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

Abstract

Li-Chin Sung,1– 4 Chuen-Chau Chang,5– 7 Chun-Chieh Yeh,8,9 Yih-Giun Cherng,5,10 Ta-Liang Chen,5,7,11 Chien-Chang Liao5– 7,12,13 1Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 2Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 3Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; 4Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 5Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 6Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 7Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 8Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 9Department of Surgery, University of Illinois, Chicago, IL, USA; 10Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; 11Department of Anesthesiology, Wang Fang Hospital, Taipei Medical University, Taipei, Taiwan; 12Research Center of Big Data and Meta‑Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 13School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, TaiwanCorrespondence: Chien-Chang Liao, Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 11031, Taiwan, Tel [phone], ext. 8310, Fax [phone], Email [email protected]; [email protected]: To evaluate the complications and mortality after noncardiac surgeries in patients who underwent previous coronary artery bypass grafting (CABG).Methods: We used insurance data and identified patients aged ≥ 20 years undergoing noncardiac surgeries between 2010 and 2017 in Taiwan. Based on propensity-score matching, we selected an adequate number of patients with a previous history of CABG (within preoperative 24 months) and those who did not have a CABG history, and both groups had balanced baseline characteristics. The association of CABG with the risk of postoperative complications and mortality was estimated (odds ratio [OR] and 95% confidence interval [CI]) using multiple logistic regression analysis.Results: The matching procedure generated 2327 matched pairs for analyses. CABG significantly increased the risks of 30-day in-hospital mortality (OR 2.28, 95% CI 1.36– 3.84), postoperative pneumonia (OR 1.49, 95% CI 1.12– 1.98), sepsis (OR 1.49, 95% CI 1.17– 1.89), stroke (OR 1.53, 95% CI 1.17– 1.99) and admission to the intensive care unit (OR, 1.75, 95% CI 1.50– 2.05). The findings were generally consistent across most of the evaluated subgroups. A noncardiac surgery performed within 1 month after CABG was associated with the highest risk for adverse events, which declined over time.Conclusion: Prior history of CABG was associated with postoperative pneumonia, sepsis, stroke, and mortality in patients undergoing noncardiac surgeries. Although we raised the possibility regarding deferral of non-critical elective noncardiac surgeries among patients had recent CABG when considering the risks, critical or emergency surgeries were not in the consideration of delay surgery, especially cancer surgery.Keywords: adverse events, coronary artery bypass surgery, noncardiac surgeries, postoperative complications, postoperative mortality

Keywords

• adverse events
• coronary artery bypass surgery
• noncardiac surgeries
• postoperative complications
• postoperative mortality