title: Morbidity and mortality following coronary artery bypass graft surgery in patients with cirrhosis: a population-based study.
abstract: BACKGROUND
  The risk of cardiac surgery in patients with cirrhosis is poorly defined. Our objective was to describe outcomes of coronary artery bypass graft (CABG) surgery in cirrhotic patients from a population-based perspective.
  
  
  METHODS
  We analysed the 1998-2004 Nationwide In-patient Sample to identify patients hospitalized for CABG surgery. The effect of cirrhosis on mortality, complications, length of stay (LOS) and charges was evaluated using logistic regression models.
  
  
  RESULTS
  Between 1998 and 2004, there were 403 094 CABG admissions; 711 patients (0.2%) had cirrhosis. The average annual number of surgeries increased 4.2% [95% confidence interval (CI) 0.7-7.8] in cirrhotic patients, but decreased 5.5% (3.4-7.5) in non-cirrhotic patients. Patients with cirrhosis had an increased risk of mortality [17 vs. 3%; adjusted odds ratio (OR) 6.67; 95% CI 5.31-8.31], complications [43 vs. 28%; OR 1.99 (95% CI 1.72-2.30)] and greater LOS and charges (P<0.0001). Predictors of mortality included age over 60 (OR 2.21; 95% CI 1.31-3.73), female gender (OR 1.92; 95% CI 1.08-3.41), ascites (OR 3.80; 95% CI 1.95-7.39) and congestive heart failure (OR 1.75; 95% CI 1.08-2.84). Hospital volume and off-pump CABG did not affect mortality.
  
  
  CONCLUSIONS
  Patients with cirrhosis have an increased risk of morbidity and mortality following CABG surgery. Additional studies are necessary to refine risk stratification in this high-risk patient population.
authors.affiliation: Liver Unit, Department of Medicine, Division of Gastroenterology, University of Calgary, Calgary, AB, Canada.
authors.forename: Abdel Aziz M
authors.initials: AA
authors.lastname: Shaheen
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
authors.forename: James N
authors.initials: JN
authors.lastname: Hubbard
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
mesh_terms: D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000191:economics / Q000401:mortality*; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D015996:Survival Rate