Perioperative outcomes among patients with end-stage renal disease following coronary artery bypass surgery in the USA.
BACKGROUND
Patients with end-stage renal disease (ESRD) requiring chronic haemodialysis who undergo coronary artery bypass graft surgery (CABG) are at significant risk for perioperative mortality. However, the impact of changes in ESRD patient volume and characteristics over time on operative outcomes is unclear.


METHODS
Using the Nationwide Inpatient Sample database (1988-03), we evaluated rates of CABG surgery with and without concurrent valve surgery among ESRD patients and outcomes including in-hospital mortality, and length of hospital stay. Multivariate regression models were used to account for patient characteristics and potential cofounders.


RESULTS
From 1988 to 2003, annual rates of CABG among ESRD patients doubled from 2.5 to 5 per 1000 patient-years. Concomitantly, patient case-mix changed to include patients with greater co-morbidities such as diabetes, hypertension and obesity (all P < 0.001). Nonetheless, among ESRD patients, in-hospital mortality rates declined nearly 6-fold from over 31% to 5.4% (versus 4.7% to 1.8% among non-ESRD), and the median length of in-hospital stay dropped in half from 25 to 13 days (versus 14 to 10 days among non-ESRD).


CONCLUSIONS
Since 1988, an increasing number of patients with ESRD have been receiving CABG in the USA. Despite increasing co-morbidities, operative mortality rates and length of in-hospital stay have declined substantially. Nonetheless, mortality rates remain almost 3-fold higher compared to non-ESRD patients indicating a need for ongoing improvement.
Parikh
Dipen S
DS
Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. dipenparikh@yahoo.com
Swaminathan
Madhav
M
Archer
Laura E
LE
Inrig
Jula K
JK
Szczech
Lynda A
LA
Shaw
Andrew D
AD
Patel
Uptal D
UD
D000368:Aged; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States