Post-CABG pleural effusions : Does previous asbestos exposure increase the risk?

Abstract

Development of a pleural effusion (PE) after CABG is common. These are divided into early onset PE (within 30 days of surgery) and delayed PE, developing from 30 days – 1 year (probably caused by a different pathological process). Single centre experience suggests that asbestos exposure may confer an independent risk for late onset post-CABG PE, however no published studies have examined this. <b>Aims:</b> The authors wished to explore this association using a large-scale dataset. <b>Methods:</b> All patients who underwent CABG in the period 01/04/2013 – 31/03/2018 were identified from the NHS Heath Episode Statistics (HES) Database. This population was evaluated for evidence of asbestos exposure, pleural plaques or asbestosisand a diagnosis of PE or a procedure for PE from 30&nbsp;days to 1 year post CABG. Patients with evidence of PE three months prior to CABG were excluded. The population (CABG), asbestos exposure and PE diagnosis/procedure for PE were identified using appropriate ICD-10 diagnosis and OPCS procedure codes. <b>Results:</b> 69,860 patients were identified, of whom 1,035 (1%) had asbestos exposure and 4,088 (6%) developed PE 30-365 days post CABG. After adjusting for demographic data, Index of Multiple Deprivation decile and Charlson Co-morbidity Index patients recorded as exposed to asbestos had increased odds of PE diagnosis or procedure (OR 1.30, 95% CI 1.04-1.61, p=0.02). In those who had evidence of PE procedure alone, the adjusted OR was 1.43 (95% CI 1.04-1.96, p=0.03). Comclusion: This large-scale study demonstrates that prior asbestos exposure is associated with a moderate increased risk of developing post-CABG PE. A prospective study is now required to quantify this risk more fully.