How Long After Coronary Artery Bypass Surgery Can Patients Have Elective Safer Non-Cardiac Surgery?

Figures & data

Table 1 Characteristics of Surgical Patients with and without CABG (After Propensity-Score Matching)

	No CABG (N=2327)		CABG (N=2327)		Standardized Mean Difference
Sex	n	(%)	n	(%)	<0.01
Female	495	(21.3)	495	(21.3)
Male	1832	(78.7)	1832	(78.7)
Age, years					<0.01
20–29	5	(0.2)	5	(0.2)
30–39	10	(0.4)	10	(0.4)
40–49	67	(2.9)	67	(2.9)
50–59	353	(15.2)	353	(15.2)
60–69	880	(37.8)	880	(37.8)
70–79	762	(32.8)	762	(32.8)
≥80	250	(10.7)	250	(10.7)
Low income					<0.01
No	2301	(98.9)	2301	(98.9)
Yes	26	(1.1)	26	(1.1)
Medical conditions
Hypertension	752	(32.3)	752	(32.3)	<0.01
Diabetes	871	(37.4)	871	(37.4)	<0.01
Hyperlipidemia	130	(5.6)	130	(5.6)	<0.01
Heart failure	199	(8.6)	199	(8.6)	<0.01
Ischemic heart disease	1810	(77.8)	1810	(77.8)	<0.01
COPD	179	(7.7)	179	(7.7)	<0.01
Liver cirrhosis	25	(1.1)	25	(1.1)	<0.01
Parkinson’s disease	21	(0.9)	21	(0.9)	<0.01
Renal dialysis	203	(8.7)	203	(8.7)	<0.01
Types of surgery					<0.01
Skin	132	(5.7)	132	(5.7)
Breast	10	(0.4)	10	(0.4)
Musculoskeletal	669	(28.8)	669	(28.8)
Respiratory	136	(5.8)	136	(5.8)
Digestive	686	(29.5)	686	(29.5)
Kidney, ureter, bladder	245	(10.5)	245	(10.5)
Delivery, CS, abortion	3	(0.1)	3	(0.1)
Neurosurgery	280	(12.0)	280	(12.0)
Eye	32	(1.4)	32	(1.4)
Others	134	(5.8)	134	(5.8)
Types of anesthesia					<0.01
General	1792	(77.0)	1792	(77.0)
Epidural or Spinal	535	(23.0)	535	(23.0)

Abbreviation: CABG, coronary artery bypass grafting.

Table 2 Adverse Outcomes After Non-Cardiac Surgeries in Patients with and without Previous CABG

	No CABG (N=2327)		CABG (N=2327)		Risk of Outcomes
	Events	%	Event	%	OR	(95% CI)^a
30-day in-hospital mortality	21	0.9	47	2.0	2.28	(1.36–3.84)
Postoperative complications
Pulmonary embolism	3	0.1	3	0.1	1.00	(0.20–5.02)
Acute myocardial infarction	20	0.9	31	1.3	1.56	(0.89–2.75)
Acute renal failure	40	1.7	57	2.5	1.44	(0.96–2.17)
Pneumonia	88	3.8	127	5.5	1.49	(1.12–1.98)
Sepsis	127	5.5	182	7.8	1.49	(1.17–1.89)
Stroke	107	4.6	155	6.7	1.53	(1.17–1.99)
Urinary tract infection	175	7.5	164	7.1	0.93	(0.73–1.17)
Postoperative bleeding	14	0.6	19	0.8	1.36	(0.68–2.73)
Deep wound infection	11	0.5	10	0.4	0.91	(0.38–2.17)
ICU stay	379	16.3	563	24.2	1.75	(1.50–2.05)
Medical expenditure, USD‡	3677±5214		4322±6292		p=0.0001
Length of hospital stay, days‡	8.9±10.0		10.6±11.7		p<0.0001

Notes: ^aAdjusted for all covariates listed in Table 1. ^‡Prior CABG was associated with medical expenditure (beta=644, p=0.0001) and length of hospital stay (beta=1.71, p<0.0001) in the multiple linear regression.

Abbreviations: CABG, coronary artery bypass grafting; CI, confidence interval; OR, odds ratio.

Table 3 The Stratified Analysis for the Association Between Postoperative Adverse Events and Previous CABG

		n	Adverse Events*
			Events	Rate, %	OR	(95% CI)^†
Female	No CABG	495	59	11.9	1.00	(Reference)
	CABG	495	92	18.6	1.74	(1.21–2.51)
Male	No CABG	1832	224	12.2	1.00	(Reference)
	CABG	1832	334	18.2	1.64	(1.36–1.98)
Age 20–49 years	No CABG	82	4	4.9	1.00	(Reference)
	CABG	82	14	17.1	6.75	(1.59–28.6)
Age 50–59 years	No CABG	353	22	6.2	1.00	(Reference)
	CABG	353	58	16.4	3.31	(1.93–5.70)
Age 60–69 years	No CABG	880	99	11.3	1.00	(Reference)
	CABG	880	158	18.0	1.78	(1.35–2.35)
Age 70–79 years	No CABG	762	108	14.2	1.00	(Reference)
	CABG	762	139	18.2	1.37	(1.03–1.80)
Age ≥80 years	No CABG	250	50	20.0	1.00	(reference)
	CABG	250	57	22.8	1.19	(0.77–1.86)
0 medical condition	No CABG	148	14	9.5	1.00	(Reference)
	CABG	148	34	23.0	3.33	(1.62–6.88)
1 medical condition	No CABG	758	63	8.3	1.00	(Reference)
	CABG	758	127	16.8	2.31	(1.66–3.21)
2 medical conditions	No CABG	926	124	13.4	1.00	(Reference)
	CABG	926	159	17.2	1.36	(1.05–1.76)
≥3 medical conditions	No CABG	495	82	16.6	1.00	(Reference)
	CABG	495	106	21.4	1.39	(1.00–1.93)
Musculoskeletal surgery	No CABG	669	75	11.2	1.00	(Reference)
	CABG	669	106	15.8	1.50	(1.09–2.07)
Digestive surgery	No CABG	686	72	10.5	1.00	(Reference)
	CABG	686	102	14.9	1.50	(1.09–2.08)
Neurosurgery	No CABG	280	61	21.8	1.00	(Reference)
	CABG	280	91	32.5	1.78	(1.21–2.63)

Notes: *Adverse events included with 30-day in-hospital mortality, pneumonia, sepsis, and stroke. ^†Adjusted for all covariates listed in Table 1.

Abbreviations: CABG, coronary artery bypass grafting; CI, confidence interval; OR, odds ratio.

Table 4 The Risk of Postoperative Adverse Events Associated with the Characteristics of Previous CABG

	n	Adverse events*
		Events	Rate, %	OR	(95% CI)^†
No CABG	2327	283	12.2	1.00	(Reference)
Received CABG within preoperative
1 month	33	16	48.5	7.94	(3.70–17.0)
2 months	97	44	45.4	6.28	(3.96–9.96)
3 months	164	62	37.8	4.32	(2.99–6.23)
6 months	315	88	27.9	2.83	(2.11–3.80)
12 months	594	138	23.2	2.13	(1.68–2.70)
≥13 months	1733	288	16.6	1.47	(1.22–1.76)
Preoperative no heart valve surgery	2132	390	18.3	1.65	(1.39–1.95)
Preoperative heart valve surgery	195	36	18.5	1.73	(1.17–2.57)

Notes: *Adverse events included with 30-day in-hospital mortality, pneumonia, sepsis, and stroke. ^†Adjusted for all covariates listed in Table 1.

Abbreviations: CABG, coronary artery bypass grafting; CI, confidence interval; OR, odds ratio.