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Cardio-pulmonary-bypass time has important independent influence on mortality and morbidity
R M Wesselink1, A de Boer, W J Morshuis
1Anaesthesiology and Intensive Care, St. Antonius Hospital, EM Nieuwegein, Netherlands. rmj.wesman@inter.nl.net
Insights
Longer cardio-pulmonary bypass times significantly increase hospital mortality and ICU complications in isolated CABG surgery. This study highlights bypass duration as a critical independent predictor of adverse postoperative outcomes.
Area of Science:
- Cardiothoracic Surgery
- Outcomes Research
Background:
- Coronary Artery Bypass Grafting (CABG) is a common cardiac surgery procedure.
- Minimizing cardiopulmonary bypass time is a key goal in CABG surgery to reduce patient morbidity and mortality.
Purpose of the Study:
- To investigate the independent impact of cardiopulmonary bypass time on hospital mortality and intensive care unit (ICU) morbidity in patients undergoing isolated CABG surgery.
Main Methods:
- Prospective data from 8578 isolated CABG operations (1985-1994) were analyzed.
- Multivariate logistic regression assessed seven variables, including cardiopulmonary bypass time (CPBT) categorized into four groups.
- Odds ratios were calculated for mortality, ICU length of stay, and eight ICU complications relative to CPBT.
Main Results:
- A significant correlation was observed between increased CPBT and adverse outcomes.
- Odds ratios for mortality increased substantially with longer CPBT categories (e.g., >3.5 hours: OR 20.7).
- Prolonged ICU stay and postoperative complications also showed a clear pattern of increasing odds ratios with longer CPBT.
Conclusions:
- Cardiopulmonary bypass time is a significant independent predictor of adverse postoperative events after isolated CABG.
- The findings underscore the importance of minimizing CPBT to improve patient outcomes.
- CPBT duration reflects both surgical challenges and physiological effects of bypass on the body.
Objective:
To determine the influence of cardio-pulmonary-bypass-time on hospital mortality and ICU-morbidity in isolated CABG surgery.
Methods:
Between 1985 and 1994 perioperative data of 8578 consecutive CABG operations were prospectively collected. Seven variables: gender, redo vs. primary operation, elective vs. urgent surgery, age in 4 categories, use of IMA, number of distal anastomoses (> 4 vs. < = 4), and cardio-pulmonary-bypass-time in four categories were entered in multivariate logistic regression analysis and odds ratios for respective cardio-pulmonary-bypass-time-categories with regard to mortality, length-of-stay in the ICU and 8 ICU-complications were calculated. Bypass-time up to 90 min was the reference category, the other categories were from 1.5 to 2.5 h, 2.5 to 3.5 h, and longer than 3.5 h.
Results:
8337 operations had complete data. Mortality and ICU-morbidity were low. The odds ratios for mortality were 2.3 (P = 0.0094), 7.4 (P < 0.0001) and 20.7 (P < 0.0001) for ascending bypass-time-categories. The odds ratios for prolonged ICU-stay were 1.8 (P = 0.0002), 3.3 (P < 0.0001) and 7.9 (P < 0.0001) for ascending bypass-time-categories. For postoperative complications the same pattern was found: consequently higher odds ratios for longer bypass-time-categories.
Conclusion:
The highly significant correlation between cardio-pulmonary-bypass-time-category and the occurrence of undesirable postoperative events is demonstrated by the consequent rise in odds ratios. This independent influence of cardio-pulmonary-bypass-time on outcome reflects both problems encountered during revascularisation and time-related influence of cardio-pulmonary-bypass on the human body. When a predictive model was created, CPBT proved to be a good predictor of undesirable postoperative events.