(Circulation. 2000;102:2973.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Risks of Morbidity and Mortality in Dialysis Patients Undergoing Coronary Artery Bypass Surgery
From the Departments of Surgery, Medicine, Community and Family Medicine, and the Center for the Evaluative and Clinical Sciences (J.Y.L., N.J.O.B., J.H.S., H.F.H., R.W.D., A.W.D., G.T.O.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; the Department of Surgery (J.R.M.), Maine Medical Center, Portland; the Department of Surgery (S.J.L.), Beth Israel-Deaconess Medical Center, Boston, Mass; the Department of Surgery (C.M.), Optima Health (Catholic Medical Center), Manchester, NH; the Department of Surgery (R.C.), Eastern Maine Medical Center, Bangor, Maine; and the Department of Surgery (B.J.L.), Fletcher-Allen Health Care, Burlington, Vt.
Background—Although dialysis patients are undergoing CABG with increasing frequency, large studies specifically comparing patient characteristics and procedure-related risks in this population have not been performed.
Methods and Results—We conducted a regional prospective cohort study of 15 500 consecutive patients undergoing CABG in northern New England from 1992 to 1997. We used multiple logistic regression analysis to examine associations between preoperative dialysis-dependent renal failure and postoperative events and to adjust for potentially confounding variables. The 279 dialysis-dependent renal failure patients (1.8%) were 4.4 times more likely to experience in-hospital mortality than were other CABG patients (12.2% versus 3.0%, respectively; P<0.001). Dialysis-dependent renal failure patients were older and had more comorbidities and more severe cardiac disease than did other CABG patients. After adjusting for these factors in multivariate analysis, however, dialysis-dependent renal failure patients remained 3.1 times more likely to die after CABG (adjusted odds ratio [OR] 3.1, 95% CI 2.1 to 4.7; P<0.001). Dialysis-dependent renal failure patients compared with other CABG patients also had a substantially increased risk of postoperative mediastinitis (3.6% versus 1.2%, respectively; adjusted OR 2.4, 95% CI 1.2 to 4.7; P=0.011) and postoperative stroke (4.3% versus 1.7%, respectively; adjusted OR 2.1, 95% CI 1.1 to 3.9; P=0.016), even after controlling for potentially confounding variables. Risks of reexploration for bleeding were similar for patients with and without dialysis-dependent renal failure.
Conclusions—Preoperative dialysis-dependent renal failure is a strong independent risk factor for in-hospital mortality and mediastinitis after CABG.
Key Words: kidney • mortality • morbidity • bypass
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