Coronary artery bypass grafting in patients with dialysis-dependent end stage renal disease: a prospective, nested case-control study.
OBJECTIVE
To assess if coronary artery bypass grafting (CABG) patients with dialysis-dependent end stage renal disease (ESRD) experience greater intraoperative and postoperative morbidity and mortality compared to CABG patients without ESRD.


METHODS
We conducted a nested case-control study from an 8-year hospitalization cohort in which data were collected prospectively. Inclusion criteria included CABG surgery and age greater than 18 years. Cases were patients with dialysis dependent ESRD (N = 28) and controls were patients without ESRD (N = 84). Cases were matched to controls 1:3 on age, gender, tobacco history, and New York Heart Association Functional Class. The outcomes of interest were mortality, intensive care unit length of stay, total length of hospitalization, time on the ventilator, wound complications, pulmonary complications, neurological complications, gastrointestinal complications, arrhythmia, and intraoperative complications. Using logistic regression we controlled for 13 potential confounding variables.


RESULTS
There were no significant differences between the groups with the exception of total length of hospitalization. Patients with dialysis-dependent ESRD had a significantly longer total hospitalization stay (21%) than patients without ESRD. There were no significant differences for the remaining nine outcomes of interest, including perioperative morbidity or mortality.


CONCLUSIONS
Intraoperative and postoperative morbidity and mortality for CABG were not increased for patients with dialysis-dependent ESRD compared to patients without ESRD. However, patients on dialysis undergoing CABG experienced a greater length of hospitalization than patients undergoing CABG who were not on dialysis.
Powell
Kevin L
KL
Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA.
Smith
J Michael
JM
Woods
Scott E
SE
Hendy
Mary Pat
MP
Engel
Amy M
AM
Hiratzka
Loren F
LF
D016022:Case-Control Studies; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000706:statistics & numerical data; D003956:Dialysis; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D009820:Ohio / Q000453:epidemiology; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome