The impact of comorbidities on the length of hospital stay after coronary artery bypass grafting
Abstract
ABSTRACT
Introduction: Ischemic heart disease is one of the leading causes of death worldwide and occurs as a result of an imbalance between the myocardium's oxygen demand and its blood supply. The most common cause of ischemic heart disease is atherosclerosis of the coronary arteries. The main methods of treatment include myocardial revascularization through coronary artery bypass grafting or percutaneous coronary intervention, as well as pharmacological therapy.
Aim: The aim of this study is to analyze the impact of comorbidities, lifestyle habits, and heredity on the length of hospitalization after aortocoronary bypass grafting.
Material and methods: Data for this study were obtained from medical records of patients operated at the Institute for Cardiovascular Diseases Dedinje from November 30th, 2022 to January 19th, 2023. This is a descriptive epidemiological study. Statistical analysis was performed using SPSS 21.0 software.
Results: A total of 106 patients were operated on from November 30th, 2022 to January 19th, 2023, of whom 76 (71.7%) were male. The median age of patients was 66 (range 39-78) years. Patients who underwent simultaneous valve and bypass surgery were statistically significantly longer hospitalized than those who did not undergo valve surgery (p=0.008). The research results indicate that age (p=0.001) and NYHA class of heart failure (p=0.006) are statistically significantly positively correlated with the length of hospitalization. The presence of other comorbidities, hereditary burden, and smoking, in this study, was not statistically significantly associated with the length of hospitalization after aortocoronary bypass grafting (p>0.05).
Conclusion: The practical application of the results of this study lies in the ability to predict the length of hospitalization based on the presence of certain comorbidities, advanced heart failure, valve surgery, and patient age.
References
1. Pepine CJ, Nichols WW. The pathophysiology of chronic ischemic heart disease. Clin Cardiol. 2007 Feb; 30(2 Suppl 1): :I4-9.
2. Medina-Leyte DJ, Zepeda-García O, Domínguez-Pérez M, González-Garrido A, Villarreal-Molina T, Jacobo-Albavera L. Endothelial Dysfunction, Inflammation and Coronary Artery Disease: Potential Biomarkers and Promising Therapeutical Approaches. Int J Mol Sci. 2021 Apr 8; 22(8): 3850.
3. Henderson A. Coronary heart disease: overview. Lancet. 1996 Nov; 348 Suppl 1: s1-4.
4. Khera AV, Kathiresan S. Genetics of coronary artery disease: discovery, biology and clinical translation. Nat Rev Genet. 2017 Jun; 18(6): 331-344.
5. Bruning RS, Sturek M. Benefits of exercise training on coronary blood flow in coronary artery disease patients. Prog Cardiovasc Dis. 2015 Mar-Apr; 57(5): 443-53.
6. Kubal C, Srinivasan AK, Grayson AD, Fabri BM, Chalmers JA. Effect of risk-adjusted diabetes on mortality and morbidity after coronary artery bypass surgery. Ann Thorac Surg. 2005 May; 79(5): 1570-6.
7. Libby P, Theroux P. Pathophysiology of coronary artery disease. Circulation. 2005 Jun 28; 111(25): 3481-8.
8. Yerokun BA, Williams JB, Gaca J, Smith PK, Roe MT. Indications, algorithms, and outcomes for coronary artery bypass surgery in patients with acute coronary syndromes. Coron Artery Dis. 2016 Jun; 27(4): 319-26.
9. Breeman A, Hordijk-Trion M, Lenzen M, Hoeks S, Ottervanger JP, Bertrand M et al; Euro Heart Survey on Coronary Revascularization. Treatment decisions in stable coronary artery disease: insights from the Euro Heart Survey on Coronary Revascularization. J Thorac Cardiovasc Surg. 2006 Nov; 132(5): 1001-9.
10. Steg PG, Ducrocq G. Future of the Prevention and Treatment of Coronary Artery Disease. Circ J. 2016 Apr 25; 80(5): 1067-72.
11. Smith JN, Negrelli JM, Manek MB, Hawes EM, Viera AJ. Diagnosis and management of acute coronary syndrome: an evidence-based update. J Am Board Fam Med. 2015 Mar-Apr; 28(2): 283-93.
12. Tinica G, Vartic CL, Mocanu V, Baran D, Butcovan D. Preoperative graft assessment in aortocoronary bypass surgery. Exp Ther Med. 2016 Aug; 12(2): 804-808.
13. Sajja LR, Mannam G, Pantula NR, Sompalli S. Role of radial artery graft in coronary artery bypass grafting. Ann Thorac Surg. 2005 Jun; 79(6): 2180-8.
14. Stenvall H, Tierala I, Räsänen P, Laine M, Sintonen H, Roine RP. Long-term clinical outcomes, health-related quality of life, and costs in different treatment modalities of stable coronary artery disease. Eur Heart J Qual Care Clin Outcomes. 2017 Jan 1; 3(1): 74-82.
15. Torabipour A, Arab M, Zeraati H, Rashidian A, Sari AA, Sarzaiem MR. Multivariate Analysis of Factors Influencing Length of Hospital Stay after Coronary Artery Bypass Surgery in Tehran, Iran. Acta Med Iran. 2016 Feb; 54(2): 124-33.
16. Bottle A, Mozid A, Grocott HP, Walters MR, Lees KR, Aylin P. et al. Preoperative risk factors in 10 418 patients with prior myocardial infarction and 5241 patients with prior unstable angina undergoing elective coronary artery bypass graft surgery. Br J Anaesth. 2013 Sep; 111(3): 417-23.
17. Almashrafi A, Alsabti H, Mukaddirov M, Balan B, Aylin P. Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study. BMJ Open. 2016 Jun 8; 6(6): e010764.
18. Peterson ED, Coombs LP, Ferguson TB, Shroyer AL, DeLong ER, Grover FL et al. Hospital variability in length of stay after coronary artery bypass surgery: results from the Society of Thoracic Surgeon's National Cardiac Database. Ann Thorac Surg. 2002 Aug; 74(2): 464-73.
19. Carson JL, Scholz PM, Chen AY, Peterson ED, Gold J, Schneider SH. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002 Aug 7; 40(3): 418-23.
20. Engel AM, McDonough S, Smith JM. Does an obese body mass index affect hospital outcomes after coronary artery bypass graft surgery? Ann Thorac Surg. 2009 Dec; 88(6): 1793-800.
21. Butterworth J, James R, Prielipp R, Cerese J, Livingston J, Burnett D. Female gender associates with increased duration of intubation and length of stay after coronary artery surgery. CABG Clinical Benchmarking Database Participants. Anesthesiology. 2000 Feb; 92(2): 414-24.
22. Mehta GS, LaPar DJ, Bhamidipati CM, Kern JA, Kron IL, Upchurch GR J. et al. Previous percutaneous coronary intervention increases morbidity after coronary artery bypass grafting. Surgery. 2012 Jul; 152(1): 5-11.
23. Lazar HL, Fitzgerald C, Gross S, Heeren T, Aldea GS, Shemin RJ. Determinants of length of stay after coronary artery bypass graft surgery. Circulation. 1995 Nov 1; 92(9 Suppl): II20-4.