperative dementia in patients undergoing coronary artery bypass grafting: A propensity-matched analysis

As the US population ages and the burden of dementia increases, an increasing number of patients with dementia will be evaluated by surgeons for coronary artery bypass grafting. Currently, there is little evidence on how dementia changes preoperative risk stratification. This study aims to characterize baseline characteristics and outcomes in patients with dementia who underwent CABG.

We used data from the National Inpatient Sample database from 2008 to 2018 for patients ≥18 years old who underwent coronary artery bypass grafting. Patients were divided into 2 groups on the basis of dementia diagnosis. A propensity-matched analysis was used to account for attributable risk of dementia. Our primary outcome was in-hospital mortality. Secondary outcomes included postoperative delirium, length of stay, and total charges submitted to payors.

Of 522,949 total patients who met inclusion criteria, 8,487 carried a preoperative diagnosis of dementia. There was not a significant difference in 30-day mortality when compared with patients without dementia who had a coronary artery bypass grafting (odds ratio, 0. 834; P = .17). Dementia patients had longer length of stay (estimated treatment effect = 0.522 days, P < .01) and greater total charges submitted to payors (estimated treatment effect = $8,371, P = .00135). They were also significantly more likely to experience postop delirium (OR, 3.9; P < .001) and were more likely to be discharged to a nursing facility after their index hospitalization (41% vs 17%, P < .01).

Our study suggests that patients with dementia are at no greater risk for postoperative mortality but have significantly greater length of stay, costs, and risk of delirium. In carefully selected patients, dementia should not be a contraindication for coronary artery bypass grafting.