JTCVS Open (Dec 2023)

Nonelective coronary artery bypass graft outcomes are adversely impacted by Coronavirus disease 2019 infection, but not altered processes of care: A National COVID Cohort Collaborative and National Surgery Quality Improvement Program analysisCentral MessagePerspective

  • Emily A. Grimsley, MD,
  • Johnathan V. Torikashvili, BS,
  • Haroon M. Janjua, MS,
  • Meagan D. Read, MD,
  • Anai N. Kothari, MD, MS,
  • Nate B. Verhagen, BS,
  • Ricardo Pietrobon, MD, PhD,
  • Paul C. Kuo, MD, MS, MBA,
  • Michael P. Rogers, MD, MS,
  • Adam B. Wilcox,
  • Adam M. Lee,
  • Alexis Graves,
  • Alfred (Jerrod) Anzalone,
  • Amin Manna,
  • Amit Saha,
  • Amy Olex,
  • Andrea Zhou,
  • Andrew E. Williams,
  • Andrew Southerland,
  • Andrew T. Girvin,
  • Anita Walden,
  • Anjali A. Sharathkumar,
  • Benjamin Amor,
  • Benjamin Bates,
  • Brian Hendricks,
  • Brijesh Patel,
  • Caleb Alexander,
  • Carolyn Bramante,
  • Cavin Ward-Caviness,
  • Charisse Madlock-Brown,
  • Christine Suver,
  • Christopher Chute,
  • Christopher Dillon,
  • Chunlei Wu,
  • Clare Schmitt,
  • Cliff Takemoto,
  • Dan Housman,
  • Davera Gabriel,
  • David A. Eichmann,
  • Diego Mazzotti,
  • Don Brown,
  • Eilis Boudreau,
  • Elaine Hill,
  • Elizabeth Zampino,
  • Emily Carlson Marti,
  • Emily R. Pfaff,
  • Evan French,
  • Farrukh M. Koraishy,
  • Federico Mariona,
  • Fred Prior,
  • George Sokos,
  • Greg Martin,
  • Harold Lehmann,
  • Heidi Spratt,
  • Hemalkumar Mehta,
  • Hongfang Liu,
  • Hythem Sidky,
  • J.W. Awori Hayanga,
  • Jami Pincavitch,
  • Jaylyn Clark,
  • Jeremy Richard Harper,
  • Jessica Islam,
  • Jin Ge,
  • Joel Gagnier,
  • Joel H. Saltz,
  • Joel Saltz,
  • Johanna Loomba,
  • John Buse,
  • Jomol Mathew,
  • Joni L. Rutter,
  • Julie A. McMurry,
  • Justin Guinney,
  • Justin Starren,
  • Karen Crowley,
  • Katie Rebecca Bradwell,
  • Kellie M. Walters,
  • Ken Wilkins,
  • Kenneth R. Gersing,
  • Kenrick Dwain Cato,
  • Kimberly Murray,
  • Kristin Kostka,
  • Lavance Northington,
  • Lee Allan Pyles,
  • Leonie Misquitta,
  • Lesley Cottrell,
  • Lili Portilla,
  • Mariam Deacy,
  • Mark M. Bissell,
  • Marshall Clark,
  • Mary Emmett,
  • Mary Morrison Saltz,
  • Matvey B. Palchuk,
  • Melissa A. Haendel,
  • Meredith Adams,
  • Meredith Temple-O'Connor,
  • Michael G. Kurilla,
  • Michele Morris,
  • Nabeel Qureshi,
  • Nasia Safdar,
  • Nicole Garbarini,
  • Noha Sharafeldin,
  • Ofer Sadan,
  • Patricia A. Francis,
  • Penny Wung Burgoon,
  • Peter Robinson,
  • Philip R.O. Payne,
  • Rafael Fuentes,
  • Randeep Jawa,
  • Rebecca Erwin-Cohen,
  • Rena Patel,
  • Richard A. Moffitt,
  • Richard L. Zhu,
  • Rishi Kamaleswaran,
  • Robert Hurley,
  • Robert T. Miller,
  • Saiju Pyarajan,
  • Sam G. Michael,
  • Samuel Bozzette,
  • Sandeep Mallipattu,
  • Satyanarayana Vedula,
  • Scott Chapman,
  • Shawn T. O'Neil,
  • Soko Setoguchi,
  • Stephanie S. Hong,
  • Steve Johnson,
  • Tellen D. Bennett,
  • Tiffany Callahan,
  • Umit Topaloglu,
  • Usman Sheikh,
  • Valery Gordon,
  • Vignesh Subbian,
  • Warren A. Kibbe,
  • Wenndy Hernandez,
  • Will Beasley,
  • Will Cooper,
  • William Hillegass,
  • Xiaohan Tanner Zhang

Journal volume & issue
Vol. 16
pp. 342 – 352

Abstract

Read online

Objective: The effects of Coronavirus disease 2019 (COVID-19) infection and altered processes of care on nonelective coronary artery bypass grafting (CABG) outcomes remain unknown. We hypothesized that patients with COVID-19 infection would have longer hospital lengths of stay and greater mortality compared with COVID-negative patients, but that these outcomes would not differ between COVID-negative and pre-COVID controls. Methods: The National COVID Cohort Collaborative 2020-2022 was queried for adult patients undergoing CABG. Patients were divided into COVID-negative, COVID-active, and COVID-convalescent groups. Pre-COVID control patients were drawn from the National Surgical Quality Improvement Program database. Adjusted analysis of the 3 COVID groups was performed via generalized linear models. Results: A total of 17,293 patients underwent nonelective CABG, including 16,252 COVID-negative, 127 COVID-active, 367 COVID-convalescent, and 2254 pre-COVID patients. Compared to pre-COVID patients, COVID-negative patients had no difference in mortality, whereas COVID-active patients experienced increased mortality. Mortality and pneumonia were higher in COVID-active patients compared to COVID-negative and COVID-convalescent patients. Adjusted analysis demonstrated that COVID-active patients had higher in-hospital mortality, 30- and 90-day mortality, and pneumonia compared to COVID-negative patients. COVID-convalescent patients had a shorter length of stay but a higher rate of renal impairment. Conclusions: Traditional care processes were altered during the COVID-19 pandemic. Our data show that nonelective CABG in patients with active COVID-19 is associated with significantly increased rates of mortality and pneumonia. The equivalent mortality in COVID-negative and pre-COVID patients suggests that pandemic-associated changes in processes of care did not impact CABG outcomes. Additional research into optimal timing of CABG after COVID infection is warranted.

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