Prediction of major complications after isolated coronary artery bypass grafting: the CGMH experience.
BACKGROUND
The in-hospital mortality of coronary artery bypass grafting (CABG) is low but can be significant if catastrophic complications occur. To increase the safety of CABG, we aimed to establish a predictive model of major postoperative complications that incorporated patient characteristics and operative strategies.


METHODS
A retrospective study was performed which included all consecutive patients receiving isolated CABG from August 2006 to February 2008 (n = 319). Patient characteristics were quantified by the additive EuroSCORE. Operative strategies were classified as cardioplegic arrest, on-pump beating, and off-pump.


RESULTS
Four major complications were identified to be connected to the in-hospital mortality: (1) requirement of mechanical circulatory supports > 72 h (odds ratio [OR] 28.9, 95% confidence interval [CI] 6.0-139.9), (2) requirement of mechanical ventilator supports > 72 h (OR 9.5., 95%, CI 2.2- 42.7), (3) acute renal failure requiring dialysis (OR 9.2, 95% CI 2.2-38.3), (4) major gastrointestinal complications (OR 5.4., 95% CI 1.1-26.7). An increase of additive EuroSCORE (OR 1.2, 95% CI 1.1-1.4) and the cardioplegic strategy (OR 2.7, 95% CI 1.2-6.0) were independent risk factors for major complications. The probability of one or more major complication was > 50% for patients receiving cardioplegic CABG with an additive EuroSCORE > 8.


CONCLUSIONS
Dependence on the mechanical ventilator or circulatory supports > 72 h, acute renal failure requiring dialysis, and major gastrointestinal complications were major complications of CABG. The individual risk of having at least one of these complications could be predicted by the patient's preoperative EuroSCORE and operative strategy. A surgical plan tailored by institutional experiences on specific risk factors and aggressive therapeutic plans for major complications are helpful in improving the overall results of CABG.
Lin
Chien-Chao
CC
Division of Cardiovascular Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Wu
Meng-Yu
MY
Tsai
Feng-Chun
FC
Chu
Jaw-Ji
JJ
Chang
Yu-Sheng
YS
Haung
Yoa-Kuang
YK
Liu
Kuo-Sheng
KS
Lin
Pyng Jing
PJ
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012121:Respiration, Artificial; D012189:Retrospective Studies