M. M. Jamil1, W. Qu1, F. C. Brunicardi1, M. M. Nazzal1, J. Ortiz1 1University Of Toledo Medical Center,Surgical Education,Toledo, OH, USA
Introduction:
The purpose of the study is to determine if the outcomes after CABG or valvuloplasty are different among centers that perform cardiac transplant and centers that do not.
Methods:
Centers performing cardiac transplants during 2008-2014 were identified from the National Inpatient Sample. All CABGs and valvuloplasties within this period were stratified by whether they were performed at a cardiac transplant center (CTC) or a non-transplant center (NTC). Demographics and comorbidities were extracted using ICD-9 codes. Outcomes were in-hospital mortality, acute stroke, acute renal failure (ARF), deep sternal wound infection (DSWI), reoperation, and length of stay (LOS) >14 days. Χ2, Mann Whitney tests were used for comparison. The effect of being in CTC vs NTC on each outcome was derived from logistic regression and expressed as Odd’s ratio (OR) with 95% confidence interval (CI), after adjustment for covariates.
Results:
2,003,765 cases of CABGs or valvuloplasties were identified. 18% (n=366,877) of these were in CTC and 82% (n=1,636,888) in NTC. The mean age in CTC vs. NTC was 65 and 66 years, respectively. 33% of cases in CTC were females vs. 31% in NTC (p<0.01). African Americans comprised of 9.3% of cases in CTCs and 6.5% of cases in NTCs (p<0.01). Among comorbidities, cases in CTC had higher rates of congestive cardiac failure (2.2% vs. 1.3%), renal failure (16% vs. 14%), atrial fibrillation (38.1% vs. 32.5%), with all p<0.01. Cases in CTC had lower rates of obesity (16.6% vs. 19.6%), HTN (71.6% vs 74.3%), COPD (18.6% vs. 22.1%), and diabetes (25.5% vs. 31.1%) compared to NTC (all p<0.01). Fewer cases in CTC had intra-aortic balloon pump (6.6% vs. 8.5%, p<0.01). NTC had more emergent cases (47.5% vs. 41.8%, p<0.01) than CTC. Cases in CTC had a higher in-hospital mortality (3.2% vs. 2.7%, p<0.01) than NTC. The adjusted OR for mortality for cases in CTC was 1.13 (95% CI 1.07-1.18). CTC cases also had a higher rate of ARF (17.4% vs. 15.3%, p<0.01) with adjusted OR 1.05 (95% CI 1.03-1.08, p<0.01); reoperation (2.6% vs. 2.0%, p<0.01) with adjusted OR 1.19 (95% CI 1.13-1.26, p<0.01); deep sternal wound infection (1.1% vs. 0.8%, p<0.01) with adjusted OR 1.35 (95% CI 1.24-1.46, p<0.01); and LOS>14 days (23.3% vs. 16.8%, p<0.01) with adjusted OR 1.47 (95% CI 1.44-1.50, p<0.01). CTC cases had a lower rate of acute stroke (7.8% vs. 8.1%, p<0.01), but adjustment for covariates revealed an OR of 1.00 (95% CI 0.97-1.04, p=0.82).
Conclusion:
CABGs and valvuloplasties performed in CTCs have worse outcomes than those in NTCs with higher rates of in-hospital mortality, acute renal failure, reoperation, deep sternal wound infection, and LOS>14 days.