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J Thorac Cardiovasc Surg 2007;134:53-58
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Effect of complications on mortality after coronary artery bypass grafting surgery: Evidence from New York State

Laurent G. Glance, MDa,*, Turner M. Osler, MD, FACSb, Dana B. Mukamel, PhDc, Andrew W. Dick, PhDd

a University of Rochester School of Medicine, Rochester, NY
b University of Vermont Medical College, Burlington, Vt
c Center for Health Policy Research, University of California, Irvine, Calif
d RAND, Pittsburgh, Pa.

Received for publication January 2, 2007; accepted for publication February 12, 2007.

* Address for reprints: Laurent G. Glance, MD, Department of Anesthesiology, University of Rochester Medical Center, 601 Elmwood Ave, Box 604, Rochester, NY 14642. (Email: Laurent_Glance{at}urmc.rochester.edu).

Objective: Complications are associated with increased risk of death. The objective of this study is to quantify the increased odds of dying from complications after isolated coronary artery bypass grafting surgery.

Methods: We conducted a retrospective cohort study using the New York State Coronary Artery Bypass Grafting Surgery Reporting System for all patients undergoing isolated coronary artery bypass grafting surgery in New York State who were discharged between 1997 and 1999 (51,750 patients; 2.20% mortality). We estimated the independent effect of individual postoperative complications on in-hospital mortality after controlling for patient clinical risk factors and demographics.

Results: The mortality rate for patients without complication was 0.77% versus 16.1% for patients with complications (P < .001). After adjusting for preoperative risk factors, transmural myocardial infarction (adjusted odds ratio, 7.90; P < .001), respiratory failure (adjusted odds ratio, 6.02; P < .001), renal failure (adjusted odds ratio, 7.15; P < .001), and stroke within 24 hours (adjusted odds ratio, 4.09; P < .001) were the most strongly associated with mortality.

Conclusions: There is a strong association between postoperative complications and in-hospital mortality. Complications after isolated coronary artery bypass grafting surgery are associated with a 1.4- to 8-fold increase in the odds of death after adjusting for severity of disease and comorbidities. This information might prove valuable to hospitals in their efforts to design quality improvement initiatives and care protocols to improve mortality after coronary artery bypass grafting surgery.

Abbreviations and Acronyms ACC = American College of Cardiology; AHA = American Heart Association; CABG = coronary artery bypass grafting; CSRS = Coronary Artery Bypass Surgery Reporting System; NYS = New York State; OR = odds ratio






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