Emergency and elective coronary artery bypass grafting: comparisons of risk profiles, postoperative outcomes, and resource requirements.
OBJECTIVE
To investigate the association between preoperative risk factors and postoperative outcomes in emergency and elective coronary artery bypass graft (CABG) patients and to quantify resource requirements.


METHODS
Retrospective database review.


METHODS
New York State SPARCS database.


METHODS
Data from 4,001 emergency and 7,489 elective CABG patients were evaluated retrospectively.


METHODS
Data were compared between groups using chi-squares, t tests, and logistic regression analysis.


RESULTS
Preoperatively, 47.1% of patients in the emergency group had unstable angina and 34.1% had acute myocardial infarction compared with 33.9% and 15.2% in the elective group, respectively (p < 0.0001). There were no marked differences in the preoperative noncardiac risk factors between groups. The mortality rate was 4.7% in the emergency group and 2.6% in the elective group (p < 0.0001). The emergency group had more postoperative cardiac complications (18.3% v 8.3%, p < 0.0001). The length of hospital stay in the emergency group was 17.5 +/- 15.8 days (median 14 days) compared with 12.9 +/- 15.1 days (median 9 days) in the elective group (p < 0.00001). Total hospital charges in the emergency and elective groups were 46,700 US dollars +/- 42,400 US dollars (median 35,600 US dollars ) and 34,800 US dollars +/- 36,400 US dollars (median 26,500 US dollars) (p < 0.00001), respectively. The median total cost was 26,300 US dollars for emergency and 19,600 US dollars for elective group (p < 0.00001).


CONCLUSIONS
Patients undergoing emergency CABG had greater postoperative morbidity and mortality, longer LOS, and higher total costs than patients undergoing elective surgery. This difference is predictable on the basis of preoperative cardiac risk factors. Emergency operations have a major impact on the rates of morbidity, mortality, and use of resources.
Department of Anesthesiology, Helsinki University Central Hospital, Finland.
Tuula S
TS
Kurki
Matti
M
Kataja
David L
DL
Reich
D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D001026:Coronary Artery Bypass / Q000191:economics; D017558:Elective Surgical Procedures / Q000191:economics; D004632:Emergency Medical Services / Q000191:economics; D005260:Female; D006295:Health Resources / Q000191:economics; D017722:Hospital Charges; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013223:Statistics as Topic; D016896:Treatment Outcome