62 Angiography after cabg surgery; solving the problem of missing surgical records with a sternal wire code

Abstract

Background The recommendation that surgical records (graft notes) are obtained before coronary angiography in patients with previous coronary artery bypass graft (CABG) surgery is not always followed. Lack of prior information on the number and origin of grafts increases procedure time, complexity and risk to patients. Here, we determine the proportion of angiograms undertaken without graft notes, and propose a code to permanently provide this information. Methods For patients undergoing angiography at the Barts Heart Centre, London (September 2015-September 2016), records of patients with previous CABG were retrieved. From the procedure reports, we identified patients without graft notes and the indication for the angiogram. Results Of 6483 patients undergoing angiography, 559 had undergone previous CABG surgery; graft notes were unavailable in 91/559 patients (16%). In 88/91 patients (97%), angiography was an unplanned emergency procedure; 84 acute coronary syndromes and 4 out-of-hospital arrests. Three patients had planned angiograms for stable angina. In 20/91 patients additional imaging investigations were required because of uncertainty over whether all grafts had been identified and one patient consequently developed pulmonary oedema due to a large contrast load. Conclusion About 1 in 6 patients with previous CABG surgery, who require coronary angiography, undergo this procedure without graft notes, almost all in the emergency setting. A clinical code, based on the orientation of the wires used to close the sternum after CABG, could provide a permanent record of the number and origin of the surgical grafts (see Table). We propose that this code, which requires no new technology or technique, be adopted routinely in CABG surgery.