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Third coronary artery bypass operations: risks and costs
B W Lytle1, J L Navia, P C Taylor
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
The Annals of Thoracic Surgery
|December 5, 1997
Summary
Third coronary artery bypass operations carry increased risk, especially for patients 70 or older. However, outcomes for younger patients are favorable, with manageable hospital costs. This highlights age as a key predictor of success.
Area of Science:
- Cardiovascular Surgery
- Cardiac Reoperations
- Outcomes Research
Background:
- Third coronary artery bypass grafting (CABG) is a complex procedure with elevated risks.
- Identifying factors influencing outcomes is crucial for patient management.
Purpose of the Study:
- To analyze the outcomes and costs associated with third isolated coronary artery bypass operations.
- To identify preoperative and operative variables affecting patient results and healthcare expenditures.
Main Methods:
- Retrospective review of 469 patients undergoing a third isolated CABG.
- Univariate and multivariate analyses to assess risk factors and cost determinants.
Main Results:
- In-hospital mortality was 7.0%, significantly higher in patients aged 70+ with severe symptoms (14%).
- Long-term survival rates were 94% (1 year), 84% (5 years), and 66% (10 years).
- Advanced age (≥70), poor left ventricular function, and diabetes predicted decreased late survival. Mean costs were 21% higher than primary CABG, influenced by outliers and female sex.
Conclusions:
- Preoperatively identifiable factors, especially age ≥70, are linked to unfavorable outcomes in third CABG.
- Patients under 70 experienced low in-hospital mortality and favorable long-term survival.
- Increased hospital costs are primarily due to a few high-cost cases and are unpredictable.