Abstract
BackgroundTo determine the impact of preoperative Liver Dysfunction (LD) on outcomes after elective Coronary Artery Bypass Grafting (CABG) and Valvular surgery (VS).MethodsThe Nationwide Inpatient Sample (2002–2010) was queried to identify patients with LD who had elective CABG or VS utilizing ICD-9-CM diagnosis and procedure codes. These patients were matched with the similar patients without LD (controls) by propensity score matching. Chi-square and Wilcoxon rank sum tests were used for analysis.ResultsWe identified 1197 patients with LD (CABG = 755; VS = 442) who were matched to 2394 controls. LD significantly increased hospital mortality after both CABG (OR = 5.19; 95%CI = 2.93–9.20) and VS (OR = 7.49; 95%CI = 3.12–17.96). Overall rates of complications after CABG with LD were greater than in non-complicated cases (OR = 1.73; 95%CI = 1.46–2.05). Among them, there was an increase in bleeding (OR = 1.81;95%CI = 1.44–2.28), respiratory (OR = 2.33;95%CI = 1.86–2.93), renal (OR = 2.79;95%CI = 2.04–3.81), and infectious (OR = 2.93;95%CI = 2.14–4.01) complications. In general, the rates of complications after VS with LD were also greater than in non-complicated cases (OR = 2.77;95%CI = 2.13–3.60), specifically for bleeding (OR = 3.07;95%CI = 2.17–4.34), respiratory (OR = 3.57;95%CI = 2.51–5.07), renal (OR = 4.40;95%CI = 2.80–6.92), and infectious (OR = 4.63;95%CI = 2.85–7.51) complications. The development of LD significantly increased mean hospital length of stay (LOS) and total hospital charges after both CABG (from7.0 ± 4.0 to 9.2 ± 9.1 days and from $100,265 ± 87,107 to $117,756 ± 99,320, respectively; P < 0.0001 for both) and VS (from 7.9 ± 5.0 to 11.4 ± 9.9 days and from $134,306 ± 114,216 to $176,620 ± 147,049, respectively; P < 0.0001 for both).ConclusionsLD worsened the outcomes after cardiac surgery. It increased rates of complications, hospital mortality, length of stay and total hospital charges after both procedures.
Highlights
To determine the impact of preoperative Liver Dysfunction (LD) on outcomes after elective Coronary Artery Bypass Grafting (CABG) and Valvular surgery (VS)
Postoperative complication rates for bleeding, respiratory distress, infection, and bleeding were measured on both LD patients and nonLD patients who underwent CABG or VS
The postoperative mortality rates increased for patients with LD in both CABG (OR = 5.19; 95%CI = 2.93–9.20) and VS (OR = 5.19; 95% confidence interval (95% CI) = 2.93–9.20) (Fig. 4)
Summary
To determine the impact of preoperative Liver Dysfunction (LD) on outcomes after elective Coronary Artery Bypass Grafting (CABG) and Valvular surgery (VS). Despite advances in cardiothoracic (CT) surgery, patients with known or unknown Liver Dysfunction (LD) are suspected of experiencing worse outcomes [1]. Patients identified with LD are often viewed as high risk if the LD is severe the outcome of patients with LD who undergo cardiac surgery is not entirely clear. It’s not possible to estimate the true percentage of risks in these patients who undergo cardiac surgery. There is unclear recommendations for surgery in the presence of LD and adult cardiac disease. Bizouarn et al report the only prospective analysis of outcomes in elective cardiac surgery with cardiopulmonary bypass (CPB) in patients with “suspected” LD.
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