National Analysis of Coronary Artery Bypass Grafting in Autoimmune Connective Tissue Disease.

Abstract

BACKGROUND:

Autoimmune connective tissue diseases (CTDs) are associated with accelerated atherosclerosis and inflammation, while often requiring immunosuppression. Large-scale outcomes of coronary artery bypass graft (CABG) surgery in this population have not been reported thus far. This study characterized trends in use of CABG in patients with CTDs and the impact of the disease on mortality, in-hospital complications, length of stay, and costs.

METHODS:

The 2005 to 2015 National Inpatient Sample was used to identify all adult patients undergoing isolated CABG. The CTDs cohort included rheumatoid arthritis, lupus erythematosus, and antiphospholipid syndrome (APLS), among others. Hierarchical multivariable logistic models were used to calculate the independent impact of CTDs on clinical outcomes and costs.

RESULTS:

Of an estimated 2,101,591 patients, 41,567 (1.8%) were diagnosed with CTDs (rheumatoid arthritis, 58%; systemic lupus erythematosus, 12%; APLS, 11%) Although the overall annual use of CABG decreased, the proportion of patients with CTDs receiving the operation significantly increased. After adjusting for patient and hospital characteristics, CTDs were not associated with increased mortality (adjusted odds ratio [AOR], 0.91; P = .34) but were protective against cardiovascular (AOR, 0.92; P < .003), neurologic (AOR, 0.81; P = .01), and infectious (AOR, 0.80; P = .01) complications. The diagnosis of CTDs was also predictive of reduced length of hospital stay (β-coefficient = -0.40; P < .001) and costs (β-coefficient, -$1200; P = .01). On subgroup analysis patients with APLS had significantly increased odds of mortality (AOR, 1.5) and increased renal (AOR, 1.3), infectious (AOR, 1.7), and thromboembolic (AOR, 4.3) complications (all P < .05).

CONCLUSIONS:

CABG in patients with CTDs provides acceptable outcomes and paradoxically improved resource use. However CABG in patients with APLS warrants careful consideration given inferior outcomes.

• Authors: Esteban Aguayo, Vishal Dobaria, Sohail Sareh, Yas Sanaiha, Young-Ji Seo, Joseph Hadaya, Peyman Benharash
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 110 Issue 6 Pg. 2006-2012 (12 2020) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 32439392 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Autoimmune Diseases (complications)
• Connective Tissue Diseases (complications)
• Coronary Artery Bypass (adverse effects)
• Coronary Artery Disease (complications, mortality, surgery)
• Female
• Hospital Mortality
• Humans
• Length of Stay
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Treatment Outcome
• United States