Worsening preoperative functional status increases morbidity and mortality in patients undergoing coronary artery bypass grafting: A propensity matched study of the ACS-NSQIP database

Abstract

Introduction: Dependent functional status is correlated with increased mortality in patient undergoing coronary artery bypass grafting (CABG). However, patients who are partially dependent and totally dependent may have different peri‑operative outcome profiles. This study aims to retrospectively examine the effect of different levels of functional dependency on post-CABG morbidity and mortality. Methods: Patients who underwent a CABG from 2005 to 2021 were identified in the ACS-NSQIP database. Subjects were stratified into independent (IFS), partially dependent (PDFS), and totally dependent functional status (TDFS). A 5:1 propensity matching between IFS and each functional dependent group was performed, respectively. The 30-day peri‑operative outcomes of PDFS and TDFS were compared to that of IFS. Peri-operative outcomes between PDFS and TDFS were compared using multivariable logistic regression, adjusted for demographics and co-morbidities. Results: There were 968 PDFS with 4779 matched IFS and 247 TDFS with 1202 matched IFS. Compared to IFS, PDFS and TDFS had higher mortality, sepsis, bleeding, and length of stay>7 days. TDFS have higher MACE, cardiac/pulmonary/renal complications, and OR return than IFS. Compared to PDFS, TDFS had higher mortality (aOR 1.68, p = 0.03), higher risk of MACE (aOR 1.88, p<0.01), cardiac events (aOR 2.74, p<0.01), perioperative sepsis (aOR 1.73, p = 0.03), pulmonary complications (aOR 2.16, p<0.01), and returning to OR (aOR 1.68, p = 0.02). Conclusion: Our study shows that dependent functional status is associated with increased morbidity and mortality after CABG. Additional post-CABG complication monitoring and care may be required for TDFS.

Keywords

• Coronary artery bypass grafting
• Functional status
• Clinical outcomes