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Predictors and Outcomes of Nonvariceal Upper Gastrointestinal Bleed After Coronary Artery Bypass Grafting: A
Umesh Bhagat1, Ankit Agrawal1, Ahmad Safdar1
1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH USA.
Insights
Nonvariceal upper gastrointestinal bleeding (NVUGIB) readmissions after coronary artery bypass grafting (CABG) are associated with significant mortality. Early esophagogastroduodenoscopy is linked to improved outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Gastroenterology
- Health Services Research
Background:
- Upper gastrointestinal bleeding is a serious complication following coronary artery bypass grafting (CABG).
- Identifying risk factors and outcomes for nonvariceal upper gastrointestinal bleeding (NVUGIB) readmissions after CABG is crucial.
Purpose of the Study:
- To determine the incidence, predictors, and outcomes of 30-day NVUGIB readmissions after isolated CABG.
- To evaluate the impact of early esophagogastroduodenoscopy on mortality in readmitted patients.
Main Methods:
- Utilized the Nationwide Readmission Database (2016-2020) to identify patients undergoing isolated CABG.
- Employed International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to define the study cohort.
- Statistical analysis was performed using Stata 17.
Main Results:
- Of 801,221 isolated CABG patients, 5,180 (0.65%) were readmitted with NVUGIB within 30 days, with a 5.4% mortality rate.
- NVUGIB readmissions were associated with higher comorbidity burdens (e.g., atrial fibrillation) and increased blood transfusion rates.
- Key predictors for NVUGIB readmission included atrial fibrillation and age >65 years; female sex was linked to higher mortality.
Conclusions:
- NVUGIB readmissions post-CABG contribute significantly to patient morbidity and mortality.
- Early esophagogastroduodenoscopy (within 24 hours) demonstrated improved mortality outcomes, highlighting its importance in management.
Background:
Upper gastrointestinal bleeding is a severe postoperative complication after coronary artery bypass grafting. We aimed to identify the incidence, predictors, and outcomes of nonvariceal upper gastrointestinal bleeding (NVUGIB) readmissions within 30 days after coronary artery bypass grafting from a nationwide database.
Methods:
The Nationwide Readmission Database 2016 to 2020 was queried to identify patients who had isolated coronary artery bypass grafting and were readmitted with NVUGIB in 30 days. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System codes were used to identify the cohort. As the Nationwide Readmission Database is an anonymous public database, the study was exempt from the institutional review board. The analysis was conducted using Stata 17 (StataCorp LLC, College Station, TX).
Results:
Of 801 221 patients who underwent isolated coronary artery bypass grafting, 784 280 were discharged alive. Within 30 days, of the 5180 patients who were readmitted with a diagnosis of NVUGIB, the mortality rate was 5.4%. Compared with nonreadmitted patients, patients with NVUGIB had a lower proportion of women (25.4% versus 31.2%, P<0.001) but higher comorbidity burdens, such as atrial fibrillation (44.4% versus 39.1%, P<0.001), and blood transfusion (39.1% versus 6.0%, P<0.001). Key predictors for 30-day readmission with NVUGIB were atrial fibrillation (hazard ratio [HR], 1.31 [95% CI, 1.20-1.44]; P<0.001) and higher age (>65 years) (HR, 1.25 [95% CI, 1.01-1.53]; P=0.04). Female sex (odds ratio, 2.01 [95% CI, 1.28-3.17]; P=0.002) was strongly associated with death. Early (≤24 hours) esophagogastroduodenoscopy had better mortality outcomes (odds ratio, 0.23 [95% CI, 0.09-0.53]; P<0.001).
Conclusions:
NVUGIB readmissions after coronary artery bypass grafting are linked to significant morbidity and death. Early esophagogastroduodenoscopy is associated with improved outcomes, emphasizing its role in management.
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