Total Intravenous Anesthesia was Associated With Better Survival Outcomes After Coronary Artery Bypass Grafting: A Retrospective Cohort Study With 3-Year Follow-Up in South Korea

Abstract

The authors aimed to investigate if the anesthetic technique was associated with 3-year all-cause mortality after isolated coronary artery bypass grafting (CABG). Population-based cohort study. Cohort data obtained from the National Health Insurance Service database in South Korea. All adult patients diagnosed with ischemic heart disease who underwent isolated CABG between January 2012 and December 2015. The authors divided the cohort into the following 2 groups: the total intravenous anesthesia group using propofol (TIVA group) and the volatile anesthesia group. The primary study endpoint was 3-year all-cause mortality. The authors enrolled 10,440 patients from 91 hospitals; among them, 3,967 patients were in the TIVA group and 6,473 were in the volatile anesthesia group. After propensity score matching, the authors included 5,656 patients (2,828 patients per group) in the final analysis. The 3-year all-cause mortality rates in the TIVA and volatile anesthesia groups were 15.3% (434/2,828) and 18.3% (518/2,828), respectively. The risk of 3-year all-cause mortality was 16% lower in the TIVA group than in the volatile anesthesia group (hazard ratio: 0.84, 95% confidence interval: 0.75-0.94; p = 0.002). Similar results were observed for 30-day, 90-day, and 1-year all-cause mortality after CABG. Compared with volatile anesthesia, propofol-based TIVA was associated with decreased 3-year all-cause mortality in patients undergoing CABG. This was the first study to suggest that TIVA might be associated with an increase in survival at 3-year follow-up after CABG, and further studies are needed to confirm the optimal anesthetic choice for CABG.