Journal Article

Perioperative outcomes among patients with end-stage renal disease following coronary artery bypass surgery in the USA

Dipen S. Parikh, Madhav Swaminathan, Laura E. Archer, Jula K. Inrig, Lynda A. Szczech, Andrew D. Shaw and Uptal D. Patel

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 7, pages 2275-2283
Published in print July 2010 | ISSN: 0931-0509
Published online January 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfp781
Perioperative outcomes among patients with end-stage renal disease following coronary artery bypass surgery in the USA

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Background. Patients with end-stage renal disease (ESRD) requiring chronic haemodialysis who undergo coronary artery bypass graft surgery (CABG) are at significant risk for perioperative mortality. However, the impact of changes in ESRD patient volume and characteristics over time on operative outcomes is unclear.

Methods. Using the Nationwide Inpatient Sample database (1988–03), we evaluated rates of CABG surgery with and without concurrent valve surgery among ESRD patients and outcomes including in-hospital mortality, and length of hospital stay. Multivariate regression models were used to account for patient characteristics and potential cofounders.

Results. From 1988 to 2003, annual rates of CABG among ESRD patients doubled from 2.5 to 5 per 1000 patient-years. Concomitantly, patient case-mix changed to include patients with greater co-morbidities such as diabetes, hypertension and obesity (all P < 0.001). Nonetheless, among ESRD patients, in-hospital mortality rates declined nearly 6-fold from over 31% to 5.4% (versus 4.7% to 1.8% among non-ESRD), and the median length of in-hospital stay dropped in half from 25 to 13 days (versus 14 to 10 days among non-ESRD).

Conclusions. Since 1988, an increasing number of patients with ESRD have been receiving CABG in the USA. Despite increasing co-morbidities, operative mortality rates and length of in-hospital stay have declined substantially. Nonetheless, mortality rates remain almost 3-fold higher compared to non-ESRD patients indicating a need for ongoing improvement.

Keywords: coronary artery bypass graft; end-stage renal disease; in-hospital mortality; perioperative outcomes

Journal Article.  4469 words.  Illustrated.

Subjects: Nephrology

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