title: Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group.
abstract: BACKGROUND
  Although dialysis patients are undergoing CABG with increasing frequency, large studies specifically comparing patient characteristics and procedure-related risks in this population have not been performed.
  
  
  RESULTS
  We conducted a regional prospective cohort study of 15,500 consecutive patients undergoing CABG in northern New England from 1992 to 1997. We used multiple logistic regression analysis to examine associations between preoperative dialysis-dependent renal failure and postoperative events and to adjust for potentially confounding variables. The 279 dialysis-dependent renal failure patients (1.8%) were 4.4 times more likely to experience in-hospital mortality than were other CABG patients (12.2% versus 3.0%, respectively; P:<0.001). Dialysis-dependent renal failure patients were older and had more comorbidities and more severe cardiac disease than did other CABG patients. After adjusting for these factors in multivariate analysis, however, dialysis-dependent renal failure patients remained 3.1 times more likely to die after CABG (adjusted odds ratio [OR] 3.1, 95% CI 2.1 to 4.7; P:<0.001). Dialysis-dependent renal failure patients compared with other CABG patients also had a substantially increased risk of postoperative mediastinitis (3.6% versus 1.2%, respectively; adjusted OR 2.4, 95% CI 1.2 to 4.7; P:=0.011) and postoperative stroke (4.3% versus 1.7%, respectively; adjusted OR 2. 1, 95% CI 1.1 to 3.9; P:=0.016), even after controlling for potentially confounding variables. Risks of reexploration for bleeding were similar for patients with and without dialysis-dependent renal failure.
  
  
  CONCLUSIONS
  Preoperative dialysis-dependent renal failure is a strong independent risk factor for in-hospital mortality and mediastinitis after CABG.
authors: Departments of Surgery, Medicine, Community and Family Medicine, and the Center for the Evaluative and Clinical Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors: J Y
authors: JY
authors: Liu
authors: N J
authors: NJ
authors: Birkmeyer
authors: J H
authors: JH
authors: Sanders
authors: J R
authors: JR
authors: Morton
authors: H F
authors: HF
authors: Henriques
authors: S J
authors: SJ
authors: Lahey
authors: R W
authors: RW
authors: Dow
authors: C
authors: C
authors: Maloney
authors: A W
authors: AW
authors: DiScipio
authors: R
authors: R
authors: Clough
authors: B J
authors: BJ
authors: Leavitt
authors: G T
authors: GT
authors: O'Connor
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011446:Prospective Studies; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000150:complications / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome