Eastern Cardiothoracic Surgical Society

In-Hospital Outcome and Complications of Coronary Artery Bypass Grafting in the United States Between 2008 and 2012
Elena Dolmatova, Kasra Moazzami, James Maher, Christine Gerula, Marc Klapholz, Justin Sambol,  Alfonso H. Waller,  Rutgers New Jersey Medical School, Newark, NJ


OBJECTIVE: To investigate the frequency and predictors of in-hospital complications among patients undergoing CABG in the United States (CABG).

METHODS: From 2008 to 2012, 1,970,661 CABG surgeries were identified using the National (Nationwide) Inpatient Sample database. Information regarding demographic details, including age, sex, race, insurance status, hospitalization outcome, total cost, and length of stay were collected. In-hospital complications including postoperative hemorrhage, cardiac complications (iatrogenic cardiac complications, pericardial complications, and acute myocardial infarction); pulmonary complications (pneumothorax, postoperative respiratory failure, and iatrogenic complications); neurological complications (stroke and transient ischemic attack); and postoperative infectious complications were investigated.

RESULTS: There was a 21.38% (P<0.001) decrease in the annual number of CABG surgeries between 2008 and 2012. The Deyo comorbidity index showed a steady increase from 2008 to 2012 (P<0.001). The rate of in-hospital mortality decreased by 34.8% during the study period (P<0.001). The most common in-hospital complication was postoperative hemorrhage (29.2%), followed by cardiac (11.89%) and respiratory complications (2.4%). During the 5-year period, the rates of in-hospital cardiac, respiratory and infectious complications decreased (P< 0.001), while the rate of postoperative hemorrhage showed a 36.1% relative increase in 2012 compared to 2008 (P<0.001). Cost of hospitalizations and length of stay remained stable from 2008 to 2012.

CONCLUSIONS: The annual number of CABG operations is declining in the United States. While the burden of comorbidities is increasing, the rates of mortality and most in-hospital complications are improving. The increasing rate of postoperative bleeding necessitates the need to develop strategies to improve the risk of bleeding in this patient population.