A case‐control study of the impact of WBC reduction on the cost of hospital care for patients undergoing coronary artery bypass graft surgery

Background & Aim: Reducing readmissions is a major goal of health care systems. This study aimed to identify readmission risk factors following coronary artery bypass graft surgery. Methods & Materials: This case-control study analyzed 540 patients who underwent coronary artery bypass graft surgery between January 2016 and December 2019 at Shahid Beheshti Hospital in Qom, Iran. The case group contained 270 patients who were readmitted to the hospital during the 30-day after discharge and the control group comprised 270 non-readmitted patients. Results: Readmit patients suffered from higher rates of cardiac failure, myocardial infarction, hypertension, myocardial dysrhythmia, and using antiplatelet coagulant medication (P<0.05). Compared with non-readmitted patients, readmitted patients were more likely to have emergency surgery (OR 1.62; CI 1.11-2.38), cardiac arrest (OR 2.52; CI 2.39-2.85), and massive intraoperative hemorrhage during surgery (OR 2.36; CI 2.13-2.67). Postoperative disorders such as surgical site infection, pleural effusion, dysrhythmias, and myocardial infarction were independent risk factors for readmission (P<0.05). Conclusion: Patients at risk for readmission should be closely monitored. Furthermore, careful decision-making about surgical criteria by a multidisciplinary team can help improve outcomes as well as reduce readmissions.

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Perioperative urinary thromboxane metabolites and outcome of coronary artery bypass grafting: a nested case-control study

BMJ Open ◽

10.1136/bmjopen-2017-021219 ◽

2018 ◽

Vol 8 (8) ◽

pp. e021219

Author(s):

Hanning Liu ◽

Zhengxi Xu ◽

Cheng Sun ◽

Qianlong Chen ◽

Ning Bao ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass ◽

Case Control Study ◽

Artery Bypass ◽

Bypass Graft ◽

Case Control ◽

Chinese Patients ◽

Cabg Surgery ◽

Nested Case Control ◽

Control Study

ObjectiveAs a marker of in vivo thromboxane generation, high-level urinary thromboxane metabolites (TXA-M) increase the occurrence of cardiovascular events in high-risk patients. To investigate whether perioperative urinary TXA-M level is associated with major adverse cardiac and cerebrovascular events (MACCE) after coronary artery bypass graft (CABG) surgery, we designed a nested case-control study.DesignObservational, nested case-control study.SettingSingle-centre outcomes research in Fuwai Hospital, Beijing, China.ParticipantsOne thousand six hundred and seventy Chinese patients undergoing CABG surgery from September 2011 to October 2013.MethodsWe obtained urinary samples from 1670 Chinese patients undergoing CABG 1 hour before surgery (pre-CABG), and 6 hours (post-CABG 6 hours) and 24 hours after surgery (post-CABG 24 hours). Patients were followed up for 1 year, and we observed 56 patients had MACCE. For each patient with MACCE, we matched three control subjects. Perioperative urinary TXA-M of the three time spots was detected in these 224 patients.ResultsPost-CABG 24 hours TXA-M is significantly higher than that of patients without MACCE (11 101vs8849 pg/mg creatine, P=0.007). In addition, patients in the intermediate tertile and upper tertile of post-CABG 24 hours urinary TXA-M have a 2.2 times higher (HR 2.22, 95% CI 1.04 to 4.71, P=0.038) and a 2.8 times higher (HR 2.81, 95% CI 1.35 to 5.85, P=0.006) risk of 1 year MACCE than those in the lower tertile, respectively.ConclusionsIn conclusion, post-CABG 24 hours urinary TXA-M elevation is associated with an increase of 1 year adverse events after CABG, indicating that the induction of cyclo-oxygenase-2 by surgery-related inflammatory stimuli or platelet turnover may be responsible for the high levels of post-CABG urinary TXA-M.Trial registration numberNCT01573143.

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