Impact of surgical urgency on outcomes after minimally invasive coronary artery bypass surgery: a retrospective cohort study

Background Surgical urgency in minimally invasive coronary artery bypass grafting (MICS-CABG) is associated with increased perioperative risk. This study evaluates the impact of surgical urgency on early postoperative outcomes in patients undergoing isolated MICS-CABG. Methods A retrospective cohort study was conducted at Shar Hospital, Erbil, Iraq, including 311 patients who underwent isolated MICS-CABG between September 2021 and December 2024. Patients were classified as elective group ( n = 285) and urgent group ( n = 26) according to Society of Thoracic Surgeons criteria. Baseline demographics, intraoperative variables, and early postoperative outcomes were compared using appropriate statistical tests with a significance level of p < 0.05. Results Baseline characteristics, including, gender, and body mass index, showed no significant differences between elective and urgent groups. However, the urgent group had significantly lower preoperative left ventricular ejection fraction (49.2% ± 12.0 vs. 53.8% ± 10.0, p = 0.032) and higher preoperative serum creatinine levels (1.59 ± 1.58 vs. 1.19 ± 1.94 mg/dL, p = 0.008). Intraoperatively, urgent patients required more vasopressor support (adrenaline: 26.9% vs. 10.2%, p = 0.020; noradrenaline: 73.1% vs. 40.7%, p = 0.001). Postoperatively, urgent cases had higher serum creatinine (1.86 ± 1.79 vs. 1.14 ± 0.58 mg/dL, p = 0.037) and more frequent incidence of acute respiratory failure in urgent group (39.1% vs. 17.5%, p = 0.023). Conclusions Urgent MICS-CABG was associated with increased vasopressor use, renal dysfunction, and respiratory complications. Trial registration Not applicable.