Age, Renal Failure and Transfusion are Risk Predictors of Prolonged Hospital Stay after Coronary Artery Bypass Grafting Surgery

Andrade, Diego Pereira Gregório de; Freitas, Fabiane Letícia de; Borgomoni, Gabrielle Barbosa; Goncharov, Maxim; Silva, Pedro Gabriel Melo de Barros e; Nakazone, Marcelo Arruda; Campagnucci, Valquiria Pelisser; Tiveron, Marcos Gradim; Lisboa, Luiz Augusto; Dallan, Luís Alberto Oliveira; Jatene, Fabio Biscegli; Mejia, Omar Asdrúbal Vilca

doi:10.36660/abc.20230769i

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Original Article • Arq. Bras. Cardiol. 121 (6) • 2024 • https://doi.org/10.36660/abc.20230769i copy

Age, Renal Failure and Transfusion are Risk Predictors of Prolonged Hospital Stay after Coronary Artery Bypass Grafting Surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Identifying risk factors in cardiovascular surgery assists in predictability, resulting in optimization of outcomes and cost reduction.

Objective:

This study aimed to identify preoperative and intraoperative risk predictors for prolonged hospitalization after coronary artery bypass grafting (CABG) surgery in the state of São Paulo, Brazil.

Methods:

A cross-sectional analysis using data from the REPLICCAR II database, a prospective, consecutive, multicenter registry that included CABG surgeries performed between August 2017 and July 2019. The primary outcome was a prolonged hospital stay (PHS), defined as a postoperative period exceeding 14 days. Univariate and multivariate logistic regression analyses were performed to identify the predictors with significance set at p <0.05.

Results:

The median age was 63 (57-70) years and 26.55% of patients were female. Among the 3703 patients analyzed, 228 (6.16%) had a PHS after CABG, with a median hospital stay of 17 (16-20) days. Predictors of PHS after CABG included age >60 years (OR 2.05; 95% CI 1.43-2.87; p<0.001); renal failure (OR 1.73; 95% CI 1.29-2.32; p <0.001) and intraoperative red blood cell transfusion (OR 1.32; 95% CI 1.07-2.06; p=0.01).

Conclusion:

Age >60 years, renal failure, and intraoperative red blood cell transfusion were independent predictors of PHS after CABG. The identification of these variables can help in multiprofessional strategic planning aimed to enhance results and resource utilization in the state of São Paulo.

Keywords:
Length of Stay; Myocardial Revascularization; Process Optimization

		Length of stay after CABG
Characteristics		≤ 14 days (n=3475)		> 14 days (n=228)
		n	%	n	%	95% CI	p-value
Age (years)*		63 (57-70) *		67 (62-72) *		62.76 a 63.35	< 0.001 §
Gender (female)		908	26.13	75	32.89	0.25 a 0.28	0.02 ‡
Urgency (admission)		1505	43.31	118	51.75	0.42 a 0.45	0.01 §
Body mass index (kg/m²)
	<18.5	15	0.44	0	-	0.002 a 0.007	0.01 †
	18.5-24.9	1064	30.87	67	29.78	0.31 a 0.34
	25-29.9	1513	43.89	42	18.67	0.31 a 0.34
	≥ 30	855	24.80	116	51.56	0.27 a 0.29
Previous myocardial infarction		1821	52.4	131	57.46	0.51 a 0.54	0.13 ‡
Systemic arterial hypertension		3072	88.4	198	88.64	0.87 a 0.89	0.47 ‡
Diabetes mellitus		1690	45.13	111	48.68	0.44 a 0.47	0.98 ‡
Cerebrovascular disease¹ 1 Cerebrovascular disease: stroke, transient ischemic attack, or carotid stenosis		314	9.04	31	13.6	0.08 a 0.10	0.02 ‡
Atrial fibrillation		50	1.44	5	2.19	0.01 a 0.02	0.39 †
Ejection fraction (<30%)		49	1.41	8	3.51	0.01 a 0.02	0.02 †
Renal failure² 2 Creatinine clearance <60 ml/min/1.73 m2		955	27.48	112	49.12	0.27 a 0.30	< 0.001 ‡
CCS angina class
	IV	325	9.35	31	13.6	0.08 a 0.10	0.03 ‡
NYHA functional class
	I and II	3051	87.8	185	81.14	0.86 a 0.88	<0.001 ‡
	III and IV	424	12.2	43	18.86	0.11 a 0.13	<0.001 ‡
Anemia³ 3 Anemia: Hemoglobin <11.9 mg/dL for women and <13.6 mg/dL for men;17 CCS: Canadian Cardiovascular Society; NYHA: New York Heart Association; OR: odds ratio.		1263	36.35	112	49.12	0.35 a 0.38	< 0.001 ‡
Intraoperative red blood cell transfusion		560	16.12	66	28.95	0.16 a 0.18	< 0.001 ‡
Use of cardiopulmonary bypass		3163	91.02	201	88.16	0.89 a 0.91	0.14 ‡
STS score (prolonged stay)*		1.66 (1.10 - 2.61) *		2.11 (1.43 - 3.31) *		2.14 a 2.26	< 0.001 §
Length of stay after CABG*		7 (5-8) *		17 (16-20) *		7.52 a 7.75	< 0.001 §
STS score (mortality)*		0.62 (0.41- 0.99) *		0.8 (0.53 - 1.21) *		0.82 a 0.87	< 0.001 §
Death		57	1.64	10	4.38	0.01 a 0.02	0.007 †

Variable		OR	95 % CI	p-value
Age >60 years		2.62	1.89 a 3.65	< 0.001
Gender (female)		1.38	1.04 a 1.84	0.02
Urgency (admission)		1.40	1.07 a 1.83	0.01
Cerebrovascular disease¹ 1 Cerebrovascular disease: stroke, transient ischemic attack, or carotid stenosis		1.58	1.07 a 2.35	0.022
Ejection fraction (<30%)		3.02	1.3 a 6.83	0.03
Renal failure² 2 Creatinine clearance <60 ml/min/1.73 m2		2.55	1.00 a 3.43	< 0.001
CCS angina class
	IV	1.52	1.03 a 2.26	0.04
NYHA functional class
	III and IV	1.67	1.18 a 2.36	0.004
Anemia³ 3 Hemoglobin <11.9 mg/dLFor women and <13.6 mg/dL for men;17 CCS: Canadian Cardiovascular Society; NYHA: New York Heart Association; OR: odds ratio.		1.69	1.29 a 2.21	< 0.001
Intraoperative red blood cell transfusion		2.12	1.57 a 2.86	< 0.001

Variable	OR	95 % CI	p-value
Age >60 years	2.05	1.43 a 2.87	< 0.001
Renal failure¹ 1 Creatinine clearance < 60 ml/min/1.73m2.	1.73	1.29 a 2.32	< 0.001
Intraoperative red blood cell transfusion	1.32	1.07 a 2.06	0.01

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