Emergency and elective coronary artery bypass grafting: comparisons of risk profiles, postoperative outcomes, and resource requirements

Abstract

Objective: To investigate the association between preoperative risk factors and postoperative outcomes in emergency and elective coronary artery bypass graft (CABG) patients and to quantify resource requirements. Design: Retrospective database review. Setting: New York State SPARCS database. Participants: Data from 4,001 emergency and 7,489 elective CABG patients were evaluated retrospectively. Interventions: Data were compared between groups using chi-squares, t tests, and logistic regression analysis. Measurements and Main Results: Preoperatively, 47.1% of patients in the emergency group had unstable angina and 34.1% had acute myocardial infarction compared with 33.9% and 15.2% in the elective group, respectively ( p < 0.0001). There were no marked differences in the preoperative noncardiac risk factors between groups. The mortality rate was 4.7% in the emergency group and 2.6% in the elective group ( p < 0.0001). The emergency group had more postoperative cardiac complications (18.3% v 8.3%, p < 0.0001). The length of hospital stay in the emergency group was 17.5 ± 15.8 days (median 14 days) compared with 12.9 ± 15.1 days (median 9 days) in the elective group ( p < 0.00001). Total hospital charges in the emergency and elective groups were $46,700 ± $42,400 (median $35,600) and $34,800 ± 36,400 (median $26,500) ( p < 0.00001), respectively. The median total cost was $26,300 for emergency and $19,600 for elective group ( p < 0.00001). Conclusion: Patients undergoing emergency CABG had greater postoperative morbidity and mortality, longer LOS, and higher total costs than patients undergoing elective surgery. This difference is predictable on the basis of preoperative cardiac risk factors. Emergency operations have a major impact on the rates of morbidity, mortality, and use of resources.