Pre-operative, Intraoperative, and Post-operative Determinants Associated with 30-day Mortality Post-Coronary Artery Bypass Graft: A Retrospective Cohort Study

Ikhwan Rinaldi; Mondastri K. Sudaryo; Arif Mansjoer

doi:10.3889/oamjms.2022.9563

Authors

Ikhwan Rinaldi Department of Internal Medicine, Division of Hematology and Medical Oncology, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Mondastri K. Sudaryo Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, West Java, Indonesia
Arif Mansjoer Department of Internal Medicine, Division of Cardiology, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia https://orcid.org/0000-0001-8675-8063

DOI:

https://doi.org/10.3889/oamjms.2022.9563

Keywords:

CABG, Mortality, Ischemic heart disease

Abstract

Abstract

Background: Various determinants of 30-day mortality risk in CABG patients have been formulated into certain scoring models such as the EuroSCORE and ACEF model. However, these models only consider preoperative parameters while excluding intraoperative, postoperative, and perioperative parameters. Currently, the prior research has increasingly emphasized the role of these excluded parameters as determinants of post-CABG mortality. Furthermore, there are differences in mortality rate of CABG procedures in Indonesia when compared with other countries. Hence, this study aimed to identify preoperative, intraoperative, and postoperative determinants of 30-day mortality after CABG surgery in Indonesian population.

Methods: In this retrospective cohort study, secondary data were obtained from the medical records of 263 patients aged ≥ 18 years who underwent CABG at a single center in Indonesia during the year 2012–2015. Selected preoperative, intraoperative, postoperative, and perioperative determinants were analyzed in both bivariate and multivariate Cox regression models to identify determinants associated with 30-day mortality.

Results: The 30-day mortality rate after CABG was 11.8%. Multivariate analysis identified neurological dysfunction (HR 6.16; 95% CI 2.42-15.66), renal impairment (HR 3.9; 95% CI 1.46-10.38), left ventricle dysfunction (HR 3.53;95% CI 1.55-8.03), aortic clamp duration (HR 3.7;95% CI 1.53-8.96), surgery duration (HR 3.85;95% CI 1.39-10.70), postoperative thrombocytopenia (HR 3.99;95% CI 1.72-9.23), and postoperative intra-aortic balloon pump (HR 10.98; 95% CI 4.77-25.28) as significant determinants associated with 30-day mortality after CABG

Conclusions: Neurological dysfunction, renal impairment, left ventricle dysfunction, aortic clamp duration, surgery duration, postoperative thrombocytopenia, and postoperative intra-aortic balloon pump were independent determinants for 30-day mortality after CABG.

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