Years of Life Lost After Complications of Coronary Artery Bypass Operations

摘要

Background We currently have an incomplete understanding of which postoperative complications after coronary artery bypass grafting (CABG) are associated with long-term death. The purpose of this study was to find the associations between complications and attributable death.;Methods Prospectively collected data on patient characteristics, risk factors, and complications of patients undergoing isolated CABG with 20-year follow-up were analyzed with a Cox regression model to calculate the overall hazard of dying associated with each postoperative complication. An individual’s age and hazard of dying from each complication were then used to calculate years of life lost to each complication.;Results The postoperative mortality rate was 0.79% (69 of 8,773) at 30 days, 2.85% (250 of 8,773) at 180 days, and 6.38% (560 of 8,773) at 2 years. At a median follow-up of 9.8 years, 1,891 patients (21.6%) had died. Postoperative complications occurred in 3,438 patients (39.2%). Cardiac arrest (hazard ratio, 2.153), reoperation (hazard ratio, 1.679), and new dialysis (hazard ratio, 1.64) were the complications with the greatest hazard of death. After adjusting for complication incidence and patient age, cardiac arrest (703 years), reoperation (544 years), atrial fibrillation (470 years), and prolonged mechanical ventilation (371 years) were associated with the greatest number of years of life lost.;Conclusions Acute cardiac arrest, reoperation for other cardiac reasons, new dialysis, atrial fibrillation, and prolonged mechanical ventilation are associated with the largest increase in attributable deaths. Prevention and treatment of these complications may improve mortality rates after cardiac operations.;The Society of Thoracic Surgeons Quality Measurement Task Force chose death after coronary artery bypass graft (CABG) operations as a key national benchmark for comparison of perioperative care [1, 2, 3]. The operative mortality rate (defined as death during index admission or out-of-hospital death within 30 days) after CABG is 1% to 3% [2, 4, 5]. The annual mortality rate after CABG operations ranges from 2.7% to 4.2% [6, 7, 8], which leads to 9% to 10.2%, 26.4%, and 64.4% of patients having died at 5, 10, and 20 years, respectively [6, 9, 10].A problem with using just the operative mortality rate as the quality benchmark is that it does not account for deaths that occur more than 30 days after discharge or provide insight into the cause of death. Complications will?occur in half of patients undergoing cardiac operations, and although most—particularly the most common complications—rarely lead to death during the same hospitalization, they may be associated with increased late death [11][11]. Consequently, such complications, especially if common (eg, postoperative atrial fibrillation), may have a large effect on the total years of life lost. Such attributable loss of life may be more significant for younger patients. Therefore, the long-term effect of various postoperative complications must be understood to optimally guide future improvement efforts. Because complications may be preventable (or more optimally treated), complications associated with more years of life lost may be prime candidates for deployment of targeted efforts.Our study tested the hypothesis that the years of life lost attributable to different postoperative complications will vary considerably. Consequently, attributable death and years of life lost may be reduced by targeting care improvement and complication reduction efforts toward those complications with the largest effects on late death.Jump to SectionPatients and MethodsData CollectionStatistical AnalysisResultsCommentReferences;Institutional Review Board approval and waiver of informed consent was obtained for this project from Mercy St. Vincent Medical Center, Toledo, Ohio, and from the University of Michigan, Ann Arbor, Michigan (HUM00108370). This study is a retrospective analysis of existing registry data