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Published on: March 27, 2018
Left Upper Lobectomy After Coronary Artery Bypass Grafting: A National Analysis of Postoperative Outcomes
Arman Ashrafi1, Li Ding2, Alexander T Kim1
1Division of Thoracic Surgery, Keck School of Medicine, The University of Southern California, Los Angeles, California.
Insights
History of coronary artery bypass grafting (CABG) does not increase mortality or complications after left upper lobectomy. Thoracoscopic surgery may offer better outcomes for these patients compared to thoracotomy.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Pulmonary Oncology
Background:
- Assessing the impact of prior coronary artery bypass grafting (CABG) on outcomes following left upper lobectomy is crucial for surgical decision-making.
- Previous CABG is a common comorbidity in patients undergoing thoracic procedures.
Purpose of the Study:
- To investigate whether a history of CABG is a risk factor for adverse postoperative outcomes in patients undergoing left upper lobectomy.
- To evaluate the association between prior CABG and mortality, morbidity, and quality metrics.
Main Methods:
- Utilized the Nationwide Readmissions Database (2016-2018) to identify patients undergoing left upper lobectomy.
- Categorized patients based on a history of CABG and analyzed sociodemographic factors, comorbidities, and hospital characteristics.
- Employed univariable and multivariable regression analyses to assess outcomes.
Main Results:
- Of 11,118 patients, 4.2% had a history of CABG. Bivariate analysis showed higher rates of postoperative myocardial infarction and atrial fibrillation in the CABG group.
- Multivariable analysis found no significant association between prior CABG and in-hospital mortality, cardiovascular or pulmonary complications, length of stay, or readmission rates.
- Thoracoscopy was associated with better outcomes than thoracotomy, irrespective of CABG history. Patients with prior CABG incurred higher, though not statistically significant, additional charges.
Conclusions:
- A history of CABG is not associated with increased mortality, morbidity, or length of stay after left upper lobectomy.
- Thoracoscopic left upper lobectomy may be a preferred approach, offering improved outcomes compared to thoracotomy in patients with prior CABG.
- Further investigation into cost implications is warranted.
Background:
To determine whether previous coronary artery bypass grafting (CABG) is a risk factor for postoperative mortality, morbidity, or worse quality metrics in patients undergoing left upper lobectomy.
Methods:
Using International Classification of Diseases 10th revision codes, the Healthcare Cost and Utilization Project Nationwide Readmissions Database was queried for patients with pulmonary neoplasms undergoing left upper lobectomy from 2016 to 2018 and categorized by history of CABG. Sociodemographic factors, comorbidities, and hospital characteristics were analyzed using univariable and multivariable regressions.
Results:
A total of 11,118 patients met inclusion criteria, of whom 465 (4.2%) had a history of CABG. On bivariate analysis, postoperative myocardial infarction and atrial fibrillation rates were higher (P < .004) in patients with prior CABG. However, multivariable modeling revealed no association between history of CABG and worse outcomes across all metrics: in-hospital mortality (odds ratio [OR], 0.806; P = .563), cardiovascular complications (OR, 0.826; P = .0985), pulmonary complications (OR, 0.849; P = .154), length of stay (relative risk, 0.982; P = .619), 30-day readmission (OR, 1.057; P = .747), and 90-day readmission (OR, 1.137; P = .396). Thoracotomy patients experienced worse outcomes across all metrics (P < .05) compared with thoracoscopy. Prior CABG was not associated with worse outcomes in either thoracoscopy or thoracotomy subgroup analyses. Although not statistically significant (P = .255), patients with previous CABG had approximately $6500 in additional charges.
Conclusions:
Prior CABG in patients undergoing left upper lobectomy is not associated with increased mortality, morbidity, length of stay, readmissions, or increased hospital charges. Thoracoscopy may be preferred in this population and is associated with improved outcomes compared with thoracotomy.
