How Long After Coronary Artery Bypass Surgery Can Patients Have Elective Safer Non-Cardiac Surgery?

Li-Chin Sung; Chuen-Chau Chang; Chun-Chieh Yeh; Yih-Giun Cherng; Ta-Liang Chen; Chien-Chang Liao

doi:10.2147/JMDH.S449614

How Long After Coronary Artery Bypass Surgery Can Patients Have Elective Safer Non-Cardiac Surgery?

J Multidiscip Healthc. 2024 Feb 19:17:743-752. doi: 10.2147/JMDH.S449614. eCollection 2024.

Authors

Li-Chin Sung^{1

2

3

4}, Chuen-Chau Chang^{5

6

7}, Chun-Chieh Yeh^{8

9}, Yih-Giun Cherng^{5

10}, Ta-Liang Chen^{5

7

11}, Chien-Chang Liao^{5

6

7

12

13}

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
² Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
³ Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.
⁴ Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁶ Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.
⁷ Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
⁸ Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
⁹ Department of Surgery, University of Illinois, Chicago, IL, USA.
¹⁰ Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
¹¹ Department of Anesthesiology, Wang Fang Hospital, Taipei Medical University, Taipei, Taiwan.
¹² Research Center of Big Data and Meta‑Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
¹³ School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.

Abstract

Objective: To evaluate the complications and mortality after noncardiac surgeries in patients who underwent previous coronary artery bypass grafting (CABG).

Methods: We used insurance data and identified patients aged ≥20 years undergoing noncardiac surgeries between 2010 and 2017 in Taiwan. Based on propensity-score matching, we selected an adequate number of patients with a previous history of CABG (within preoperative 24 months) and those who did not have a CABG history, and both groups had balanced baseline characteristics. The association of CABG with the risk of postoperative complications and mortality was estimated (odds ratio [OR] and 95% confidence interval [CI]) using multiple logistic regression analysis.

Results: The matching procedure generated 2327 matched pairs for analyses. CABG significantly increased the risks of 30-day in-hospital mortality (OR 2.28, 95% CI 1.36-3.84), postoperative pneumonia (OR 1.49, 95% CI 1.12-1.98), sepsis (OR 1.49, 95% CI 1.17-1.89), stroke (OR 1.53, 95% CI 1.17-1.99) and admission to the intensive care unit (OR, 1.75, 95% CI 1.50-2.05). The findings were generally consistent across most of the evaluated subgroups. A noncardiac surgery performed within 1 month after CABG was associated with the highest risk for adverse events, which declined over time.

Conclusion: Prior history of CABG was associated with postoperative pneumonia, sepsis, stroke, and mortality in patients undergoing noncardiac surgeries. Although we raised the possibility regarding deferral of non-critical elective noncardiac surgeries among patients had recent CABG when considering the risks, critical or emergency surgeries were not in the consideration of delay surgery, especially cancer surgery.

Keywords: adverse events; coronary artery bypass surgery; noncardiac surgeries; postoperative complications; postoperative mortality.

Grants and funding

This study was supported in part by the National Science and Technology Council, Taiwan (NSTC112-2314-B-038-141; MOST111-2320-B-532-001-MY3; MOST110-2314-B-038-108-MY2; MOST108-2320-B-038-070-MY3).